Principles of evidence-based screening
Routine prescription of a complete blood count, urinalysis, stool test, basic metabolic panel, coagulogram, hormone and vitamin panels for asymptomatic patients lacks an evidence base as a universal check-up. This approach enriches insurance companies and laboratories but does not improve patient prognosis. The basis for rational screening is provided by USPSTF (U.S. Preventive Services Task Force) guidelines, which classify interventions by levels of evidence from A (recommended) to D (harmful).
The physician's task is to separate methods with proven benefit from tests that lead to overdiagnosis, false-positive results, and a cascade of unnecessary interventions.
Oncological screening with proven benefit
- Breast: mammography starting at age 40; cervical cytology starting at age 21.
- Colorectal cancer: fecal immunochemical test (FIT) for occult blood and/or colonoscopy at ages 45–75.
- Lung cancer: low-dose chest CT only for patients over 50 with a smoking history of 20 pack-years or more.
- Prostate cancer: PSA in men over 55 is a Grade C recommendation, discussed on an individual basis.
- HPV testing: included in cervical cancer screening (Grade A).
Interventions that cause harm
A number of popular "check-up" methods have proven harm due to overdiagnosis:
- Thyroid ultrasound and palpation in asymptomatic patients leads to the excessive detection of clinically insignificant nodules and unnecessary surgeries.
- Brain CT and MRI aimed at "ruling out a tumor" in asymptomatic individuals—no evidence of mortality reduction, high rate of incidental findings.
- Ovarian ultrasound and the CA-125 tumor marker—high rate of false-positive results, risk of unnecessary laparotomies.
- Pancreatic and liver cancer screening with tumor markers in the general population is ineffective.
Screening for chronic diseases and infections
- Arterial hypertension: blood pressure measurement for everyone starting at age 18.
- Dyslipidemia: lipid profile (total cholesterol, LDL, HDL, triglycerides) for men starting at age 35, women at age 45; earlier if risk factors are present.
- Diabetes mellitus: blood glucose and glycated hemoglobin starting at age 35 with a BMI ≥25 (≥23 for Asians).
- Osteoporosis: densitometry starting at age 65 or earlier if risk factors are present.
- Infections: HIV, hepatitis B and C, syphilis, chlamydia, gonorrhea; latent tuberculosis (tuberculin skin test, preferably T-SPOT) if risk factors are present.
Behavioral and mental health screenings
An often overlooked but evidence-based part of a check-up consists of validated questionnaires for:
- depression;
- anxiety disorders;
- alcohol abuse;
- substance use;
- domestic violence.
These tools are inexpensive, safe, and genuinely influence management tactics.
Expanded panel: neither harmful nor proven
Some tests are included in the Russian health check-up program (disdispanserizatsiya) and belong to Grade C—they do not contradict safety, but offer no significant benefit in asymptomatic patients:
- Complete blood count with differential, ESR; urinalysis.
- Liver and kidney function panels: ALT, AST, GGT, bilirubin, alkaline phosphatase, creatinine with estimated GFR, urea, total protein.
- CRP, uric acid.
- TSH is acceptable as an isolated marker of thyroid function (unlike ultrasound).
- Resting ECG—every 3 years for ages 18–39, annually after age 40.
Mass prescribing of trace elements (sodium, potassium, calcium), vitamin D, B12, ferritin, sex hormones, and insulin in asymptomatic patients is unjustified: parameters are labile, interpretation is difficult, and treatment decisions are rarely altered.
Tumor markers and coagulogram
Tumor markers (except for PSA in the designated age group) should not be used for screening: CA-125, CA-19-9, CA-15-3, and CEA in asymptomatic patients yield an unacceptable rate of false-positive results and provoke invasive follow-up testing.
Routine coagulogram (aPTT, INR, prothrombin time, fibrinogen, D-dimer, antithrombin III) is not indicated for asymptomatic patients; it is prescribed only for clinical indications or before surgical interventions.
Key points
- Routine "full check-up" for asymptomatic patients lacks an evidence base.
- The basis of screening is USPSTF guidelines with the categorization of methods into Grades A–D.
- Proven benefits include: mammography, cervical cytology, fecal occult blood test, low-dose chest CT in smokers, and monitoring of BP, lipids, and glucose.
- Thyroid and ovarian ultrasound, brain CT/MRI, and tumor markers in asymptomatic patients do more harm than good.
- Behavioral screenings (depression, anxiety, alcohol, substance use, violence) are underutilized and should be performed routinely.
- Vitamin D, ferritin, sex hormones, and trace elements are not screening tools.
- Before an extended examination, the patient should be informed of the lack of proven benefit.