Are health checks worthwhile ?

[Doc Alan]

Health screening means testing at any stage in our life for possible illness when there are NO symptoms. Whereas in the UK many tests are " free " on the NHS, in the Philippines there is more likely to be an upfront cost.


Treatment of disease at an early stage is more successful than when it’s advanced. So while prevention is clearly best, surely screening is next best ?


Many people approve of screening. If it helps prevention or at least early diagnosis and chances of cure, it’s worthwhile, right ? Not completely true .



There needs to be evidence that the benefits outweigh the risks. Screening may lead to a false positive result ( condition not present ), or false negative result ( it misses a condition ). Either way, problems can arise. The condition may be over-treated ( perhaps by surgery ), or diagnosis delayed because of misguided reassurance.


Most would likely prefer an informed choice – whether they are paying directly, or indirectly through taxation.



Throughout the UK, a National Screening Committee tries to make sure that screening programmes are only offered when there is good evidence they will do more good than harm, at a cost affordable to the NHS. The Netherlands and New Zealand have national responsibility for screening. More commonly, as in the Philippines, it’s up to the individual and their own doctor / screening agency.


A basic health check every 2 - 5 years – including blood pressure, blood tests for cholesterol / diabetes, plus eyesight and dental check ups, would seem worthwhile over the age of 40. That’s part of common sense looking after your health - including weight control , diet, exercise, and drinking / smoking habits. But the benefits of such checks on people WITHOUT symptoms have been questioned by some experts. They claim a danger of being diagnosed with diseases or risk factors which wouldn’t have caused serious illness over a lifetime.


Some screening tests are not available on the NHS – not just for reasons of cost, but also lack of evidence that the benefits outweigh the disadvantages. These include whole body CT scans. Apart from exposure to radiation, they may pick up " lesions " leading to more investigations and treatment, which may be unnecessary, or not available ( dementia ). Tests of the entire genome ( genetic makeup of an individual ) also run the risk of showing abnormalities which may or may not be significant and treatable. Paying for such tests privately could lead to more than the initial cost, if more investigations are needed to rule out treatable illness.


The NHS screening timeline may be helpful to make informed decisions about screening, whether or not it has to be paid for directly ( click on image to enlarge, and see link below ) :-






Main conditions are dealt with in other Forum threads ( see links below ) and other links may also be helpful.


• Annual check ups (http://filipinaroses.com/showthread....175#post351175 )


• Breast (http://filipinaroses.com/showthread....350#post489350 )


• Cervix (http://filipinaroses.com/showthread....487#post488487 )


• Prostate (http://filipinaroses.com/showthread....379#post505379 )


• Bowel cancer (http://filipinaroses.com/showthread....175#post351175 )


• " Thinking of having a private screening test? " - search internet for PDF with this title ( UK National Screening Committee )




• Health checks in adults (
http://www.bmj.com/content/345/bmj.e7191
).

[stevewool]

I had one done early this year, and for me it was peace of mind.

[Steve.r]

Good information Alan Thanks

[Michael Parnham]

Health screening means testing at any stage in our life for possible illness when there are NO symptoms. Whereas in the UK many tests are " free " on the NHS, in the Philippines there is more likely to be an upfront cost.


Treatment of disease at an early stage is more successful than when it’s advanced. So while prevention is clearly best, surely screening is next best ?


Many people approve of screening. If it helps prevention or at least early diagnosis and chances of cure, it’s worthwhile, right ? Not completely true .



There needs to be evidence that the benefits outweigh the risks. Screening may lead to a false positive result ( condition not present ), or false negative result ( it misses a condition ). Either way, problems can arise. The condition may be over-treated ( perhaps by surgery ), or diagnosis delayed because of misguided reassurance.


Most would likely prefer an informed choice – whether they are paying directly, or indirectly through taxation.



Throughout the UK, a National Screening Committee tries to make sure that screening programmes are only offered when there is good evidence they will do more good than harm, at a cost affordable to the NHS. The Netherlands and New Zealand have national responsibility for screening . More commonly, as in the Philippines, it’s up to the individual and their own doctor / screening agency.


