Preventive Health Check-Ups: Which Tests Are Worth Doing
Annual “full body check-up” packages are heavily marketed and only loosely connected to evidence. Some of what they contain is valuable, much of it is useless, and a portion is actively harmful through overdiagnosis.
What makes a screening test worthwhile
A test is worth doing when the condition is common enough and serious enough to matter, there is a detectable early stage, treating it early improves outcomes more than treating it later, the test is reasonably accurate, and the harms of false positives are acceptable.
Many tests in commercial packages fail at least one of these.
Screening with good evidence
Blood pressure. From age 18, at least every one to two years, more often if raised or with risk factors. Cheap, quick, and treating hypertension prevents strokes, heart failure and kidney disease.
Blood glucose or HbA1c. From 30 to 35 in Indian populations, or earlier with obesity, family history, PCOS or previous gestational diabetes. Prediabetes is reversible and that window is the entire point.
Lipid profile. From around 20 to 25, repeated every few years, more often with risk factors or abnormal results.
Body weight and waist circumference. Waist below half your height.
Cervical cancer screening. HPV testing or Pap smear from around 30, repeated at the recommended interval. One of the few screening tests that unambiguously saves lives, and badly under-used in India.
Breast cancer screening. Breast awareness from early adulthood, clinical examination, and mammography from around 40 to 50 depending on guidance and risk.
Colorectal cancer screening. Faecal occult blood testing or colonoscopy from 45 to 50, earlier with family history.
Oral examination, particularly for tobacco and areca nut users.
Hepatitis B and C, at least once in a lifetime for most adults in India.
HIV, at least once.
Vision and hearing, periodically with age.
Dental check-up, every six to twelve months.
Tuberculosis symptom screening where risk is relevant.
Bone density for women over 65, men over 70, and earlier with risk factors.
Depression and alcohol screening, brief and high-yield.
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Thyroid function in women with symptoms, in pregnancy and when planning it.
Complete blood count to detect anaemia, which is very common in Indian women.
Tests of limited value as routine screening
- ECG in an asymptomatic person without risk factors, which rarely changes management
- Treadmill test in asymptomatic people, which produces false positives leading to angiograms
- Whole-body CT or MRI scans, which deliver radiation in the CT case and reliably find incidental findings that generate anxiety, further tests and occasional complications without improving outcomes
- Tumour markers as screening: CEA, CA-125, CA 19-9 and PSA used indiscriminately. These are for monitoring known disease, not for finding it. CA-125 screening in average-risk women does not reduce ovarian cancer deaths and causes unnecessary surgery
- Vitamin panels in asymptomatic people beyond B12 and D where there is reason
- Food intolerance IgG panels, which have no validity
- Routine chest X-ray
- Carotid Doppler without symptoms
- Thyroid ultrasound as routine, which finds nodules in a large proportion of healthy people and triggers biopsies for lesions that would never have caused harm
- Coronary calcium scoring is useful in specific intermediate-risk patients, not as a general add-on
PSA sits in between: it is a discussion, not a recommendation, because of real over-diagnosis of cancers that would never have caused symptoms.
Overdiagnosis, explained plainly
Finding something real that would never have harmed you, then treating it with procedures that can. Thyroid cancer screening in South Korea is the textbook example: detection rose fifteen fold, almost everyone had surgery with lifelong hormone replacement, and the death rate from thyroid cancer did not move at all.
A test is not free simply because it is non-invasive.
What to do instead of a package
Ask your doctor to construct a screening plan based on your age, sex, family history, lifestyle and existing conditions. That conversation is worth more than any package.
A reasonable baseline for a healthy adult in India:
- Blood pressure, weight and waist, annually
- Fasting glucose or HbA1c, lipids, complete blood count, every one to three years from 30
- Kidney and liver function periodically
- Vitamin D and B12 where risk or symptoms exist
- Age and sex-appropriate cancer screening as above
- Vaccination review
- Dental and eye checks
- An honest conversation about tobacco, alcohol, activity, sleep and mood
Before accepting any test, ask
- What will you do differently depending on the result?
- What happens if it is abnormal but I am well?
- What is the chance of a false positive?
- Is there evidence that doing this test improves outcomes?
If the answer to the first question is “nothing”, the test is not needed.
This is general information, not a screening prescription. Build a plan with a doctor who knows your history rather than buying a package off a price list.