Testing, Testing

5 minute read

We have become obsessed with health, a global pandemic will do that to you I guess. We’re now sharing our favourite brand of Vitamin D with friends, the way we used to recommend a new bar. People with kids in school have WhatsApp groups dedicated to the latest bugs instead of playdates, and every woman over 40 seems to be charting their perimenopausal symptoms.

It’s a good thing. It’s time we all took control of our health and were more aware of what was going on in our bodies. But it seems there’s a fine line between having all the information and becoming obsessed.

There are things that we should be doing regularly. We should be keeping up to date with any screening programmes that we qualify for including Cervical Check, Breast Check, and Bowel Screen.

We should be checking our breasts monthly, keeping an eye on moles, being aware of changes in our menstrual cycle, having an eye test every two years (more if you wear glasses or have any eye issues) and going to the dentist at least once a year (more often if you have any existing complaints). Women in menopause should also think about their bone health.

It’s a lot to keep on top of, isn’t it? But to add to that list is the growing industry around full health NCTs. Some health care providers have always included these full screens that you can have done every two years and are made up of things like a panel of bloods, a stool sample, a cardio check, lung function tests and more. I had one myself about four years ago. I loved it. I got to sit in an unused office with a doctor I didn’t know for 20 minutes and do every test imaginable. I wore my excellent results as a badge of honour. Had it not been included on my corporate health insurance it would have cost me around €600.

But it turns out not knowing that doctor is key. There are a lot of conflicting opinions out there about these general health screens. On the surface, it boils down to people wanting them and doctors think they’re a waste of time. The arguments for them are strong. What if it picks up something that you had no idea was going on? Surely forewarned is forearmed?

It can feel like GPs are very dismissive of these private companies offering the tests, so I asked them why.

One doctor I spoke to explained her misgivings. “I remember only one significant pick up from these screens. For the most part, I feel they are money-grabbing. I noticed that one of the covid testing companies is offering a service of a very extensive panel of blood tests for an extortionate cost, and in my view, they aren't clinically indicated unless someone has symptoms. It's all very interesting and a complex topic. Screening particular at-risk populations is very beneficial in certain circumstances (breast cancer, aneurysms, conditions where people have a strong family history).

“However, in many cases, when you undertake these tests without a formal referral from a medical professional, the indication, and thus the result is dubious and difficult to interpret. A simple, and common example is testing men for PSA (a biomarker for prostate cancer). The test result can be influenced by many variables, and when carried out in isolation, it can be elevated. Without the clinical history to go behind it, patients all need to be assessed clinically by a urology specialist. And a lot of them need to then undergo invasive biopsies that have significant complication profile.”

So, it’s not as straightforward as we think. Another doctor I spoke to, Dr Sinead Cronin, a GP in Drumcondra had other reservations about their helpfulness.

“It’s a tricky one. The tests are very attractive to patients who lead busy lives – they see them as a one-stop shop. But often patients are unaware of what these NCTs test for. They can assume they are testing for more than they actually are and so there is a false sense of security there. There can be a reluctance to then go to a doctor about something that occurs after the NCT because they might assume that the issue was looked at during the NCT. These types of screening tests are also only a snapshot in time, so their predictive ability is often poor and in my experience, that's something patients have little understanding of. So essentially, they’re grand if you understand the limitations of the tests you're getting done and if you accept that it's a snapshot in time of your health in that moment.”

When it’s explained like that it makes sense that you’re better off going to your own doctor, who knows you and your history, with your concerns and asking for the tests that they would suggest and would put your mind at ease.

But even with all of that, it feels like the HSE might be missing a trick here. In the UK the NHS offers a health check every five years to everyone between 40 and 74. They specifically look for early signs of diabetes, dementia, heart and kidney disease and stroke. One in 27 of the 1.5million adults who have opted for this health check were found to have undiagnosed high blood pressure.

In Ireland, according to the Irish Heart Foundation, over half of all adults over 45 have high blood pressure. About four in every five men and two in every three women with high blood pressure are not being treated. The higher your blood pressure, the greater your risk of heart attack or stroke, heart failure, kidney failure, and poor circulation in your legs. Almost 9,000 people die each year, making heart disease and stroke one of the nation’s biggest killers.

Surely then, general health checks, like the one available in the UK would save lives and ease pressure on the health system?

The answer, for now, seems to be that in 2022 we should all become our own health advocates. See your GP, ask for the tests you want, check your breasts, your skin, your cholesterol and your mental health, and take control of your wellbeing.

As with everything in life, there’s an app to help. There are lots of really great health trackers like Symple that can help you diary symptoms, set to remind you to do physical checks and take information from your smartwatch.

I was considering a private booking in for a private screening but I’m going to see my GP first and arrive armed with my list of questions. I might need to book a double appointment.

Jennifer Stevens, November 2021