When you need a health check ‒ and why

YOUR HEALTH

Grocott's Mail - - HEALTH & WELLNESS - By DR ROGER WALSH

Pri­vate Health care pro­vi­sion is skewed to cu­ra­tive care. This is short-sighted and leads to high med­i­cal care in­fla­tion, higher pre­mi­ums and has lim­ited ef­fects on mor­tal­ity and mor­bid­ity.

Treat­ments for cancer and life­style diseases have im­proved out­comes, but early de­tec­tion can also have a pos­i­tive ef­fect on sur­vival and re­duce treat­ment costs.

Screen­ing for diseases should be an ev­i­dence-based ac­tiv­ity.

Screen­ing tests are use­ful only if they re­duce mor­tal­ity or mor­bid­ity.

Tests that gen­er­ate many false-pos­i­tive re­sults may cause harm from anx­i­ety and un­nec­es­sary pro­ce­dures.

Tests that gen­er­ate many false-neg­a­tive re­sults may worsen out­comes by lead­ing to de­layed di­ag­no­sis and treat­ment. Char­ac­ter­is­tics that make a disease amenable to screen­ing in­clude; a sig­nif­i­cant neg­a­tive im­pact on health, an iden­ti­fi­able asymp­to­matic pe­riod, and im­proved out­comes with early in­ter­ven­tion.

A use­ful screen­ing test must have sen­si­tiv­ity and speci­ficity for the disease be­ing screened.

It also must be cost ef­fec­tive and ac­cept­able to pa­tients. Sen­si­tiv­ity, speci­ficity, and disease preva­lence all in­ter­act to de­ter­mine a test’s pos­i­tive pre­dic­tive value – the like­li­hood that a pos­i­tive test re­sult in­di­cates that the disease is present.

In screen­ing for ill­nesses, the goal must not be merely to do some­thing. It must be to do some­thing use­ful.

Most of mor­tal­ity in the over 40s is re­lated to diseases of life­style such as Di­a­betes Mel­li­tus, Hyper­ten­sion and Smok­ing, with strokes and heart con­di­tions be­ing the bulk of the causes of death. Can­cers are the next most im­por­tant diseases that are amenable to screen­ing.

The com­mon­est are Lung cancer (in smokers only), Colon cancer.

In women, breast and cer­vi­cal cancer and in men prostate cancer.

Be­low is a list of screen­ing tests for healthy adults rec­om­mended by var­i­ous med­i­cal bod­ies from the US, the World Health Or­gan­i­sa­tion, Eu­ro­pean so­ci­eties and the South African Na­tional Depart­ment of Health (a ref­er­ence list is avail­able).

They are an ap­prox­i­mate guide and may vary in com­mence­ment age and fre­quency if there are pre-ex­ist­ing med­i­cal con­di­tions or a rel­e­vant fam­ily his­tory; • Blood pres­sure – an­nu­ally – bed side test can be done at GPS, phar­macy or when do­nat­ing blood • Choles­terol – ev­ery five years from age 40 – fast­ing blood test • Di­a­betes Mel­li­tus – ev­ery three years – fin­ger prick bed­side test • Colon cancer – from 50 yrs of age – (i) an­nual stool oc­cult blood test or (ii) ev­ery three years with a flex­i­ble sig­moi­doscopy or (iii) colonoscopy ev­ery 10 years. • Den­tal exam – an­nual check and clean • Eye exam – year • De­pres­sion – If you’ve felt “down”, sad or hope­less ev­ery sec­ond with no in­ter­est or plea­sure in things for over two weeks straight approach your health ser­vice provider to ask for a de­pres­sion screen. • Sex­u­ally trans­mit­ted Diseases – de­pen­dent on risk. • Lung Cancer – from age 55yrs if have a 30 pack-year* smok­ing his­tory AND cur­rently smoke or quit within last 15 years – Low-dose com­puted to­mog­ra­phy.

MEN

• Prostate Cancer – from age 50 ev­ery sec­ond year - blood test. The dig­i­tal ex­am­i­na­tion is no longer rou­tine.

WOMEN

• Breast Cancer – from age 40yrs ex­am­i­na­tion by health pro­fes­sional an­nu­ally, from 45yrs a mam­mo­gram ev­ery sec­ond year; ge­netic screen­ing if you have a fam­ily his­tory. • Cer­vi­cal Cancer – from five years af­ter sex­ual de­but - ev­ery years – Pap Smear • Os­teo­poro­sis – from age 65yrs (younger if frac­ture his­tory) – once-off DEXA scan

Screen­ing for diseases is im­por­tant, but liv­ing a healthy life­style (no smok­ing!), eat­ing a bal­anced diet and ex­er­cis­ing reg­u­larly is of vi­tal im­por­tance.

The above list is meant as a guide only us­ing cur­rent med­i­cal knowl­edge.

On­go­ing re­search, ad­vances in med­i­cal tech­nol­ogy and re­duc­tion in its cost of ap­pli­ca­tion as well as changes in disease preva­lence may lead to changes and ad­di­tions.

*1 pack year = 20 cig­a­rettes per day for one year.

• Dr Roger Walsh is a GP cur­rently serv­ing in a pri­vate

prac­tice.

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