Health check packages have become a large industry, and the number of tests in a package is often treated as a measure of its quality. It is not.
A small number of tests catch the conditions that actually matter. A large number of unnecessary tests generate incidental findings, anxiety and further investigation without improving health.
What Screening Is Meant to Do
A test is worth including in a screening panel only if it meets certain conditions: the disease is common enough to look for, it has a detectable stage before symptoms, treating it early improves outcomes, and the test is reasonably accurate.
Blood pressure meets all of these. So do blood sugar, cholesterol, cervical screening and mammography in the right age groups.
Many other tests do not. A tumour marker panel in a healthy person, for example, produces far more false alarms than early cancers, and each false alarm leads to scans and sometimes biopsies.
The Core Tests by Age
These are the elements with the strongest justification.
From 20: blood pressure every one to two years, weight and waist measurement, and cervical screening for women from 21.
From 30: add fasting glucose or HbA1c and a lipid profile every three to five years, or annually with risk factors. Thyroid function for women planning pregnancy.
From 40: annual blood pressure, glucose and lipids. An ECG. Mammography for women. Eye examination for glaucoma and diabetic changes.
From 50: add colorectal cancer screening. Bone density for postmenopausal women with risk factors. Discussion about PSA for men.
From 60: add hearing assessment, falls risk review, cognitive assessment where there is concern, and vaccination review.
The Tests Worth Having Every Year
A sensible annual panel for most adults over forty is short.
- Blood pressure, weight and waist circumference
- Fasting glucose or HbA1c
- Lipid profile
- Full blood count
- Kidney function with creatinine and eGFR
- Urine albumin to creatinine ratio if diabetic or hypertensive
- Liver function tests
- Thyroid function, particularly in women
- Urine routine examination
That covers the conditions that are common, silent and treatable. Our health check packages are built around this core with age and sex appropriate additions.
Tests That Are Often Included Unnecessarily
Several tests appear routinely in packages with limited justification in a person without symptoms.
- Tumour marker panels: CA 125, CEA, CA 19 9 and similar are not screening tests. They produce frequent false positives in healthy people
- Whole body CT or PET scans: significant radiation, and they find incidental abnormalities in a large proportion of healthy people, most of which are harmless but require follow up
- Routine treadmill tests in people with no symptoms and no risk factors
- Extensive vitamin panels beyond vitamin D and B12 where indicated
- Routine ultrasound of the whole abdomen in asymptomatic people, which frequently finds small cysts and other findings of no consequence
- Food intolerance panels, which have no diagnostic validity
The problem is not the cost alone. It is the cascade of further tests, procedures and anxiety that an incidental finding triggers.
Screening That Genuinely Saves Lives
A small number of cancer screening programmes have clear evidence of benefit.
- Cervical screening: Pap smear or HPV testing. Prevents cancer rather than only detecting it
- Breast screening: mammography from around 40 to 74, every one to two years
- Colorectal screening: colonoscopy from 45 to 50, which removes polyps before they become cancer
- Oral cancer screening: particularly important in India given tobacco chewing rates, and a simple examination
- Lung cancer screening with low dose CT for heavy smokers in specific age ranges
Oral examination deserves emphasis. Oral cancer is common in India, is often preceded by visible white or red patches, and is easily examined for by any dentist or doctor.
What a Check Should Include Beyond Blood Tests
The consultation matters as much as the panel, and it is often the part that gets rushed.
- A proper history: symptoms, family history, medications, tobacco, alcohol, activity, diet and sleep
- Physical examination including blood pressure in both arms, abdominal examination and, where relevant, breast and prostate examination
- Mental health enquiry, which is almost universally omitted
- Vaccination review, including influenza, pneumococcal, hepatitis B, tetanus and HPV
- Discussion of the results and what to do about them
- A plan with specific targets and a follow up date
A package that hands over a printout without a consultation has done the easy part and skipped the useful part.
Preparing for Your Check
A few steps make the results more accurate and the consultation more useful.
- Fast for nine to twelve hours if triglycerides or fasting glucose are being measured, taking only water
- Take your regular medications unless told otherwise, and bring the boxes or a list
- Bring previous reports, which make trends visible and are far more informative than a single result
- Avoid heavy exercise and alcohol for twenty four hours beforehand
- Do not have a check during an acute illness, since results will be distorted
- Women should schedule cervical screening away from menstruation
- Write down your questions and any symptoms beforehand
Bringing previous reports is the most useful and least followed piece of advice. A creatinine that has risen from 0.8 to 1.1 within the normal range is more informative than either value alone.
Acting on the Results
The health check achieves nothing without follow through, and this is where most of the value is lost.
- Ask what each abnormal result means and what should be done
- Ask what your targets are, not just whether you are within a printed range
- Agree specific actions with dates rather than general advice
- Book any recommended follow up before you leave
- Keep your reports together so trends are visible next year
- Understand that a normal result today does not cover you for symptoms tomorrow
That last point matters. People sometimes ignore new symptoms because a recent health check was normal. Screening tests look for specific conditions in people without symptoms. Once you have a symptom, you need assessment for that symptom.
A good annual check is short, age appropriate and followed by a proper conversation. Blood pressure, glucose, lipids, kidney function and the relevant cancer screening cover most of what matters. Be sceptical of packages selling large numbers of tests, particularly tumour markers and whole body scans.
Our health check packages at T. Nagar include consultation and result review rather than a report alone.
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