Many believe health checks will keep them well but they can lead to worry, tests and even surgery. Sylvia Thompson reports
The growing popularity of executive health checks and private individualised cancer screening is causing some concern among general practitioners and hospital-based health professionals.
Apart from the fact that the majority of such health checks are corporate packages (paid for by the employer and sometimes mandatory for employees), there is another more insidious issue which is whether a battery of tests carried out as part of an executive health check can, in fact, lead to needless worry and sometimes even further invasive tests and, in rare cases, unnecessary surgery. Take prostate cancer for example. If a man in his 40s discovers from a PSA (prostate specific antibodies) test that he has prostate cancer, it can provoke a personal crisis that may be disproportionate to the seriousness of his illness.
Generally speaking, prostate cancer is a slow-growing tumour which only becomes a terminal illness when it has spread beyond the prostate gland into the bone causing fractures, paralysis and excruciating bone pain. However, the public mindset of cancer is still often one that sees all cancers as life-threatening, regardless of expert opinion.
Dr Denis Murphy, consultant urologist at Beaumont Hospital, Dublin, admits that many men would be better off not knowing they had prostate cancer because once they have the diagnosis, they almost always want treatment, regardless of whether treatment is genuinely the best course of action.
"The standard advice is that men should be screened for prostate cancer between the ages of 50 and 70, not before and not after. If there has been prostate cancer in the family, the screening should begin at age 45.
"And the message that needs to get across is that a PSA test is looking for the disease at an early stage so that men can be more comfortable if there is a positive result and not automatically think they have a life-threatening cancer," says Murphy.
The chief medical officer in the Department of Health, Dr Jim Kiely, raised other concerns about private tests for cancer in his annual report last year. He referred specifically to cervical smear testing, PSA testing and non-BreastCheck mammograms being carried out by private health professionals.
"Without appropriate quality assurance mechanisms, clear referral and follow-up procedures, call and recall processes. . . this form of testing does not carry the benefits of organised population-based screening and may actually be injurious to health," he says.
In terms of screening for certain cancers, there is a greater risk of what are called false positives (ie results which show the person has the cancer) when screening is done outside the high-risk age group.
"There is no evidence that screening for cancers and cardiac disease in those under the age of 50 will result in more [ diagnosed] cases," says Dr Niall O'Cleirigh, spokesman for the Irish College of General Practitioners.
"For the majority of people, it will make no difference at all. There is no need for men and women in their 30s who are well to have executive health checks," he says. "They may just need to stop smoking and reduce their alcohol intake.
"The scenario changes for those with a family history of cancer or heart disease. Then, you have to be highly vigilant. When it comes to the age of 50, it's probably a good idea to go for a health check - particularly for men who haven't been to their GP in years," O'Cleirigh says.
In Britain, the British Medical Association (BMA) said recently that patients may be wasting their time and money paying for tests such as whole body CT scans and cancer screening. The exercise electrocardiogram (ECG) or stress test was also criticised for being of little value to those who have not been diagnosed with heart disease. Dr Vivienne Nathanson, the BMA's head of science and ethics, says that often private tests pick up something that will never develop into a major health concern.
The BMA's concerns came following last year's Which? report which asked two public health screening experts to give their verdicts on information and tests provided by five private full-body screening services.
Dr Muir Gray, programme director of the NHS Screening Committee, says: "private health screens are big business. . . Most of us don't understand exactly what the tests can do but put our faith in them anyway. It's like taking your car for an MOT. You might not be clear about all the checks but you assume they'll help prevent a crash."
The Which? report found little evidence to back up claims that a barrage of health checks is the key to your future health.
The Irish College of General Practitioners adds that the blood pressure testing and cholesterol checks available in supermarket car parks on a walk-in basis also have little value.
"A once-off check for blood pressure is useless, especially if the person has been rushing around. You really need to do a series of readings. And, in terms of cholesterol, such tests would almost always be based on non-fasting blood samples which isn't ideal," says O'Cleirigh.
According to Prof Ian Graham, department of cardiology at the Adelaide, Meath and National Children's Hospital, Tallaght, Dublin: "Any health check for heart disease should be part of a total risk assessment so looking at one risk factor alone can give an incorrect risk assessment. For instance, a 60-year-old female non-smoker with a cholesterol level of eight has a lower risk of heart disease than a 60-year-old male smoker with a cholesterol level of five."
In her address to the Irish College of General Practitioners last month, Dr Iona Heath, GP in Camden, London, author and international lecturer on general practice, summed up the situation quite neatly: "Leave the worried well alone and let them get on with their lives and treat people who are sick," she told the assembled audience of general practitioners.