Routine health checks not always of benefit
General health checks are no guarantee of reducing the number of deaths from serious diseases like cancer and heart disease, according to a systematic review on the subject carried out by an international research team for The Cochrane Library. While general health checks are offered in many countries, the researchers warn against offering general health checks as part of a public health programme. Their results, recently published, are based on 14 trials involving more than 180,000 people.
'From the evidence we've seen, inviting patients to general health checks is unlikely to be beneficial,' said lead researcher of the study, Lasse Krogsbøll of The Nordic Cochrane Centre in Copenhagen, Denmark. 'One reason for this might be that doctors identify additional problems and take action when they see patients for other reasons.'
General health checks are standard practice in many European countries and are offered with the intention of reducing deaths and ill health by enabling early detection and treatment of disease. What the team discovered, however, is that there are potential negative implications that had not been foreseen. An example is the diagnosis and treatment of conditions that might never have led to any symptoms of disease or shortened life.
The researchers' findings were based on 14 trials involving 182,880 people. Their trials divided participants into at least two groups: one where participants were invited to general health checks and another where they were not. The number of new diagnoses was generally poorly studied, but in one trial, health checks led to more diagnoses of all kinds. In another trial, people in the group invited to general health checks were more likely to be diagnosed with high blood pressure or high cholesterol, as might be expected. In three of the trials, large numbers of abnormalities were identified in the screened groups.
However, based on 9 trials featuring a total of 11,940 deaths, the researchers discovered no difference between the number of deaths in the two groups in the long term, either overall or specifically due to cancer or heart disease. Other outcomes were poorly studied, but suggested that offering general health checks has no impact on hospital admissions, disability, worry, specialist referrals, additional visits to doctors or time off work.
'What we're not saying is that doctors should stop carrying out tests or offering treatment when they suspect there may be a problem. But we do think that public healthcare initiatives that are systematically offering general health checks should be resisted.'
According to the recently published review, new studies should focus on the individual components of health checks and the better targeting of conditions such as kidney disease and diabetes. Furthermore they should be designed to explore the harmful effects of general health checks, which are often ignored, producing misleading conclusions about the balance of benefits and harm. Another problem is that those people who attend health checks when invited may be different to those who do not. Lastly, people who are at a high risk of serious illness may be less likely to attend.