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Taking care of your health in advance is simple, but the main thing is to build the right algorithm of actions and not succumb to the tricks of clinics who want to earn money
In May 2022, VTsIOM published data from a study conducted for the IV International Congress “Health age. Active longevity”: most of our countries visit doctors only when something hurts, and only 14% go to regular medical examinations. At the same time, we often hear that many diseases can be prevented, the main thing is to take care of yourself in time. Trends figured out how medical checkups help with this.
Check-up as part of the medicine of the future
Checkup (from the English check up “to check”) is a comprehensive preventive examination of apparently healthy people who are not bothered by anything, in order to assess the state of the body.
The idea of catching a disease before the first symptoms appear is not new. But only in the XX century there are scientific data in the field of preventive medicine. Thus, the famous Framingham Study (still ongoing) dedicated to cardiovascular health began in 1948 largely thanks to US President Franklin Roosevelt. More precisely, his sad experience. Roosevelt died in 1945 of a cerebral hemorrhage at the age of 63, sharing the fate of most of his compatriots. The next US President, Harry Truman, realized that it was impossible to delay and obtained the consent of Congress to fund the study.
Today we already know a lot about risk factors and how to prevent or at least delay heart and vascular disease. However, according to the WHO, they still occupy the first place in the list of leading causes of death among the adult population.
In the coming decades, scientists are sure, medicine will change its vector – from a reactive one it will turn into a proactive discipline. This, in particular, is evidenced by the concept of 4P-medicine (from the English. predictive, preventive, personalized, participatory): predictive, preventive, personalized and participatory, when the patient becomes an equal partner of the doctor. The main task of the medicine of the future is to learn how to prevent diseases, taking into account the individual characteristics of each person. In our country, the concept was approved in 2018.
Check-up, screening and clinical examination: what are the differences
Clinical examination – the state program of preventive examination of certain groups of the population to assess the state of health, is carried out in polyclinics under the compulsory medical insurance policy. In fact, this is a free checkup, but with a regulated set of analyzes – that is, it is difficult to call it personalized. However, thanks to medical examinations, according to the Ministry of Health, in 2018 alone, malignant neoplasms were detected in 199 people.
As part of the medical examination, you can undergo examinations that are carried out up to 40 years once every three years, and after 40 – annually.
- Under 40 years old:
- blood test for cholesterol and glucose,
- fluorography,
- ECG,
- examination by a gynecologist and Pap test for women.
- After 40 years:
- add a complete blood count,
- examination of feces for occult blood,
- mammography for women.
- After 45 years:
- added gastroscopy,
- analysis for prostate-specific antigen for men.
Since June 18, 2021, a resolution on in-depth medical examination for those who have recovered from COVID-19 has been in force. If the doctor considers it necessary, he will write out a referral for an ultrasound of the heart, a CT scan of the lungs, and a Doppler study of the blood vessels of the lower extremities. Last year, 2 million of our countries underwent in-depth medical examinations, ₽5,68 billion were allocated from the budget for examinations.
At the same time, as opinion polls show, more than 45% of our countries consider medical examinations inappropriate and ineffective.
Screening – a study that is carried out not to assess the state of the body in general, but to identify a specific disease in an outwardly healthy person or to determine risk factors. For example, this is how the PAP test, which became widespread back in the 1930s and 1940s, works – a smear from the cervix to determine malignant tumors.
According to WHO, today in the world one in six people die from cancer: breast (2,26 million cases), lung (2,21 million cases), colon and rectum (1,93 million cases). Therefore, screenings are more relevant than ever.
No time and money: why our country does not go to medical examinations
It seems obvious that it is necessary to take care of your health in advance, but in fact, people are in no hurry to undergo medical examinations. A joint study of the Dobro.Mail.ru service and the ReserchMe agency showed that most of the 2 respondents in different cities of our country do not trust doctors (24%), one in five (20%) do not have money for visits, and almost the same number ( 18%) are sure that checkups are carried out for show.
17% of respondents indicated that they do not have time for preventive examinations. However, according to experts, often there is another problem behind this, such as the fear of appearing weak or anxious avoidance.
“People are afraid that they will be diagnosed with a serious disease. They understand that they will have to go to the doctors for a long time, to be treated, to take pills. They will become addicted, the usual life will end. Therefore, many do not think about it at all. It’s like with a car: I’d rather drive a beautiful Ferrari for a short time than drag myself around in a tarantay for many years, ”says Daniyal Ibragimov, a psychiatrist, Ph.D., founder of the Elementarno consultative and psychological center.
Director of VK social projects, head of the Dobro Mail.ru service and author of the “We Need to Talk” project dedicated to check-ups, Alexandra Babkina is sure that it is possible to fight a reactive attitude to health with the help of education: “Most often we are faced with already existing stories where donations so that the person can recover or undergo rehabilitation. It was important for us to understand why, despite the large number of offers to go through a free check-up, for example, in pavilions in Moscow parks, people who discovered the disease too late still apply to the foundations. It seems that honest conversations about the problem, an attempt to understand the causes of its occurrence, as well as real stories of people – this is exactly what can motivate you to pay more attention to your health. In some cases, a timely check-up would help to detect the disease at an early stage and then the treatment would not be so difficult for the patient and for his family.”
How to know what to check
If a person nevertheless decides that it is time for him to be examined, the doors of various clinics and laboratories are open for him. Today you can choose a check-up for every taste and budget: a full comprehensive examination, “for office employees”, “for those over 40”, “women’s issue”, “everything is under control” or according to the profile – “healthy back”, “healthy heart” and so on.
