Screening and prevention

‘Screening is a way of finding out if people are at higher risk of a health problem so that early treatment can be offered or information given to help them make informed decisions. Screening is a way of identifying apparently healthy people who may have an increased risk of a particular condition. The (NHS UK) offers a range of screening tests to different sections of the population.

The aim is to offer screening to the people who are most likely to benefit from it. For example, some screening tests are only offered to newborn babies, while others such as breast screening and abdominal aortic aneurysm screening are only offered to older people.’ [Ref NHS UK] This will give a very good understanding of what screening is and what are the screening tests that are recommended by the NHS-UK. This may be somewhat different from what the MoH recommends for Sri Lankan citizens. (I will try and get a link to the recommended screening programs by the Ministry). 

‘Very importantly, screening is not for people with symptoms. If you have any symptoms, go to your doctor.’

 

‘Prevention is better than cure’ makes intuitive sense. Yet there is evidence that some preventive activities are not effective, some are actually harmful. It has been said ‘all screening programs do some harm; some do good as well’. Screening of asymptomatic patients may lead to overdiagnosis, causing needless anxiety, appointments, tests, drugs and even operations, and may leave the patient less healthy as a consequence. Therefore, it is crucial that evidence clearly demonstrates that benefits outweigh those harms for each preventive activity. [Ref – RACGP Red book]

You can download the 9th ed Redbook

 

Screening test by the private sector

There are many screening tests offered by private sector laboratories and health care institutions. The UK government advice before you go for a test will be important and extremely helpful if you are planning to do so. “Private companies offer a wide range of health checks, from simple blood tests and physical examinations to full body scans and screening for serious conditions like aneurysms or heart failure. Some of the tests offered by private companies are not recommended by the UK NSC because it is not clear that the benefits outweigh the harms. If you’re thinking about paying for any of these checks, it’s worth asking the following questions first.’ Read the full instructions- LINK


LINK

General health checks for reducing illness and mortality

What is the aim of this review?

The aim of this Cochrane Review was to find out if general health checks reduce illness and deaths. This is an update of a previous Cochrane Review.

Key messages

Systematic offers of health checks are unlikely to be beneficial and may lead to unnecessary tests and treatments.

What was studied in the review?

General health checks involve multiple tests in a person who does not feel ill. The purpose is to find the disease early, prevent the disease from developing, or provide reassurance. Health checks are a common element of health care in some countries. Experience from screening programmes for individual diseases have shown that the benefits may be smaller than expected and the harms greater. We identified and analyzed all randomized trials that compared invitations for one or more health checks for the general public with no invitations. We analyzed the effect on illness and the risk of death, as well as other outcomes that reflect illness, for example, hospitalization and absence from work.

What are the main results of the review?

We found 17 randomized trials that had compared a group of adults offered general health checks to a group not offered health checks.

Fifteen trials reported results and included 251,891 participants. Eleven of these trials had studied the risk of death, and included 233,298 participants and assessed 21,535 deaths. This is an unusually large amount of data in healthcare research, which allowed us to draw our main conclusions with a high degree of certainty. Health checks have little or no effect on the risk of death from any cause (high‐certainty evidence), or on the risk of death from cancer (high‐certainty evidence), and probably have little or no effect on the risk of death from cardiovascular causes (moderate‐certainty evidence). Likewise, health checks have little or no effect on heart disease (high‐certainty evidence) and probably have little or no effect on stroke (moderate‐certainty evidence).

We propose that one reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons. Also, those at high risk of developing disease may not attend general health checks when invited or may not follow suggested tests and treatments.

How up to date is the review?

The review authors searched for studies published up to 31 January 2018.

Authors’ conclusions

Implications for practice

Our results do not support the use of general health checks aimed at a general population. On the other hand, they do not imply either that physicians should stop clinically motivated testing and preventive activities, as such activities may be an important reason why an effect of general health checks has not been shown. Public healthcare initiatives to systematically offer general health checks and offers from private suppliers of general health checks are not supported by the best available evidence.

Implications for research

We see no reason to do more trials of general health checks, as it seems futile based on a large amount of available data and the fact that the results of previous trials have now been confirmed by a recent large trial. Further research in health checks should be limited to studying the effect of one component at a time and should include harmful effects. We also suggest that surrogate outcomes such as changes in risk factors are not used for assessing benefits since they do not capture harmful effects and since their relation to meaningful outcomes is usually in doubt. The required large randomized trials with long follow‐up are expensive but not nearly as expensive as the implementation of ineffective or harmful screening programmes. We suggest more focus on the effects of structural interventions to reduce disease, for example, higher taxes on tobacco and alcohol, or restricting corporate advertising for harmful products.

2019 – 03 – 17

Screening and General Health Checks in adults – the latest from Cochrane

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