[Health in the 100-Year Life Era] Excessive Health Checkups Are Not Beneficial

Professor Son Ki-young, Department of Family Medicine, Asan Medical Center, Seoul.

Korea is a country that conducts a lot of health screenings. Hospitals each create and operate their own screening programs, and many workplaces support annual screenings as a welfare benefit for employees and their families. Nationally, screening programs are implemented for almost the entire population according to age. People are often contacted and urged to undergo screenings, being told that they will not receive benefits if they do not. Since screening is a very important method of prevention, it is a positive phenomenon that the public is well informed about screenings and actively participates. However, there are also many misunderstandings about screenings.

Fundamentally, screenings are conducted when there are no symptoms. If you have symptoms and wonder, "Should I get tested?" it is better to consult a doctor about those symptoms and undergo appropriate examinations and tests rather than just getting a screening. When you see a doctor, they will order the exact tests needed for those symptoms, sometimes more detailed ones, rather than performing a variety of tests through screening. Often, when the cause of discomfort cannot be found through consultation and tests with a doctor, people try to find the cause through comprehensive screening, but usually, screenings do not find the cause. It is important to consider that among various symptoms in our bodies, there are many cases where no cause can be identified even after testing.

Many people believe that comprehensive screening can examine every corner of the body and reveal everything about their health. However, even if many tests are done through screening, it is impossible to look into every detail of the body. Individual tests in screenings target important diseases that need to be detected early. These are called target diseases. In other words, each test in a comprehensive screening is designed to detect specific target diseases, so it is difficult to say that screenings are effective for detecting other diseases or conditions. Sometimes, screenings may incidentally discover something other than the target diseases. However, there is no evidence that such incidental findings through screening necessarily benefit our health.

Anyway, the more tests you have, the more you learn about your body, so wouldn’t that be beneficial? Not necessarily. Screening is intended to quickly detect diseases through tests. For some diseases, early detection and early treatment lead to better outcomes than late treatment. Unfortunately, not all diseases have better outcomes just because they are detected early through screening. Recently, many patients have consulted about wanting screening for pancreatic cancer during medical visits. There is no evidence that early detection of pancreatic cancer through screening improves treatment outcomes, so it is a disease for which screening is not recommended.

Another point to consider is that not all tests are effective screening methods for the same disease. One example worth considering is screening for cancer through blood tests. For instance, colorectal cancer is a disease with proven screening effectiveness and is important to screen for. When screening for colorectal cancer, tests using stool samples, blood tests, and endoscopy can be considered. Among these, stool tests and endoscopy have been proven effective for screening, but blood tests are difficult to say are effective for screening. Most blood-based cancer screening tests often show abnormalities even when the cancer is not actually present. Currently, most blood-based cancer tests are useful for purposes other than screening.

Screening is a good method to detect important diseases early that would otherwise go unnoticed and to prevent adverse outcomes caused by those diseases. However, as with everything, excessive screening is not beneficial, and more is not always better. It is necessary to undergo screening for diseases where screening is effective and by effective testing methods, and it is advisable to consult with your primary care physician about this.

Ki-Young Son, Professor, Department of Family Medicine, Seoul Asan Medical Center