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, for example by better preventing illnesses and their consequences. But that is often more difficult than it may at first appear. Detecting risk factors alone is not 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 is no guarantee of that, it is important to carry out studies 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 work. Studies are also needed in order to find out whether there could be any such 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 16 randomized controlled trials (RCTs) involving more than 180,000 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. The check-ups took place either annually or every two to four years, depending on the study. But they were not always carried out for the entire length of the study.

The researchers kept track of the participants for up to 22 years afterwards, for instance to check whether they were still alive or had died of a heart problem.

The studies showed that the check-ups 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: People who were invited to have check-ups didn’t live any longer. There were no fewer deaths from cardiovascular diseases than among people who were not invited to go to check-ups.

There may be a number of reasons for this disappointing outcome: One reason is that family doctors know their patients well anyway, and examine them regularly and suggest treatments if necessary, perhaps because they are in a particular risk group. What’s more, 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 always cause health problems and don’t need to be treated immediately.

Most of the studies analyzed were carried out between the 1960s and 1980s. Since then many new and effective medications for the prevention and treatment of cardiovascular diseases have come onto the market. People's lifestyles have also changed. New studies are therefore needed to be able to reliably assess the benefits of regular general health check-ups today.