Which health checks are genuinely worthwhile and which are a waste of money?

Cervical cancer screening is the best-supported check that exists. Women aged 21 to 65 demonstrably lower their risk: a smear test every three years, or an HPV test every five years. In the United States, mortality fell as a result from 2.8 to 2.3 per 100,000 women. Screening below age 21 or above age 65 offers no benefit and can in fact cause harm through unnecessary follow-up investigations. The US Preventive Services Task Force (USPSTF) therefore explicitly advises against it.

Lung cancer screening via low-dose CT scan is worthwhile, but only for people aged 50 to 80 who smoke or have smoked with at least 20 pack-years. For that high-risk group there is sufficient evidence that annual screening reduces the chance of dying from lung cancer. For people who have never smoked or have smoked very little, broad lung cancer screening is not what the guidelines recommend.

PSA screening for prostate cancer is the most controversial check. Five large studies involving more than 721,000 men show that PSA screening probably has no effect on overall mortality. The benefit for prostate-cancer-specific mortality is small: in the most favourable estimate, 1 fewer man per 1,000 screened dies over ten years. But the harm side is real: per 1,000 men screened, modelling estimates that approximately 1 man is hospitalised due to a serious infection after biopsy, 3 men develop urinary incontinence, and 25 men develop erectile dysfunction as a result of overtreatment of non-dangerous tumours. This is not a simple choice; discuss it with your doctor.

Oral cancer screening via visual inspection is cost-effective in high-risk groups such as heavy smokers and heavy drinkers. For the general population only one large study is available, and the evidence that screening leads to lower mortality is weak and contradictory. The USPSTF therefore does not yet recommend population-wide oral cancer screening.

In the area of breast cancer, recent research shows that an AI tool can, following a negative mammogram, select the seven percent of women with the highest risk for additional MRI, thereby detecting more breast cancers. Routine MRI for all women is not feasible due to costs and staff shortages. Promising, therefore, but not yet widely implemented.