Medical check-ups have a clear purpose: doctors examine whether a patient is healthy. Medical examinations are also undergone by people who believe they are ill. If signs of disease are found, treatment is prescribed. To gain the greatest benefit from check-ups, most of the population is examined systematically. That is the ideal scenario.

The ideal scenario, however, is far from universal. Check-ups are marked by confusion and uncertainty, and recommendations are often not followed.

This happens partly because vested interests play a role. Take prostate cancer: the independent expert panel of the Swiss Medical Board rejected the so-called PSA test for the early detection of cancer in men without symptoms or risk factors. The test proved unsuitable partly because, despite PSA testing, a number of tumours requiring treatment still went undetected.

The Swiss Society of Urology, on the other hand, carries out its own tests – as part of individual cancer screening rather than “uncritical mass screening”. This is hardly surprising. Critics argue that urologists and laboratories earn money from these tests.

When “overdiagnosis” throws you off balance

Useful or harmful? This is an important question for the epidemiologist Johann G. Schmidt. For him it is clear that the harm caused by a fast but poor-quality test can outweigh the advantage of speed – particularly when it comes to “overdiagnosis”, where a frightened patient undergoes examinations and unnecessary interventions. According to Schmidt, one must always bear in mind that all tests, whether imaging or tissue analyses, can be wrong.

What happens without check-ups

Without systematic check-ups, people live on carefree and untroubled for a while, already carrying a disease. According to Schmidt, something is wrong in medicine if patients without complaints are not examined. The fact is: “Pathological changes can occur in anyone.” The possibility of developing prostate cancer, for example, exists in most men.

According to various studies, this disease can arise of its own accord in one in three or four men over 50. For those over 80, the likelihood is much higher. But 85 per cent “die with cancer, not of cancer”, says the German psychologist Gerd Gigerenzer. Nevertheless, many people are willing to undergo medical examinations, even though the procedure carries risks and can even lead to impotence or urinary incontinence.

What is the real benefit of screening? Dr. Schmidt shared data from two controlled groups of study participants. The comparisons repeatedly showed that cancer mortality falls only minimally. As for mammography, detecting cancer at an early stage in women is a matter of great luck – the chance is roughly 1 in 1,000.

So is it all useless? “No. But we should not apply every examination indiscriminately to thousands of healthy people,” says Marcel Zwahlen, a doctor of preventive medicine. He advocates a national, independent body that would review studies and issue binding recommendations on which tests should be performed.

For cervical cancer: on the one hand, many women are tested too often – routine business for gynaecologists, and hardly anyone has an interest in breaking this vicious circle. On the other hand, there are women who do not know about testing: foreign nationals and those aged 45 and over. For Marcel Zwahlen it is simply incredible that the list of examinations and tests keeps growing while entire groups of the population are never tested. Half of the women who develop cervical cancer have never been screened.

The following check-ups are recommended

Blood pressure measurement: men and women from the age of 20, every three to five years.

Cholesterol measurement: men aged 35 to 65 and women aged 45 to 65, every five years. In patients with risk factors for cardiovascular disease, after diagnosis.

Diabetes screening: men and women from the age of 45, every three years – especially when risk factors are present, such as high blood pressure, obesity, a family history of type 2 diabetes, or diabetes during pregnancy.

Glaucoma screening: men and women over 50, every two to three years. From 40 for patients at risk (family history of glaucoma, obesity, high blood pressure, severe short-sightedness, long-term steroid treatment).

Smear test (PAP): sexually active women from the age of 20. A second smear after one year, then every three years. After 65, only if the risk is high.

Colonoscopy: men and women over 50, every ten years up to the age of 70; for patients at risk (family history of colon cancer, chronic inflammatory bowel disease, colon polyps), every five years, as agreed with the doctor.

These check-ups are disputed

Mammography (breast cancer): for women without any risk factors, there are no general screening recommendations. For women over 40 with risk factors (family history), every two years.

PSA test (prostate): no recommendations for men without risk factors. For men with a family history (a first-degree relative diagnosed with prostate cancer under the age of 65, or two or more first-degree relatives regardless of age): testing from the age of 50, or ten years before the age at which the relative was diagnosed.

Colon (occult blood): a screening test for bowel cancer; a positive result is followed up with a colonoscopy.

These check-ups are unnecessary

When risk factors and symptoms are absent, the following medical examinations are not required:

Chest X-ray
Lung function test
Urine analysis
Tumour marker tests
ECG and exercise ECG
Abdominal ultrasound