Doctor, give me a checkup and make it a full one.

Xavier Bayona
 

The need to reduce anxiety due to the uncertainty of the possibility of getting sick and dying is one of the most frequent reasons behind the demand for a "preventive" health study, popularly known as a checkup. The purpose of the checkup is to detect the disease early, prevent it from developing, and/or provide reassurance. General health studies (checkups) involve multiple tests on a person who doesn't feel ill and is a common element of medical care in the Western world.

This is an issue that Jordi Varela already addressed in a previous post, in which he stressed that despite not being able to reduce mortality or morbidity, health checkups could be associated with overdiagnosis and overtreatment, without forgetting the risks typical of diagnostic tests, the anxiety caused by false positives, incidental findings and the sense of security produced by negative results, some of them false.

In a systematic review published by Cochrane in 2019, the following conclusion was reached: "Checkups are unlikely to be beneficial", a statement made after analysing 17 randomized clinical trials that had compared groups of adults who had been submitted as minimal to a checkup of two or more pathologies with another that doesn't and having observed that the results do not support the use of health checkups directed to the general population with preventive objectives, so everything indicates that preventive health screenings are not supported by the best available evidence.

Let's look at some examples of the ineffectiveness of checks:

1. Global mortality (global follow-up from 4 to 30 years): with a checkup, there were 68 deaths out of every 1,000 people, compared to 68 without a checkup (high GRADE).
2. Cancer mortality (global follow-up from 4 to 22 years): with a checkup, there were 26 deaths out of every 1,000 people, compared to 26 without a checkup (high GRADE).
3. Cardiovascular mortality (global follow-up from 4 to 30 years): with a checkup, there were 32 deaths out of every 1,000 people, compared to 34 without a checkup (moderate GRADE).
4. Fatal and non-fatal ischaemic heart disease (global follow-up from 4 to 30 years): with a checkup, there were 66 incidents out of every 1,000 people, compared to 65 without a checkup (high GRADE).
5. Fatal and non-fatal stroke (global follow-up from 4 to 30 years): with a checkup, there were 29 incidents out of every 1,000 people, compared to 30 without a checkup (moderate GRADE).

As a reminder, in the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, the quality of the evidence is initially classified as high or low, depending on whether it comes from experimental or observational studies. Subsequently, according to a series of considerations, the evidence is high, moderate, low and very low. The strength of the recommendations is based not only on the quality of the evidence but also on other factors such as the balance between risks and benefits, the values ​​and preferences of patients and professionals, as well as the consumption of resources or costs.

It’s clear, with the available evidence, that the practice or recommendation of checkups to the general population to influence the prevention of general, cardiovascular and cancer mortality is questionable. The evidence, today, walks in another direction: more exercise and fewer checkups if we want to reduce global and cardiovascular mortality.