Under normal circumstances, patients tend to seek their doctor’s attention when symptoms arise and there’s something wrong with their health. This is a wrong mindset as early detection of medical issues, through regular medical check-ups and routine screening programs, is the best way to live a long healthy life as it gives the best shot to completely avoid disease or, if we get sick, to more easily overcome it in the least amount of time and with the best possible outcome.
What is a health screening program?
A health screening program is a bundle of medical examinations, tests and specialist consultations which should be customized according to each patient characteristics and needs in order to prevent diseases, catch early signs of diseases, provide insights about disease risk and build rapport and trust between healthcare providers and their patients. A health check-up program can also include exams that provide insights on chronic illness so that the patient and physician can be proactive in delaying the effects of such illness or alleviating its symptoms. Health screening programs can be generalized health check-ups which take a look at the overall health and proper functioning of all body systems, or can be focused on specific fields like nutrition, for example by checking for micronutrient deficiencies, or as exposure to toxic substances such as by analyzing the levels of heavy metals or other pollutants in the body. They are sometimes called health maintenance programs as one of their goals is also to keep you in good health.
Screening programs can also be categorized according to who promotes the health check, such as:
- Yearly physical / yearly wellness check-up. Doctors or insurance companies may encourage people to undergo a yearly general health screening to catch early signs of disease and keep you in good health.
- Occupational health check. Employers may require employees to undergo tests and screenings both prior and during employment to prevent work related injuries and disease.
- Government screening programs. These are more focused on the early detection of diseases for which there’s a large body of evidence about the benefits and cost-effectiveness of such programs, giving timelines and time intervals for exams, eligibility requirements for patients, and covering only few specific conditions. They are targeted for specific “populations” where population means a group of people with common characteristics such as “all pregnant women” or “all men 50+ years old” or “patients 50-80 years old with 20 pack-year smoking history”.
- Voluntary health check-ups. These are requested by patients themselves and tend to be more comprehensive; these types of screenings can include virtually any exam or specialist consultation, according to each patient’s needs.
- High-risk group check-ups. These are designed for people with an increased risk of developing a certain disease; this could be because of:
- another condition, such as an eye screening for diabetic patients,
- genetics such as a breast exam for BRCA-1 and BRCA-2 + patients,
- familiarity such as a colonoscopy for patient with a close family member affected by colorectal cancer, or
- lifestyle like an STD panel in people with a high-risk sexual behavior.
A medical check-up program may take anywhere between a few minutes to several hours to complete, depending on what’s included in it.
What diseases and conditions can you screen for?
A medical check-up can virtually screen for any known condition or disease as well as for risk factors that lead to the development of conditions and diseases. There are a few things to keep in mind though:
- Sensitivity of the test. This value tells the ability of a test to correctly identify all those with a disease: a test with a 96% sensitivity means that if 100 people with a known disease get tested, only 96 will return a positive result hence 4 will be false negatives.
- Specificity of the test. This value tells the ability of a test to correctly identify those who do not have a disease: a test with 98% specificity means that if 100 people who do not have a disease get tested, only 98 will return a negative result hence 2 will be false positives.
- Single lab values or single tests may give more of a clue, rather than an exact diagnosis, especially when no symptoms are present. Once you know something may be wrong, they will require further testing to determine what exactly is wrong. Lab results should be looked at as a whole, not as single numbers.
- Reference values depend on biologic sex, age, race, medical history, medications or supplements taken, lifestyle, physiologic conditions (such as pregnancy) … and could be different among laboratories. They are important, but you should know what they mean and their limitations. A test should not just be compared against the reference values, but it is also very important to compare it to previous same-subject values.
Why are health screening programs so important?
Many conditions exhibit no warning signs or symptoms, or they may show few non-specific and mild symptoms that get ignored by patients. Some common diseases like hypertension, anemia or diabetes are like an iceberg with only a small percentage of cases correctly diagnosed, while many more go unreported. In diseases like hypertension, you don’t suddenly go from 120/70 to 180/110, but it’s a slow drift of BP values that often allows your body to get used to the changes without being really aware of them which is why hypertension is also known as the “silent killer”. To give you just a few examples on why a health check-up is important, here’s some statistical data on a few diseases:
- 1 out of 7 people with HIV does not know it. Undiagnosed cases are responsible for about 80% of new infections.
- More than 50% of women who develop cervical cancer have never been screened. The early detection of this condition offers a 5-year survival rate of 92% vs 13% in advanced cancer (late detection).
- While it is common knowledge that a healthy varied diet is enough to cover all nutrient requirements, according to studies nutritional deficiencies are still widespread in the population: it’s not just third world or developing countries where the population fails to meet micronutrient recommended intakes; Vitamin D for example, which is not just involved in bone health, but also in immune system and endocrine system regulation and has been linked to several chronic diseases and acute conditions is estimated to be deficient in 25% of USA population, 37% of Canadians and 40% of Europeans. Around 50% of US adults may be deficient in vitamin A and about 40% may be deficient in vitamin C. Micronutrient deficiencies often cause only nonspecific symptoms such as fatigue, insomnia, difficulty concentrating or impaired cognitive function, reduced ability to fight disease … hence they are hard to diagnose without specifically testing for it.
