Expensive “health MoT tests” aimed at the worried well are medically
misleading and can even be dangerous, a report by senior doctors and
scientists has found.
Healthy people have nothing to gain from spending hundreds of pounds on blood
tests and scans that purport to give an early warning of medical problems
such as heart disease or cancer, the experts said.
The report, from the Royal College of Pathologists and three other respected
medical and scientific groups, said that while many tests included in
commercial “well-man” and “well-woman” services have great diagnostic value
for people with symptoms, they are clinically irrelevant for those who are
well. The results often cause needless concern or false reassurance, and can
lead to unnecessary procedures that can be invasive, painful and risky.
Some of the tests are also harmful in themselves. Computerised tomography (CT)
scans involve exposure to radiation, and cause a fatal cancer in one in
every 2,000 people. One in 1,000 colonoscopies leads to a perforated bowel.
Such risks are justified if there is good reason to suspect illness, but not
for people who are apparently well, the expert panel said. It expressed
particular concern about full-body magnetic resonance imaging (MRI) and CT
scans, which often detect slight variations from the norm in healthy people.
These would probably never have caused disease, but require investigations
and raise anxiety.
Private medical screening is a multimillion-pound industry, with dozens of
companies advertising scans and tests that they claim can detect diseases
before too much damage is done.
The private health insurer BUPA performs 100,000 health assessments each year,
offering a basic package that costs £430 for men and £460 for women, and
which includes either 36 or 37 tests depending on age or sex.
Preventicum, a London clinic, offers an “ultimate check-up” for £2,950, which
includes MRI and ultrasound scans as well as more than 40 blood and urine
tests.
Home-testing kits are available for cholesterol, blood sugar, liver function
and other biological markers of disease. The value of the market has been
estimated at £99 million a year by the analyst Mintel.
The panel of GPs, medical scientists and patient representatives who compiled
the report found little evidence that such services are of clinical value to
healthy people. “For people without symptoms, there are only a small number
of screening tests that are worthwhile,” it said. “Furthermore, testing the
‘worried well’ has definite potential for harm.”
The document, published today by the charity Sense About Science with the
Royal College of Pathologists, the Association of Clinical Biochemistry, and
the Population Health and Genomics Foundation (PHGF), also said the sector
was inadequately regulated.
“With direct-to-consumer tests, anyone can set up a lab and sell testing. The
test must measure what it says it will measure, but there’s absolutely no
requirement for them to show the value of that test.”
Test providers said their services did not rely on single indicators and were
interpreted by fully-qualified doctors. Garry Savin, medical director of
Preventicum, said: “There is no doubt that over-the-counter DIY tests, which
are unregulated, can often do more harm than good. However, there is no
indication that undergoing health screening at a recognised clinic, overseen
by an experienced healthcare professional who can accurately evaluate any
results, poses any threat to the patient.”
Andrew Vallance, medical director of BUPA, said he shared the report’s
concerns about home-testing kits and full-body scans, but said that there
were great advantages to diagnosing diseases early.
“We insist that a doctor is part of the process, and because there is the
issue with false positives and negatives we don’t do full-body scans or
tests that have been poorly evaluated. By and large this is about motivating
people to improve their lifestyle.”
Andrew Green, a GP on the Sense About Science panel, said: “Nobody should
arrange their own medical tests. If you don’t have symptoms, then very few
tests are worthwhile, and those that are can be had through your doctor.”
Checks and balances
Full-body CT scan
Pro can detect tumours or heart disease before symptoms become obvious
Con danger of false positives: often reveals slight abnormalities that
would not have caused disease, but which require further investigation.
