The annual check-up: what is worth doing, and what is a waste of money

Someone brought me a full body check-up report last month: fifty-eight tests, a laminated cover, and a bill that would have covered a year of blood pressure medication. Two results were mildly abnormal, both meaningless in isolation, and both generated a fortnight of worry and two further tests. Nothing in the folder addressed the fact that his blood pressure was 158/96 and had not been treated.

A screening test is only worth doing if a positive result would change something. That single rule removes most of what those packages contain, and it leaves a short list that genuinely protects people.

Worth doing for most adults

• Blood pressure — every visit, and at least once a year from your twenties. The cheapest and highest-value measurement in medicine.
• Blood sugar — fasting glucose or HbA1c, yearly from thirty in South Asians, and earlier with a family history, obesity, or a history of gestational diabetes. We develop diabetes younger and at lower body weights than European populations.
• Lipid profile — from around thirty-five, or earlier with family history of early heart disease, diabetes, or smoking.
• Hepatitis B and C — at least once in a lifetime for every adult here, and in every pregnancy.
• Weight and waist measurement — waist matters more than the scale. Above 90 cm in men and 80 cm in women carries real metabolic risk at this ethnicity.
• Vision, particularly after forty, and eye pressure if there is glaucoma in the family.
• Dental review yearly. Neglected here, and gum disease has consequences beyond the mouth.

Worth doing, depending on who you are

Women

• Cervical screening from thirty. Cervical cancer is preventable and its screening is badly under-used in Pakistan.
• Breast awareness from your twenties, clinical examination in a routine visit, and mammography discussed from forty — earlier where there is a strong family history.
• Haemoglobin. Iron deficiency anaemia is very common here and is treated as normal tiredness for years.
• Vitamin D and calcium where there is little sun exposure, and a bone density scan after menopause with risk factors.
• Thyroid function if there are symptoms, and in pregnancy.

Men over fifty

A conversation about prostate screening rather than an automatic test. PSA has real benefits and real harms — including biopsies and treatment for cancers that would never have caused trouble — and the right answer depends on your family history and how you weigh those. Come and discuss it rather than adding it to a package.

Anyone who smokes or uses tobacco in any form

Including huqqa, naswar and gutka. The most valuable intervention available is not a test at all — it is help with stopping, and it works far better with support than alone.

Usually not worth it

• Tumour marker panels in people with no symptoms. CA-125, CEA, AFP and the rest produce far more false alarms than early cancers when used this way, and each false alarm carries its own cascade of tests.
• Whole-body CT scanning, which delivers significant radiation and reliably discovers harmless anomalies that then must be chased.
• Routine ECG or stress testing in someone with no symptoms and no risk factors.
• Broad vitamin and mineral panels, other than the ones we have reason to check.
• Repeating a normal test every few months out of anxiety. If a test was normal and nothing has changed, repeating it mostly generates noise.

“The value of a check-up is in the conversation and the six right tests — not in the thickness of the report.”

What to bring, and how to prepare

1. Fast for eight to twelve hours if lipids or fasting glucose are planned — water is fine and you should keep drinking it.
2. Take your regular medicines as normal unless we tell you otherwise, and bring the boxes.
3. Bring your previous reports, even old ones. A trend across three years is more informative than any single value.
4. Write down your family history — heart disease, stroke, diabetes and cancer, and the ages at which they happened. This changes what we recommend more than most people expect.
5. Write down the questions you actually want answered, in advance. They are otherwise remembered on the way home.

If it has been more than a year, book fifteen minutes. Most of what we find in that appointment is a number that is easy to fix now and expensive to fix in ten years.