Moreover, regular health checks allow us to compare results over time which provides a better indication on our health status rather than just comparing our results against the reference values.
Finally, the consultation with the doctor will check your immunization status and need for vaccines or booster doses, it will allow the doctor to ask about your lifestyle and advise you on the changes that will make you healthier or that will lower risks of diseases, it will allow you to talk about what you believe are minor ailments, discomfort, etc which you didn’t disclose by booking a regular doctor’s appointment as you felt it wasn’t important, even though it actually may be.
What is included in an annual health check-up package?
Each doctor, clinic, employer, insurance company or government program may include different tests and exams which will also vary depending on age, gender and risk factors. As an overview of what may be included, I divided the health check-up in different steps.
Consultation with the doctor
During the consultation, your doctor will ask many questions to get to know you better, understand your risk profile, answer any question or respond to any doubt you have concerning your heath, advise you on specific matters such as immunization or diet, and much more. The consultation may include:
- Family history collection
- Personal medical history collection including any minor symptom or ailment since last visit with a doctor
- Questions about lifestyle (smoking, excessive drinking, sexual life, diet, exercise, sleep, etc)
- Psychological health check (depression, anxiety, etc)
- Cognitive assessment (by talking to you the physician will have a chance to spot early signs of cognitive decline and neurologic conditions)
- Vaccination status
- Counseling for specific complaints, risk factors or behaviors.
After talking and counseling, the doctor proceeds with the physical examination which generally includes checking the vitals, taking some measurements, and examining the body with and without tools to spot any possible sign of disease or medical conditions. The physical check may include:
- Vital signs, such as blood pressure, heart rate and rhythm, respiration rate and SpO2, body temperature, etc
- General Appearance, by talking and looking at you during the consultation and exam there are a lot of information that can be gathered and can give clues on your health.
- Height, weight, BMI, waist circumference, and other measurements.
- Heart Examination with a stethoscope
- Lung examination
- Abdominal examination which may include tapping with fingers, palpating with the hands and listening with a stethoscope
- Neurological examination, mental status, reflexes, muscle strength, balance, ..
- Dermatological examination, infections or skin cancer, overall skin, nail, hair health, etc.
- Male physical exam, which may include testicular, penis and prostate examination and/or inguinal hernia “cough test”.
- Female physical exam, which may include a pelvic examination (vulva, vagina, cervix, uterus, ovaries), pap test or other STDs test and/or a breast exam to check for lumps or enlarged lymph nodes.
Blood, urine, and other lab tests
Most health check-ups also include some routine lab tests that most of the time give non-specific indications, unless symptoms are present, and require further testing and absolutely need to be seen as a whole and not as a single value.
Commonly performed lab tests are:
- Complete blood count (CBC)
- Lipid panel, which includes HDL and LDL cholesterol, triglycerides, …
- Liver Panel, which includes total protein in blood, albumin, bilirubin, ALT, AST, …
- Kidney panel, which includes BUN and electrolytes, creatinine, eGFR, …
- Hormone panel, which may include FSH, LH, testosterone, estrogen, …
- Tumor markers, such as PSA, CA-125, AFP, …
- Coagulation panel, which includes prothrombin, fibrinogen, factor VIII, etc.
- STD panel PCR test
- Thyroid function test, which includes TSH, T3 and T4
- Inflammation panel, which includes C reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
- Urinalysis, which tests for pH, proteins, glucose, ketones, bilirubin, red blood cells, …
- Fecal occult blood test
Medical imaging and other diagnostic tests (ekg, bone density, …)
Other commonly included tests in health check-ups are medical imaging and other instrumental screening and diagnostic tests such as:
- Chest X-Ray
- Complete abdominal ultrasound
- Electrocardiogram (ECG)
- Doppler Ultrasound of the carotid arteries or other vessels
- Low-dose CT Scan (LDCT)
- Body composition tests (% of body fat and lean muscle tissue)
- Magnetic Resonance (MRI)
- DEXA Scan (bone density test)
Extra medical screening and specialist consultation
Depending on each patient’s needs, on risk profile, on medical history, symptoms and recent changes, or on personal finances, some specialist consultation and tests may be included in your health checkup such as:
- Ophthalmologist (Eye doctor) consult and eye examination (visual acuity test, visual field test, refraction assessment, color vision test, retinal examination, glaucoma screening, … )
- Dermatologist consult and specialist skin, hair, nail examination.
- Allergist consult and Allergy screening
- ENT consult and Hearing screening
- Infectious disease specialist consultation with STD panel, immunization check and boosters/vaccine administration.
- Dentist consultation with teeth cleaning and oral examination.
- Gynecologist consultation and physical exam, fertility screening, pregnancy screening, PGD screening, etc.