Involves radiation exposure, with a 1-in-2,000 risk of causing cancer
MRI scan
Pro can detect tumours or heart disease before symptoms become obvious;
no radiation exposure involved
Con danger of false positives: often reveals slight abnormalities that
would not have caused disease, but which require further investigation; very
expensive, at around £2,000
Prostate specific antigen test
Pro bio-marker that is sometimes raised among men with prostate cancer,
and can give an early warning of the disease
Con very high false positive rate: many men with raised PSA levels do
not have prostate cancer. Results must be confirmed by biopsy, which can
cause infection, impotence and incontinence. Most men who have prostate
cancer die with it, not of it
Liver function test
Pro finger-prick blood test, easily available via the internet for
about £150
Con can be difficult to perform: squeezing out blood can dilute the
sample, raising risk of false negative; NHS will perform it within 20
minutes to 24 hours if urgent; DIY tests take two to ten days. Some tests
include just two bio-markers; NHS tests for five
Cholesterol test
Pro blood test that examines levels of LDL or “bad” cholesterol, linked
to hypertension and heart disease. It can be clinically valuable to know
cholesterol level is high if otherwise at risk of heart disease, as it can
be lowered with drugs or lifestyle changes
Con tests are already routinely available through GPs for people at
risk of heart disease
Source: Sense About Science, Times database
Health checks are a sensible thing for anyone to do, in consultation with ones GP, who can advise on the persons specifics risks, taking account of family history and a persons own medical past. Random hinvestigations are of no use at all, often causing unneccessary concern. Many prevention investigations are already available on the NHS and their is no need for people spending hughe amounts of money.
dr s scheuner, glos, uk
Mark Henderson would appear to be following the government party line on PSA testing. It only costs about £7 on the NHS and £12 to £15 privately (costs given me by Urologists and surgeons). It does have a significant false positive but if taken on a regular annual basis can give early warning of an aggressive prostate cancer. Perhaps he is happy with the final option provided by our lady Minister of Health, i.e. castration (NICE Guideline 58, Feb 2008).
I was lucky. My doctor gave me a PSA test at my request and as a result I have had the cancer removed, hopefully in time.
Brian Smart, Taunton, Somerset
It is worrying that there is no system to assess whether DIY tests available over the counter actually work. People are not qualified to fully understand the results of such tests and more information needs to be available to help them. Without a doctor’s input, many people could miss a vital sign which might adversely affect their health or worry unnecessarily about a false positive result.
Of particular concern is the raft of DIY genetic screening tests which are on the market, a number of which claim to be able to identify people’s inherited risk of disease with a saliva or blood test. Without considering environmental and lifestyle factors, these tests can create unnecessary anxiety or inaccurate reassurance. Before this trickle of products becomes a flood, we must have a robust system of regulation in place so that people fully understand what they’re getting into before they part with their money.
Dr Andrew Vallance-Owen, Bupa, London,
The conclusion of these senior doctors and scientists is so typical of the medical profession in this country and the British institutional attitude to risk in general which prefers to go for cure rather than prevention.
You go to places like France, Germany and Russia and they take the opposite approach which involves regular check ups and other measures. The only time I ever get invited for a checkup by my NHS GP is when I move surgery.
I had yearly checkups through my employer and thanks to the doctor I saw, I learned that my level of bad cholesterol had gone up. He advised me on what I should do to correct it. Without his advice left to the NHS I would have been none the wiser. I would then only find out that I had a problem after a serious disease condition had developed by which time permanent damage may have occurred.
Similarly my father only knew he had cancer just before he died. A proper checkup once a year may have detected it in the early stages and saved his life.
Ben, London, UK
I wish I'd known about BUPA's heart scan before my husband died, aged 43, of a heart attack - apparently symptom-free
C Ralph, London,
there is nothing wrong with people taking responsibility for their own health. prevention is better than cure, and hopefully these tests - BUPA particularly will save and prolong life.
jane Gould, ShaftesburY, England
The MOT Test is a vehicle check that is compulsory for all vehicles (including cars and motorbikes) that are over 3 years old and registered in the United Kingdom.
MOT stands for Ministry of Transport.
It is sometimes used, as in this case, to mean a series of health checks.
Ruth, Warks,
MoT stands for "Ministry of Transport" - an MoT (or MoT test) is, in essence, a roadworthiness test, which your car is required to pass once it reaches a certain age. It's often used as shorthand for a general well-being test of any description.
Sarah, London,
People should have the right to access tests. What better way of taking your health into your own hands ? The idea doctors care about you is nonsense. They are concerned about their status and income. Most people won't ever get access to tests unless acutely ill or too late or obvious. But you can take a paracetamol overdose whenever you want. I thought Brown was bringing in screening because of it's success ? How did they discover Blair and Clintons heart conditions ?
Percy J, Bristol,
What does MoT stand for? How can a term that is used so frequently be so difficult to find on the internet?
Gordon Ashe, Toronto, Canada
Another "popular" scan is the PET scan. Positron emission tomography. Your article should deal with this as well.
Gordon Ashe, Toronto, Canada