Which health screening tests do you really need? It's a common scenario in Singapore -- your parent or relative receives a letter offering free "basic" health screening services, usually in the form of a tie-up with the company where he or she is working.
So when my dad asked me last night:
What are the essential tests I should go for?
I had a glance through what was on offer: five pages worth of optional add-ons to the free basic screen, ranging from cancer marker tests to mind-boggling X-Rays and ultrasound scans.
If you selected every option for the "peace of mind" as I am sure many older folks would be inclined to, it would cost you a whopping $1678 according to this letter he received.
Given the huge amount of local searches for "health screening Singapore" every month, I decided to write this post to explain exactly what tests you need, and which you do not.
Is there a catch with "free" health screening?
Much as Singaporeans love the word "free", we have also wisened up to the fact that there is usually a catch somewhere in there, right?
Here is the big reveal: these basic health screening tests are "loss leaders".
You know when Ladyironchef tells you about that Japanese restaurant serving 99-cent oysters? Or when you hear about free 30-minute spa slimming packages on the radio?
In the first situation, you excitedly turn up for the cheap oysters, only to find that everything else on the menu is 30% more expensive than the norm. For the latter example, well, you know how some beauty spas in Singapore use pressure tactics.
Similarly, health screening companies commonly earn by:
- Charging you for all the additional and unnecessary tests - it is hugely enticing to tick every single add-on test for that "clean bill of health".
- Referring you to see specialists after, who usually have tie-ups with these screening companies.
What are common issues with health screening packages in Singapore?
In a nutshell:
- False alarms: screening tests are known to produce false positive results. Imagine being told that you have high prostate cancer markers when you do not actually have prostate cancer.
- Inaccurate interpretations: Often, these health screening packages only offer the "test", without an actual doctor to interpret the results correctly, which exacerbates problem one.
- Hole in your pocket: $1,678 is kind of expensive. And that is just the "beginning" - what if you need further tests?
(Also read: Should Everyone Be Tested For Everything?)
Moreover, health screening packages often advocate that “prevention is better than cure.”
Many Singaporeans thus wrongly conclude that regular screening tests can protect them from disease, when in reality screening tests cannot prevent diseases. It merely picks up early stage disease.
Which health screening tests do you really need?
The best person to decide which health screening tests you really need is your family doctor, after a complete physical examination and history taking.
Those $5 health screening packages for people aged over 40 that the government rolled out in recent years? Pretty nifty too, as it includes a doctor consultation, test interpretation, and phone review.
Do consider. Otherwise, in the absence of an initial doctor consultation, here is a breakdown of all the tests and add-ons commonly offered by health screening companies, and a set of general guidelines to follow:
Health screening tests you should do
- Body mass index: Overweight people die earlier, fall down more, and tend to get joint problems.
- Waist-hip ratio: Overweight people die earlier.
- Fasting glucose: It is a good idea to screen for diabetes!
- Blood pressure: Hypertension is a real killer, and very insidious.
- Cholesterol/fasting lipids level: Clogged arteries cause heart attacks and strokes.
The above tests usually all come under a free basic health screening package. Great news for those who are price-sensitive! Flu vaccination is frequently offered as well, and always a good idea.
Women should also add on a PAP smear test every three years.
On top of these investigations, I would probably have my own dad do a Full Blood Count (anaemia check) and Renal Profile (kidney screen). These tests are useful as a "baseline record".
If you have a family history of colorectal cancer, the Faecal Immunochemical Test (FIT) is also useful to check for blood in your stools. Read more about it here.
Health screening tests you do not need
- Imaging tests (eg. X-Ray, ultrasound scans): You should never add-on any type of imaging scans. Leave it to your doctor to decide if you need any of these.
- Tumor markers: A possibly inaccurate screening test - Many patients without cancer may have a positive result, while many patients with cancer will have a normal result.
- Spirometry: Used to check lung function, typically in smokers. Pointless screening test.
- Gout screen: No evidence. If you have gout, you will know it. Trust me.
- Rheumatoid factor: No evidence.
- Hepatitis A, B, C: If you have never had a Hepatitis A/B jab, just go and get it already, why waste time testing? Hepatitis C? No evidence.
- Heart tests (eg. exercise treadmill, cardiac markers, cardiac profile): No evidence.
- Tonometry: Check for glaucoma, an eye condition. No evidence in the absence of a family history.
- Helicobacter pylori: Stomach ulcer-causing bacteria. Not recommended as a screening test.
- Thyroid disorder: No evidence.
- Men's health screening: Check for testosterone levels, no evidence.
Situational health screening tests
Your doctor should really decide whether or not you need the following screening tests:
- STD tests (e.g. syphilis): Tests commonly offered include HIV, syphilis, chlamydia, and gonorrhoea. You will only need these tests if you have engaged in risky behaviour.
- Bone mass densitometry/bone disease: May be useful if you are overweight, frail, or at risk of falls.
- Urinalysis: Urine test that can pick up signs of diabetes and infection, as well as kidney issues.
- HbA1c: Confirmatory test for diabetes.
- Liver profile: Blood test for liver markers, sometimes ordered if you are an alcoholic or take Traditional Chinese Medicine prescriptions and herbs.
- PSA (prostate surface antigens): The usefulness of this test depends on whether you have any urinary symptoms, and only after a physical exam by your doctor.
If I am going to visit a doctor for a proper health screening, what do I need to ask him or her?
Here are some useful questions to ask the doctor at your health screening checkup:
- How likely am I to get the disease at my age?
- How often will I need to have the health screening test done in order to benefit?
- Will detecting the disease earlier benefit my health in the long term?
- Is the screening or confirmatory test associated with any adverse effects?
- How common are false positive test results (false alarms) and false negative test results (undetected disease)?
The answers to these questions will help guide which tests you and your doctor decide to perform.
As always, DoctorxDentist also caters to that small group of super geeky Singaporeans, so for those inclined, here is the full list of screening test recommendations + rationale, published by the Singapore screening test review committee in Feb 2011. Happy reading!