It's a common scenario in Singapore - your dad or mom receives a letter offering free "basic" health screening services, usually in the form of a tie-up with the company where he or she's working at.
So when my dad asked me last night:
What are the essential tests I should go for?
I had a glance through of what was on offer: 5 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'm sure many of the older folks would be inclined to, it'd cost you a whopping $1678.
Given the huge amount of local searches for "health screening Singapore" every month, I decided to write this post to tell you exactly what tests you need, and which you do not.
1. What's the catch with "free" health screening?
Much as Singaporeans love the word "free", we've also wisened up to the fact that there's usually a catch somewhere in there, right?
Here's 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 on radio that Dorra Slimming is offering you a free 30 minute spa package?
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, it's a beauty spa in Singapore. You know how that works.
Similarly, health screening companies commonly earn by:
- Charging you for all the additional and unnecessary tests - it's 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.
2. What's the issue 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 don't 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 1.
- Hole in your pocket: $1678 is kinda expensive. And that's 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.
3. 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 aged > 40 that the government rolled out in September this year? Pretty nifty too, as it includes a doctor consult, test interpretation and phone review.
Do consider. Otherwise, IN THE ABSENCE OF AN INITIAL DOCTOR CONSULT, here's 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: Fat people die earlier, fall down more, and tend to get joint problems.
- Waist hip ratio: Fat people die earlier.
- Fasting glucose: WAR ON 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 the free BASIC health screening package. Great news for all you cheapos! :-) Flu vaccination is frequently offered as well, and always a good idea.
Females should also add on a 3-yearly pap smear test.
On top of these investigations, I'd 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, although admittedly kinda icky for most patients to "perform" and collect.
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 really crap 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've got gout, you'll know it. Trust me.
- Rheumatoid factor: No evidence.
- Hepatitis A, B, C: If you've 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 absence of family history.
- Helicobacter pylori: Stomach ulcer-causing bacteria. Not recommended as a screening test.
- Thyroid disorder: No evidence.
- Men screen: 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 (eg. syphilis): Tests commonly offered include HIV, syphilis, chlamydia and gonorrhoea. You'll only need these tests if you've 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're an alcoholic or take TCM.
- PSA (prostate surface antigens): Usefulness of test depends on whether you've got any urinary symptoms, and only after a physical exam by your doctor.
4. Ok, fine. You've convinced me to visit a doctor for a proper health screening. What do I need to ask him?
Here are some useful questions to ask the doctor at your health screening check up:
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, DxD also caters to that small group of super geeky Singaporeans, so for those inclined, here's the full list of screening test recommendations + rationale (64 pages in all it's glory), published by the Singapore screening test review committee in Feb 2011. Enjoy :-)