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Routine health checks may not affect mortality

Sunday November 25, 2012
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Routine general health checks do not reduce the number of deaths from cardiovascular disease or cancer, but do increase the number of new diagnoses, according to a meta-analysis.

For the purposes of the analysis, health checks were defined as screening for more than one disease or risk factor in more than one organ system, and offered to a general population unselected for disease or risk factors.

Health checks were introduced with the intention of reducing morbidity and prolonging life, according to background information for the study, which was published Nov. 20 in the British Medical Journal. Potential benefits include detection of both increased risk factors and precursors to disease; counseling on diet, weight and smoking; and reassuring healthy people, thus reducing worry about potential disease.

However, screening healthy people can be harmful and can lead to overdiagnosis and overtreatment, the researchers noted, and invasive diagnostic tests may cause harm. Being labeled as having a disease also may negatively affect healthy people’s views of themselves and their health behavior.

Few of the individual tests commonly used in health checks have been adequately studied in trials, and whether they do more harm than good is not clear, the researchers said. When tests have been studied in trials, the results have been varied.

Seeking clarity, authors from the Nordic Cochrane Centre in Denmark carried out a review of 14 trials that examined systematic health checks. The studies had between one and 22 years of follow-up.

Nine of the 14 trials had data on mortality and included 182,880 participants, 11,940 of whom died during the study period. Of the participants, 76,403 were invited to health checks. All participants were older than 18, and the study excluded trials specifically targeting older people.

Despite some variation regarding the risk of death from cardiovascular disease and cancer, no evidence was found for a reduction of total mortality, cardiovascular mortality or cancer mortality. Unsurprisingly, the researchers found that health checks led to more diagnoses and more medical treatment for hypertension, although this issue was infrequently studied.

The lack of beneficial effects indicates that the interventions did not work as intended in the included trials. Health checks are likely to increase the number of diagnoses, but in the absence of benefits, this suggests overdiagnosis and overtreatment.

Regarding potential limitations of the analysis, the researchers noted that people who accept a health check invitation may differ in various ways from those who do not, meaning the checks might not reach those who need prevention the most. Plus, many physicians already carry out testing for cardiovascular risk factors or diseases in patients whom they judge to be at risk when they see them for other reasons.

In conclusion, the researchers said, the results do not support the use of general health checks aimed at the general population. Further research should be “directed at the individual components of health checks, [such as] screening for cardiovascular risk factors, chronic obstructive pulmonary disease, diabetes or kidney disease.”

The study is available at www.bmj.com/content/345/bmj.e7191.


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