A basic health check every 2 - 5 years – including blood pressure, blood tests for cholesterol / diabetes, plus eyesight and dental check ups, would seem worthwhile over the age of 40. That’s part of common sense looking after your health - including weight control , diet, exercise, and drinking / smoking habits. But the benefits of such checks on people WITHOUT symptoms have been questioned by some experts. They claim a danger of being diagnosed with diseases or risk factors which wouldn’t have caused serious illness over a lifetime.


Some screening tests are not available on the NHS – not just for reasons of cost, but also lack of evidence that the benefits outweigh the disadvantages. These include whole body CT scans. Apart from exposure to radiation, they may pick up " lesions " leading to more investigations and treatment, which may be unnecessary, or not available ( dementia ). Tests of the entire genome ( genetic makeup of an individual ) also run the risk of showing abnormalities which may or may not be significant and treatable. Paying for such tests privately could lead to more than the initial cost, if more investigations are needed to rule out treatable illness.


The NHS screening timeline may be helpful to make informed decisions about screening, whether or not it has to be paid for directly ( click on image to enlarge, and see link below ) :-






Main conditions are dealt with in other Forum threads ( see links below ) and other links may also be helpful.


• Annual check ups (http://filipinaroses.com/showthread....175#post351175 )


• Breast (http://filipinaroses.com/showthread....350#post489350 )


• Cervix (http://filipinaroses.com/showthread....487#post488487 )


• Prostate (http://filipinaroses.com/showthread....379#post505379 )


• Bowel cancer (http://filipinaroses.com/showthread....175#post351175 )


• " Thinking of having a private screening test? " - search internet for PDF with this title ( UK National Screening Committee )




• Health checks in adults (
http://www.bmj.com/content/345/bmj.e7191
).

Thanks Alan, never knew that one could refer oneself for screening. Good useful information!

[Dedworth]

Thanks Doc I'm planning on going for one after the Christmas excesses

[Doc Alan]

Thank you for your interest .


Of course screening of apparently healthy individuals when they don’t have symptoms / signs of illness is quite different to the more urgent need for correct diagnosis and treatment of those who DO feel unwell. There is an unfortunate tendency to promote screening - whether paid for directly or indirectly, without encouraging people who feel well to make informed choices .


It’s good if you ARE reassured that all is well. But so far the NHS has not made clear the downsides of screening – unnecessary and risky treatments OR false reassurance.


Mindful of this, the Parliamentary Science and Technology Committee has just issued a report :-

http://www.publications.parliament.u.../244/24402.htm
.

They recommend the UK National Screening Committee produces better, balanced, information to help people decide what screening to have. They also recommend that ANY screening offered is the same anywhere in the UK, with careful review of evidence for any new screening programmes.


A start had already been made with new advice about breast cancer screening ( see thread ) which explained possible over- diagnosis and treatment of abnormalities found.


Two reminders :-

• Cervical screening ( " smear test " ) is to detect changes which MIGHT lead to cancer in women without symptoms. Its purpose is NOT for diagnosis of cancer in women with symptoms – they need clinical examination and specialist referral.


• Prostate cancer screening of men without symptoms by PSA ( prostate specific antigen ) is unreliable on its own, because of false positives and negatives.


People deserve unbiased information !

Without symptoms/signs they don’t become patients, unless screening detects abnormalities. If they know screening is imperfect ( false positives as well as negatives ), hopefully each will make decisions right for THEM - whether living in the UK or the Philippines.

[grahamw48]

Very interesting and useful. Thanks for posting.

[cheekee]

Excellent post doc.

Was just thinking about my health now I'm married.

My BP and pulse were great in Cebu.

BP 110 /60 pulse 65 regular.

Doesn't help having a stressful job.

Got all my teeth sorted out whilst I was over there and had great service and was great value.

Had a new smile for my wedding.

