We asked Dr June Tan Sheren to unravel ‘health screenings’ or ‘health check-ups’ – who needs them and what do they really need?
Why should you have a health screening?
The purpose of a health screening is to help you to find out if you have a disease or a condition that may cause future health challenges, even if you feel perfectly well and healthy. Many serious illnesses do not cause discomfort in their earliest stages. For example, heart disease may not cause symptoms until a heart attack occurs. The same goes for stroke and some types of cancer as well. If these illnesses can be discovered at their earlier stages, treatment can be started before they become troublesome or lead to complications that are much more difficult to treat.
Case study #1: Mrs X, a 55 year-old piano teacher came to see me for breast screening. Her last screening mammogram was done 2 years ago. She did not have a family history of cancer. I examined her and found no breast lumps. I ordered a mammogram for her, which reported a suspicious 1 cm density (lump) deep in the breast – too small and deep to be felt. A biopsy was performed and confirmed that the lump was cancerous. Fortunately this was found to be early stage 1 cancer, and she was successfully treated with surgery to remove the lump and chemotherapy. Her prognosis (outlook) is excellent and she has quickly returned to normal life after completing her treatment. She has returned to Europe to see her children and newborn grandchild.
Things would have been very different for Mrs X if she had not come for breast screening and the cancer not caught early. Early detection gave her the best chance of cure. Early detection and treatment prevents more severe disease.
Another common condition that I screen for is high blood pressure – treating it early reduces the chance of having heart disease, stroke and kidney failure in future. Treatment may not mean having to take medications. It can simply start with changes to your diet or lifestyle such as weight loss, stop smoking, and increasing exercise.
Preventive care is an important part of what I do as a General Practitioner – I don’t just treat patients when they are ill, I want to help them prevent disease and advocate for healthy longevity.
What kind of health screening tests should you have?
There are many different tests available in Singapore, often grouped under different packages offered by clinics and hospitals. It can all appear very confusing and often come with relatively high price tags as well.
Very commonly, these packages are offered to you as a consumer and the decision lies with you. When you look at them it often seems that the more you pay the more you get. This, to me, is simply wrong.
It is crucial to consider the options carefully because some tests can actually do more harm than good. When health authorities make recommendations for health screenings, they look at many factors such as the usefulness of the test, the accuracy of the test, and the safety of the test. If detecting a disease early does not automatically lead to an improved outcome – longer lifespan of good quality – then it is neither a good nor effective screening test.
There are tests that are known to be beneficial to everyone. For example, measurements of blood pressure, body mass index and waist circumference every 1-2 years are recommended for all adults. This helps identify major risk factors leading to heart disease and stroke which are among the top causes of death.
Likewise, there are recommendations for the screening of diabetes and high cholesterol, cancers like colorectal (bowel) cancer for all adults, and cervical and breast cancer screening for women.
The following table lists the essential, no-frills bare-minimum screening tests that benefit everyone, consistent with internationally recommended best practices.
General Screening Tests for Adults
Recommended for those: | To screen for | Screening test | Screening frequency |
18 yrs and above | Obesity
| Body Mass Index (BMI)
|
|
40 yrs and above | Diabetes mellitus | Fasting blood glucose | Once every three years or more frequently as advised by your doctor |
50 yrs and above | Faecal Immunochemical Test
Colonoscopy | Once a year |
Additional Tests for Women
Women 25-69 yrs | PAP test (for 25 - 29 yrs old) | Once every three years
| |
Women 50-69 yrs | Mammogram | Once every two years |
I hope this gives you some food for thought. What age are you? When did you last have your health checked?
What other tests should be considered?
In order to make health screenings work for you, we need to take an individualized approach in considering additional screening tests and recommendations. Individualizing or customizing the health screening plan is crucial because no two persons are alike in their physical attributes, their past and present health issues, their lifestyles, diet, mental health, or family history – all of which significantly impact one’s overall health and well-being. There are some screening tests that will be suitable for some, and others that will not. There are some tests that are expensive and are of not much benefit.
Who can help you decide which tests to do in addition to the basic ones?
