A systematic review of research into general health checks shows that, although they increase the number of diagnoses, they do not reduce the number of deaths from cardiovascular disease or cancer.
Routine health checks, or testing healthy people for indicators of a range of conditions, are common elements of healthcare in some countries. The idea is that, by checking regularly for risk factors such as high blood pressure or high cholesterol, we should be able to reduce morbidity and prolong lives. It seems a very worthwhile aim, and intuitively we feel that health checks should be a good thing.
However, as we discussed with regards breast cancer screening a few weeks ago, there is always a risk of over-diagnosis – finding evidence of a condition that would not have become a problem, and potentially therefore recommending unnecessary treatments.
Little research has been done to see if health checks actually achieved their aims. So now, a team at the Nordic Cochrane Centre in Copenhagen led by Dr Lasse Krogsbøll combined data from 14 studies into a meta-analysis to examine the pros and cons of health checks.
Publishing in the British Medical Journal, Krogsbøll and colleagues looked at mortality, morbidity, number of diagnoses, hospital admissions, referrals to specialists and a number of other factors indicating health, including self-reported health, worry and absence from work. They used this to compare screened populations with those that received no intervention, in studies with between four and twenty two years follow up.
Although the results varied between studies, this meta analysis found no evidence in the health-checked group for a reduction of either total mortality, or deaths through cardiovascular disease or cancer. There was evidence for an increase in diagnosis, but as this didn’t lead to a change in mortality, we can assume that these are often over-diagnoses.
So what does this say for general health checks? The authors argue that these health checks may appeal to people who need them less, and point out that doctors already carry out screening in patients where they think it’s needed, and conclude that health checks “do not work as intended”. In a related Editorial piece, Domhnall MacAuley suggests that “Policy should be based on evidence of wellbeing, rather than on well meant good intentions.”