[cheekee]

I wish middle aged people could have a check CT scan.

For my mum it was too late and she was riddled with cancer.

[Arthur Little]

Up until recently ... ... I'd have said regular health checks were a good for BOTH sexes ... regardless of age.

Now, I'm less sure after reading an article about a 23-yr-old woman who succumbed to advanced cervical cancer and whose relatives were convinced someone so young need not have died
had screening for this disease been accessible to ALL females from puberty onwards ... instead of being mainly confined to those in a more mature age group (i.e., those over 40).

However, based on statistics indicating this particular form of cancer as being more common among older ladies, it would seem many of our leading oncologists believe performing routine cervical smear tests on a younger set to be counter productive ... in the sense that invasive procedures of this nature are likely to do more harm than good in the longer term. But ... why, I wonder?

*Age, therefore, would certainly appear to've some degree of bearing on the matter!

What's your point of view on that *factor, Alan?

[Doc Alan]

I wish middle aged people could have a check CT scan.

For my mum it was too late and she was riddled with cancer.

Thank you for your interest, Cheekee, and I’m sorry to read about your Mum.


• CT ( computerised tomography ) and MRI ( magnetic resonance imaging ) provide helpful information in a whole range of medical conditions.


• However, with respect, " check private whole body CT scans " on people with NO symptoms – apart from radiation exposure – don’t seem to have good evidence of benefit.

The private check up sector has expanded as these imaging techniques have become better and cheaper. Such clinics may or may not be owned by medically qualified doctors. Doctors are however required on site because of regulations over ionising radiation. That may lead to a sense of reassurance about respectability and a good way to spend your time and cash .


• The evidence is lacking that such scans are better for your health than running away from these clinics at top speed with your cash / credit cards in your pocket ! People should not succumb to emotional blackmail or feel bad about thinking " what if I, or my loved ones, had only had a scan before symptoms appeared ? ".


• So far the evidence is not strong for use of these scans in screening – apart from certain situations like possibly detecting lung cancer in higher risk individuals. Of course circumstances may change in the future.


• https://www.gov.uk/government/collec...comare-reports

[Doc Alan]

What's your point of view on that *factor, Alan?

Thank you Arthur .


• Cervical cancer only accounts for 2% of female cancers in the UK, and most do occur within the age range ( 25 – 60/65 ) recommended for screening ( " smear / Pap " test ) in the UK.


• However, screening for women under 25 is not beneficial. There are too many " abnormalities " which if left untreated would " heal " on their own. If they DO have worrying symptoms ( typically bleeding when not having a period ), the smear test is NOT what they need – it just delays referral. They need examination by their doctor and possible further specialist examination with biopsy samples for diagnosis.


• Around 3/4 " eligible " women in the UK have cervical screening. Most ( over 90 % ) of smear tests are normal ( negative ). The rest will show changes which if untreated MIGHT lead to cancer, and ( rarely ) actual cancer.


• Cervical screening has been on the go for 50 years. During that time numbers of this cancer have decreased – not necessarily just due to screening, even if women with it are less likely to have had a previous smear test. We know that almost all such cancers are due to a virus ( HPV ) .

Girls aged 12-13 have been vaccinated against HPV for 6 years, and in time that will lead to a further reduction of cases. Indeed smear tests may be replaced by testing for HPV.



• In the Philippines, to my knowledge, cervical screening has to be paid for - directly or through insurance. Cervical cancer is at least twice as common, and causes over four times as many deaths, compared to the UK. This reflects worldwide variation in frequency of this cancer, not just lack of screening. As in the UK, HPV vaccination should reduce the frequency in future years.



• A guide to the cost of screening, diagnosis and treatment in the Philippines can be seen here ( click on image to enlarge ):-


•



http://www.rappler.com/brandrap/stor...ncer-cost-cure


• Having an abnormal smear is relatively common, compared to the frequency of cervical cancer. We don’t know for certain which abnormal smears are especially risky, so all women with such smears are followed up, with " invasive " treatments involving excision and destruction of the abnormal areas.



