Premium health check-ups: what really matters

So-called premium check-ups are often presented as a list: twenty, forty, sometimes sixty tests. Length reassures. Yet it says little about quality. In medicine, a test is worth the decision it informs: to treat, to monitor, or to do nothing, knowingly.

The trap of “seeing everything”

The more you look, the more you find. A kidney cyst, a thyroid nodule, a small spot on the liver: such incidental findings are common and usually harmless. But once written in a report, they call for further tests, sometimes a biopsy, and weeks of worry.

This is why, in April 2023, the American College of Radiology stated that there is not enough evidence to recommend whole-body MRI for people without symptoms. The scan is not useless in itself. It is discussed in specific situations, with a physician, rather than offered as a matter of course.

The foundation, according to the guidelines

Ages vary from country to country. A good check-up tells you which guidelines it follows, and why.

Heart and blood vessels

• Blood pressure, measured at rest, more than once.
• A lipid profile, and blood sugar or glycated haemoglobin.
• Ten-year cardiovascular risk, calculated with a recognised tool such as SCORE2 in Europe.
• Lipoprotein(a), at least once in a lifetime. The 2019 European guidelines suggest it: this risk factor is largely inherited and does not show on a standard lipid profile.

Cancer screening

• Colon and rectum. From 45 under US guidelines; from 50 to 74 in European programmes.
• Breast. A mammogram every two years from 40 under the 2024 US guidelines; from 45 to 74 under the 2022 European recommendation.
• Cervix. HPV testing, at the interval set in your country.
• Lung. A yearly low-dose CT scan for current and former heavy smokers, aged 50 to 80 under US criteria.
• Prostate. PSA testing between 55 and 69 is decided with the physician, after weighing its benefits and harms.

What is decided case by case

• Coronary calcium score. A scan without contrast that measures calcium in the heart’s arteries. The 2019 US guidelines consider it useful when risk is intermediate and the decision to treat is uncertain.
• Fitness. An exercise test, with or without VO2max. In a 2018 study of 122,007 patients, low cardiorespiratory fitness was associated with a risk of death comparable to, or greater than, that of smoking or diabetes.
• Abdominal aorta. A single ultrasound for men aged 65 to 75 who have ever smoked.
• Bones. A bone density scan, depending on age, menopause and current treatment.

The ICI verdict

Four questions to ask before you book

1. Why this test, for me?
2. Which guidelines do you follow, and for what age?
3. Who will explain the results, in person, and in which language?
4. If something is found, who calls me, how soon, and at what cost?