Annual health checks neither reduce overall mortality nor the risk of dying from cardiovascular disease or cancer. However, they do increase the number of new diagnoses, which might do more harm than good.
Annual health checks neither reduce overall mortality nor the risk of dying from cardiovascular disease or cancer, although they do increase the number of new diagnoses, finds new research.
The meta-analysis, a review of past studies led by Lasse T Krogsbøll of the Nordic Cochrane Centre and published in the journal BMJ, acknowledges that visits to the doctor might be reasonably expected to catch signs or symptoms of disease a person had deemed unimportant. However, evidence for the effectiveness of those check-ups has been lacking, they say.
"While we cannot be certain that general health checks lead to benefit," the authors write, "we know that all medical interventions can lead to harm."
The litany of possible harms is long: overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, possible continuation of adverse health behaviors due to negative test results, adverse psychosocial effects due to labeling, and difficulties with getting insurance. Furthermore, organized programs of general health checks can be expensive and may result in lost opportunities to improve other areas of health care, the authors say.
The review examined 14 trials that looked at systematic health checks. The studies had between one and 22 years of follow-up. It excluded trials described as specifically targeting older people or in which only people aged 65 or older were enrolled because many such studies included additional interventions. It also excluded trials of screening for single diseases, such as prostate cancer.
The researchers also note that people who accept an invitation to a health check tend to have higher socioeconomic status, and lower cardiovascular and mortality risk than those who do not. Because of that difference, health checks might not reach those who need prevention the most.
In an editorial accompanying the review, Domhnall Macauley, primary care editor at the BMJ, agrees that although health checks are “seductive” and “seem sensible” there is little evidence to show that they reduce morbidity and mortality. As well questioning whether they do more harm than good, Macauley says that the study finds that regular health checks show “evidence of little effect” and adds that policy should be based on “wellbeing rather than on well meant good intentions.”
The researchers say that further research should examine the individual components of health checks, such as screening for cardiovascular risk factors, chronic obstructive pulmonary disease, diabetes, or kidney disease.
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