Most frequently, it is your Family Doctor who knows you, your medical history, your family history and your lifestyle factors. Your trusted doctor is therefore the best person to advise if there are additional tests suitable and recommended for you.
For example, if you are a Hepatitis B carrier, you will need regular screening tests to check your liver. If you have a strong family history of heart attacks, you may be advised to start screening for high cholesterol and other risk factors at an earlier age and more frequently than what the basic framework recommends. If there is a history of cancer, your doctor will advise the types of screening tests that might be useful, and how frequently to do these tests.
Case study #2: Ms C, a 42 year-old marketing executive came to see me for health screening. She felt well with no complaints. She was told a few years ago that her cholesterol was high and she had to watch her diet. Her diet was currently overall healthy, but she did little exercise and was mostly quite sedentary. She did not smoke or drink alcohol. Her father and older brother had heart attacks in their early 50s. I did her cholesterol tests which returned showing extremely high levels of cholesterol – levels that were frequently seen in genetic forms of high cholesterol that runs in the family. This placed her at high risk of heart disease. We made the decision to move on to the next level of screening for heart disease by a cardiologist, and fortunately her tests showed no blocked arteries yet. She was started on cholesterol-lowering medication and has responded very well, together with setting herself goals to increase physical activity and eating more healthily. With her improved cholesterol levels and healthier lifestyle, she has significantly reduced her risk of developing heart disease.
Understanding the context helps both you and your doctor better understand which tests are appropriate, and also helps greatly when it comes to interpreting the results. Undergoing a blanket of screening tests without context will often be meaningless and unhelpful to both the patient and the doctor.
What are the questions you should ask your doctor before deciding on the health screening tests?
Your doctor should have many questions to ask you in order to give the appropriate recommendations. But these are questions that you should ask him/her:
- Is the test useful for me at my age and for my current health status, lifestyle and family history?
- Is there any associated harm from the test e.g. radiation from X-rays, false alarms (false positive results) requiring further testing and leading to anxiety?
- How often should I do this test?
- Who will explain the results to me and give me the necessary advice going forward?
Far too often I see patients who have paid for an exorbitant health screening package that does not take the context of the individual into consideration. Many go away with a false sense of security if their test results appear normal and no guidance given on when the tests should be repeated.
I also regularly see patients who come to me with their reports because there has been no one at the screening centre to explain their results to them and advise on a plan for follow-up. I have seen patients being given advice that is not appropriate when considering the background and context of the patient – I suspect that goes beyond what is expected of the health-screener.
Case study #3: Mr T, a 38 year-old lawyer came to me with a massive pile of medical reports for me to review. 6 months ago he signed up for an executive health screening package at a hospital– a top-of-the-range package that promised everything. He assumed that the more tests he did, the better it was. He did not know that one of the tests, a tumour marker test, can give false positive results (false alarms) quite frequently. The test came back abnormal. What happened after that was an endless list of referrals to various specialists, Xrays and scans, endoscopy procedures and more. Thankfully everything returned normal – but his life had been severely disrupted by the worry and anxiety caused by this. Not to mention the costs incurred. He has had the tumour marker test repeated which was now lower than before, but because it was still not in the normal range this continued to worry him greatly. The specialists have reassured him that there was nothing wrong with him – but he remained anxious and upset over why the test was done in the first place.
Do not hesitate to ask your doctor questions about health screenings – your doctor will be happy to help you understand the screening tests before you proceed as well as follow-up on the results with you. The follow-up care should not be neglected.
Take-home message
Early detection not only saves lives; it also ensures a better quality of life for the longest time possible. Health screenings are a hugely important part of caring for yourself, and choosing the right screening tests is a necessary conversation to have with your trusted family doctor.
We live in a world now where we enjoy first-world medicine with the focus shifting to disease prevention and healthy longevity. You can put yourself on the right track starting with regular and appropriate health screening and engaging your family doctor as an essential partner in health.
If you want to discuss your health with me you can be sure of a confidential discussion based on your personal needs – not an ‘off the shelf’ solution.
