Prevention: Are regular health check-ups worthwhile?

Examinations like this general health check-up only make medical sense if they actually help to improve people's health. This is the case, for example, if they prevent illnesses and their effects. But that's often more difficult than it may at first appear. Detecting risk factors alone isn’t enough. Preventive measures like making permanent lifestyle changes or taking blood-pressure-lowering medications also need to be followed through on. But most importantly of all, these steps have to be effective. Because there’s no guarantee of that, it's important to carry out research on the benefits of health check-ups.

Every screening examination also has disadvantages too. For example, people may sometimes be wrongly diagnosed with something. Overdiagnosis can be especially problematic. An overdiagnosis is where something unusual is discovered, and then monitored or treated by a doctor, although it would never have caused any health problems.

For instance, many people's cholesterol levels are slightly above the level considered to be normal. That doesn’t automatically mean that they have a higher-than-average risk of cardiovascular disease. But finding “abnormal” levels of something can cause people to worry unnecessarily. Sometimes people also put up with the disadvantages of a treatment, such as the side effects of a medication, even though the medication doesn’t help their health. Good-quality research is also needed in order to find out whether screening results in these types of disadvantages.

Danish researchers from the international Cochrane Collaboration looked into the advantages and disadvantages of general health check-ups. They wanted to find out whether such check-ups increase life expectancy and prevent deaths caused by cardiovascular diseases.

The researchers analyzed the results of 15 randomized controlled trials (RCTs) involving more than 250,000 participants. RCTs are a type of study that provide the most reliable results about the benefits and harms of medical treatments.

The check-ups included regular assessments of risk factors for cardiovascular diseases. The types of diagnostic tests and procedures that were used differed slightly from study to study. They generally included several of the following, though:

• Discussion of medical conditions in the family
• General physical examination
• Height and weight measurement
• Blood test (blood sugar and cholesterol)
• Urine test
• Blood pressure measurement
• Measurement of the electrical activity of the heart (electrocardiogram, also known as an ECG)

Some studies used other diagnostic tools too, for example a lung function test. Many of the diagnostic tests and procedures used in the studies are also used in the general health check-up that is offered by statutory health insurers in Germany. The participants were mainly aged between 30 and 60. In most of the trials, the check-ups took place either annually or every two to four years. But they were not always carried out for the entire length of the study.

The researchers monitored the participants for up to 30 years to see, for instance, whether they were still alive or had died of a cardiovascular disease.

The studies showed that the check-ups usually didn’t have the expected results. Some studies found that people who were invited to have a health check-up were somewhat more likely to be diagnosed with something. For instance, they were more often diagnosed with high blood pressure or high cholesterol.

But the general check-ups still weren’t shown to have any benefits and people who were invited to have check-ups didn’t live any longer. They didn't develop or die from cardiovascular disease less often than people who were not invited for a check-up.

There may be a number of reasons for this disappointing outcome. One reason is that family doctors know their patients well anyway, examine them regularly and suggest treatments if necessary, perhaps because they are in a particular risk group. Another possible reason is that truly serious problems may be detected early enough in other ways so routine check-ups have hardly any benefits. Check-ups also often detect only slightly increased cholesterol or blood pressure levels that don’t necessarily cause health problems and don’t need to be treated immediately.