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

Not all health checks are equal. Cervical cancer screening is one of the best-evidenced screenings in existence. In women aged 21 to 65, a Pap smear every three years, or an HPV test every five years, demonstrably reduces both the incidence of and deaths from cervical cancer. In the United States, mortality from this cancer fell from 2.8 to 2.3 per 100,000 women as a result. Screening outside those age limits (below 21 or above 65 with a good screening history) offers no benefit and can actually cause harm through unnecessary follow-up procedures. The US preventive care guideline explicitly advises against this.

Lung cancer screening with a low-dose CT scan is worthwhile, but only for people aged 50 to 80 who smoke or have smoked and have accumulated at least 20 pack-years. For this high-risk group there is moderate but sufficiently strong evidence that annual screening reduces the likelihood of dying from lung cancer. There are indications that a personalised risk model (such as PLCOm2012) is more cost-effective than fixed age and pack-year criteria, but that is modelling research without a randomised trial. Population-wide lung cancer screening for arbitrary adults is therefore not what is being recommended here.

PSA screening for prostate cancer is the most controversial of all the checks discussed. Based on five randomised trials involving more than 721,000 men, 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 men dies over a ten-year period. Against this, modelling estimates suggest that per 1,000 screened men roughly 1 man is hospitalised due to a serious infection following biopsy, 3 men develop urinary incontinence, and 25 men develop erectile dysfunction as a result of overtreatment of non-dangerous tumours. This is a trade-off that every man must discuss with his doctor; it is not a straightforward choice.

Oral cancer screening through visual inspection by a dentist or doctor is cost-effective in high-risk groups such as heavy smokers and heavy drinkers. For the general population, however, only one randomised trial 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. More research is needed.

In the field of breast cancer, recent research shows that an AI tool applied after a negative mammogram can identify the seven percent of women with the highest risk for additional MRI. This reduces the number of missed breast cancers. Routine MRI for all women is not feasible due to costs and staff shortages. This is a promising but not yet widely implemented approach.