• Women – and their doctors – need to understand that the " smear test " is intended for those without symptoms, and anyone at any age WITH worrying symptoms ( even after a " normal smear " ) needs diagnosis by other means.

[Doc Alan]

And now … " 23andMe " !


• Genetic testing company " 23andMe " ( we have 22 pairs of chromosomes + two sex chromosomes ) is the latest to launch its personal genome service in the UK, after it was banned in the US. It claims not to share such data with insurance companies without a person’s consent and is backed by Google.


• It allows people to send their saliva in a testing kit to have their DNA screened for genes associated with certain inherited conditions. The UK Medicines and Healthcare Products Regulatory Agency says the test can be used " with caution ". It’s not clear who would pay for any further tests or treatment based on the results – why should it be the NHS ?



• One of the thought-provoking aspects of this test is its cost - £ 125 ( with 10% discount for more tests ) ! The human genome was mapped in its entirety in 2000 and having your genes mapped has previously cost upwards of £ 1000.


• Most illnesses are not the result of single gene abnormalities – they involve many genes interplaying with the environment , social and other biological factors.

The minority who are in high risk groups – like strong family history of breast cancer, and Ashkenazi Jews ( also at increased risk of breast cancer ), probably SHOULD be screened for breast cancer risk genes, like BRCA ( mutations stop DNA repair and increase risk of breast, also ovary or prostate cancer ) - provided they understand the consequences, and are prepared to make decisions such as having mastectomy ( even when there’s no breast cancer ) based on the results. If there is a suspected genetic pattern within a family, doctors and NHS genetic clinics are geared up to discuss the implications.


• There’s no evidence so far that genetic screening of the apparently healthy population would result in lives with less disease or premature death, or happier lives !


• Apart from the cost ( now much less than previously ) – what exactly would someone plan to do with the results ? How might it reduce the risk of premature death, and increase good quality years ? For most of us, we don’t need to pay for a genetic test to achieve these aims ! We already know what to do : don’t smoke, drink alcohol in moderation, eat sensibly, exercise regularly, watch your weight, aim for a job you like … and choose your parents – it’s in the genes
!

https://www.23andme.com/en-gb/health/

[Arthur Little]

Alan ... As always, it's most reassuring to receive your regular updates on health-related topics and I'm convinced your comprehensive and informative response to my query will, in turn, accomplish much in setting very many of our lady members' minds
at ease.

[Rosie1958]

Wow ....... thanks for taking the time so share all the information Doc Alan!

I quite often receive letters inviting me to join in a "private" health screening programme costing around £175. I've never taken it up since I appear fit and healthy, but do regularly participate in the free health MOT screening at work ...... Cholesterol, blood pressure, BMI, etc.

[Doc Alan]

I quite often receive letters inviting me to join in a "private" health screening programme costing around £175. I've never taken it up since I appear fit and healthy, but do regularly participate in the free health MOT screening at work ...... Cholesterol, blood pressure, BMI, etc.

I hope the thread has proved useful Rosie .


Of course there's NO perfect screening test for apparently well people – always right, neither invasive nor unpleasant, with a cure that’s always successful and with no side effects .

In a screening programme, the gamble is taken that ultimately it will cause more good than harm. Medics and the general public need to be aware that there should be evidence in favour of the " good " for ANY screening test, whether already on offer " for free " on the NHS, or paid for by other means. That’s why there’s no widespread screening for some serious illnesses.


We’ve reached the stage – at least in the UK - where apparently healthy people have become patients, through abnormalities detected at screening ; our bodies have become equated to cars requiring regular " MOTs " ; and patients have become customers or clients !


I'm sure members will make their own minds up before being " checked and screened " into becoming patients !




http://www.amazon.co.uk/The-Patient-.../dp/1780660006

[Rosie1958]

I hope the thread has proved useful Rosie .

Most definitely, Doc Alan, thank you for posting I had already tried to acknowledge with a rep but the system is preventing me from doing so. Next time