- Cardiologist consultation with EKG, echocardiogram, electrophysiology study, angiogram, etc
- Anti-Aging and Regenerative medicine or holistic health specialist consultation with DNA analysis, telomeres length, total body MRI, heavy metal profile in blood and urine with chelation therapy, micronutrient deficiencies, hormonal panel, etc.
Best medical screening check-up by age range for men and women
Each year around your birthday you should give yourself a gift by investing in preventive medicine and early detection of diseases and conditions. This will allow you not only to live a longer life, but also to live healthy for longer which is the most important thing. Always remember that you may need different tests or different frequency in testing based on your unique characteristics so it’s always best to have a consultation with a specialist in preventive medicine and health check-ups to get personalized advice.
Here you can find the link to other articles containing the recommended health checks by age and gender:
- Best medical screening package for 18-29 years old males
- Best medical screening package for 18-29 years old females
- Best health check-up package for 30-39 years old males
- Best health check-up package for 30-39 years old females
- Best medical screening package for 40-49 years old males
- Best medical screening package for 40-49 years old females
- Best health check-up package for 50-64 years old males
- Best health check-up package for 50-64 years old females
- Best medical screening package for 65+ years old males
- Best medical screening package for 65+ years old females
To read about the best clinics and hospitals in Bangkok, Thailand, offering comprehensive health check-ups, antiaging and wellness packages, and preventive medicine screenings check this article out!
Controversies about the routine “yearly physical” – Limitations of health check-ups
There are some limitations and controversies around yearly check-ups and health screenings: with the advancements in the field of medicine that nowadays provide us with testing tools and technologies able to spot even the tiniest abnormal variation in a subject, overdiagnosis is a rising phenomenon, especially in cancer screenings: it is defined as the diagnosis of a condition that if not otherwise found, would not cause any symptom or harm to a patient in his lifetime. This may not make sense written like this, so here’s a sample scenario: John Doe is a 65-year-old man with a very slow-growing tumor in his prostate he does not know about. Eventually John dies of heart attack at 75. If John was screened for prostate cancer at 65, he would have faced the stress of the diagnosis, frequent visits at the hospital, and a long treatment and its complications or side effects to be cured. In the end John will die of heart attack at 75 anyway, so the early diagnosis and treatment have not resulted in a longer life or in a better quality of life, the opposite is actually true.
One of the reasons against mass screening or mass routine check-up programs is the waste of resources: such programs require time and money, technology and equipment, and personnel which allegedly are reallocated from other parts of the healthcare system hence potentially leading to symptomatic patients with known diseases not receiving the attention and level of care they deserve. While this may be true from a government policy point-of-view, such logic ceases to be true when we look at it from a private hospital or private clinic POV, as they are funded by paying patients or by patients covered by insurance and for this reason have resources and technologies specifically allocated for this purpose, without having to borrow them from other departments.
False positive results lead to unnecessary and potentially harmful further testing and/or unnecessary and potentially harmful treatment; it will also cause stress, put the patient in front of hard decisions and waste their time and money; for example a mammogram may lead to the unnecessary surgical removal of a benign breast lump.
False negative results on the other hand may provide patients with false reassurance, making them less likely to correct risky behaviors or making them believe they have a low risk of disease.
Screenings look for risk markers: some of the people with these risk markers will never develop disease, while others without markers will eventually develop it. This “unreliability” of risk markers make their routine use questionable.
Overall, when it comes to voluntary comprehensive health check-ups, if a patient has the financial means to pay for them, understands their limitations and risks, and carries them out in an accredited facility with doctors who specialize in this field of medicine, there is nothing wrong in routinely undergoing health and wellness checks. When it comes to government programs or to universal health check packages, there are several factors to consider and it makes sense to not recommend a one-size-fits-all approach for testing.
Characteristics of government screening programs
The reason why only few diseases are screened in specific populations by worldwide governments is that to be eligible to be considered as a screening program, the disease, tests and treatment need to have certain characteristics:
- The disease should be serious and relatively common.
- The screening test should be available, accurate, cost-effective and with clear results.
- The risk marker should be reliable in suggesting who is going to develop the disease and who is not.
- The treatment for the disease should be available, effective and more favorable if started early.
- The cost of treatment plus screening should be compared against the cost of treatment without screening first.
- Improving Value in Health Care – Against the Annual Physical.
A Mehrotra – The New England Journal of Medicine, Oct 2015
- Toward Trusting Therapeutic Relationships – In Favor of the Annual Physical.
AH Goroll – New England Journal of Medicine, Oct 2015
- Checking in on the annual checkup.
WR Phillips – Canadian Family Physician, Jun 2018
- Vitamin D deficiency 2.0: an update on the current status worldwide.
K Amrein – European Journal of Clinical Nutrition, Jan 2020
- Making Sense of Testing – A guide to why scans and health tests for well people aren’t always a good idea.
Sense About Science, 2008
- Making Sense of Screening – Weighing up the benefits and harms of health screening programmes.
Sense About Science, 2015