Check-up?

Routine Physicals Don't Save Lives

By Charles Bankhead, Staff Writer, MedPage Today

Published: October 16, 2012

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston

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Action Points

• A Cochrane systematic review identified no benefit for general health checkups for adults in terms of decreasing overall morbidity and mortality.
• Note that there was also no demonstrated benefit to checkups for reducing cardiovascular- or cancer-related mortality.

Patients who had regular general health checkups died of cardiovascular disease and cancer at virtually the same rate as those who did not have checkups, results of a systematic review and meta-analysis showed.

Analysis of 16 clinical trials involving 183,000 patients yielded mortality risk ratios of 1.01 and 1.03 for people who had general checkups versus those who did not, according to Lasse T. Krogsboll, of the Cochrane Nordic Center in Copenhagen, and co-authors.

Nor did the data show any effect of checkups on key secondary endpoints, including hospital admission, disability, physician visits, or absenteeism from work, they reported online in the Cochrane Database of Systematic Reviews.

Some of the studies did show increased diagnosis of hypertension, hypercholesterolemia, and certain chronic diseases.

"General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased," the authors wrote in conclusion.

"With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial," they added.

General health checkups have long been recommended as a component of routine healthcare. Multiple studies have shown that diagnoses of serious conditions often occur incidentally, during totally unrelated exams, such as general health checkups.

Routine checkups often involve screening tests, many of which have not been evaluated in high-quality studies, the authors wrote in the introduction to their findings.

Even tests that have been thoroughly evaluated have faced increased scrutiny, such as screening mammography for women younger than 50 and screening prostate-specific antigen (PSA) tests for prostate cancer. In recent years, the U.S. Preventive Services Task Force has recommended against broad application of either test in the general population.

Additionally, the potential harms of broadly applied screening tests have attracted criticism for subjecting patients to unnecessary procedures and treatments that have potentially harmful effects and also add substantially to the cost of healthcare.

In an effort to quantify the benefits and harms of general health checkups. Krogsboll and colleagues searched several databases to identify well-designed clinical trials that have evaluated general checkups. They focused on checkups' impact on so-called hard endpoints of morbidity and mortality, as opposed to surrogate endpoints such as hypertension and cholesterol levels.

The analysis included 16 clinical trials involving 182,880 participants, including nine trials that reported data on total mortality (155,899 participants, 11,940 deaths). The trials had a median follow-up of 9 years. Eight trials provided data on cardiovascular mortality and eight addressed cancer mortality.

Overall, the trials involving cardiovascular mortality showed that regular checkups were associated with a risk ratio of 1.01 (95% CI 0.92 to 1.12) versus study participants who did not have regular checkups. Trials that evaluated cancer mortality yielded a risk ratio of 1.03 (95% CI 0.91 to 1.17) for general checkups versus no checkups.

The investigators performed subgroup and sensitivity analyses, which failed to produce any substantive changes in the overall findings. Notable effects of general checkups included:

• One trial that showed increased rates of hypertension and hypercholesterolemia
• One trial that showed increased rates of self-reported chronic illness
• Two of four relevant trials found checkups associated with increased prescriptions for antihypertensive drugs
• Two of four relevant trials showed small effects on self-reported health status, which could have resulted from reporting bias, according to the authors

The authors found no useful information regarding referrals to specialists, follow-up tests, or surgical procedures prompted by general checkups.

"One reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons," the authors wrote of their findings. "Also, those at high risk of developing disease may not attend general health checks when invited."

"Most of the trials were old, which makes the results less applicable to today's settings because the treatments used for conditions and risk factors have changed."

The study was supported by the Cochrane Nordic Center in Copenhagen.

The authors had no disclosures.

Primary source: Cochrane Database of Systematic Reviews
Source reference:
Krogsbøll LT, et al "General health checks in adults for reducing morbidity and mortality from disease" Cochrane Database Syst Rev 2012; DOI: 10.1002/14651858.CD009009.pub2.