It is difficult for the layman to figure out what tests to take in order to assess the state of his body. That is why you need to consult a specialist who will compile a list of necessary studies.
For someone, a general examination by a therapist (family doctor), fluorography, ECG and a basic set of blood tests – for sugar, cholesterol and glucose – is enough. And for another, an extended examination is suitable, especially if there is a predisposition to specific diseases.
“If a person is 18-24 years old, the risk of stroke is very low. They happen, but most often it’s genetics, he may not suspect anything. But if there have been cases of early heart attacks or strokes in the family, you should consult a doctor. If there were no such stories, examinations at the transition from the pediatric group and before the university are sufficient. But after 40 years, we prescribe additional examinations to all patients, even if there are no complaints, ”says Natalya Koryavtseva, expert of the ORBI Foundation.
The older we get, the higher the risk of cancer. Surgeon-oncologist Olga Lopushanskaya explains: “The main age for the development of lung cancer is 55 years, breast cancer is 40 years, colorectal tumors is 50-60 years.”
But it doesn’t make sense to check everything in a row – there is no one right check for everyone, says Alexey Paramonov, a therapist, gastroenterologist, general director of the Rassvet clinic. For example, a 60-year-old fit man without bad habits, leading an active lifestyle, will give odds to a 35-year-old obese smoker whose close relative recently died of cancer.
“At the same time, there are recommendations from various associations of doctors, for example, European and American oncologists, cardiologists, which allow us to form a conditional basic checkup. The main task of a preventive examination is to influence the duration and quality of a person’s life,” continues Paramonov.
Help in choosing studies in terms of evidence-based medicine can, for example, and the service “Humanchek”. The service algorithms select a diagnostic program for free based on the analysis of the patient’s profile, which indicates his gender, age, habits and complaints.
Can a checkup hurt
Of course, unnecessary examinations can cause psychological harm and empty the wallet. For example, for a healthy person, there is no need to take tumor markers. There are too many types of cancer and each has its own set, in addition, increased rates do not always indicate the presence of the disease. And the scary pictures in my head sometimes lead to depression.
“It is an absolute axiom: tumor markers are not a method for diagnosing oncological diseases in conditionally healthy people – this is a waste of time and money. Their indicators are important when a person already has an oncological diagnosis in order to track the effectiveness of treatment or the likelihood of relapse, ”says Lopushanskaya.
You should also be wary if you are offered to undergo an ultrasound of all organs or an MRI / CT scan of the whole body. This is fraught with overdiagnosis, when the information received has no clinical significance. And in the case of CT or PET / CT – also an additional radiation load on the body.
“Let’s take ultrasound of the abdominal organs as an example. It rarely does any good unless the person has any complaints. Of course, there are cases when a pancreatic cyst is detected, which is a harbinger of cancer. But the likelihood of such a scenario is very low. As a rule, small changes in the organs are not life-threatening and do not affect the further tactics of the patient. Therefore, ultrasound is not included in the preventive (screening) programs recommended in most countries of the world. But here in some clinic you will definitely be offered to undergo it for money, ”says Alexei Paramonov, a therapist, gastroenterologist, general director of the Rassvet clinic.
Unreasonable frequent endoscopic examinations of people under 45 years of age are also a dubious exercise, as are studies of the level of antibodies to Epstein-Barr viruses, herpes simplex or cytomegalovirus. These viruses are common in the population and the very fact of their discovery is of no clinical benefit.
“There are medical studies that should be carried out only according to indications. We must always understand what we are looking for and how to work with the results of the survey. So, after suffering COVID-19, for some reason, many people do a CT scan of the lungs without a doctor’s prescription. But the x-ray picture is often late from the clinical picture – changes are still visible in the pictures, and the condition has returned to normal. And the patient does not know what to do with this “find”. He is usually referred to a local polyclinic and given antibiotic treatment (although this is often not required). At the same time, we are already observing antibiotic resistance of some bacterial strains. It is not difficult to assume that in the near future this problem will only intensify,” Lopushanskaya notes.
My health is my responsibility
Before undergoing an examination, it is worth spending time and finding a competent doctor who will write out the correct check-up program, and then interpret the results of the studies and tell you what to do next. This may be a therapist in a regular clinic or a family doctor in a paid medical center. The main thing is his professionalism and desire to help you.
“Without a medical education, it is difficult to understand whether a good specialist is in front of you. If you are afraid of terrible diagnoses, incurability and imminent death, you should think about it. Ask clarifying questions. So you check whether the doctor is scaring you in vain because of his own incompetence or simply exacerbates the problem in order to convince you to be treated,” says Anastasia Degteva, obstetrician-gynecologist, expert of the Light in Hands Foundation, “I also recommend changing the doctor if you are condemned for not giving birth by the age of 20, or for having irregular periods because you are not sexually active.”
What else can you do?
- Gather a history of family illnesses, such as asking parents and grandparents about their illnesses. So it will be clear which organs and systems should pay special attention to.
- Give up bad habits, start exercising and adjust your weight. According to scientists, sometimes it works no worse than preventive examinations.
- Get free check-ups as part of campaigns dedicated to World Diabetes, HIV, Hepatitis, Oncology or Cardiovascular Diseases Day.
- Experts advise paying attention to your body in order to notice the changes taking place in time. For example, to study moles, as well as conduct self-examination of the mammary glands (for women) and genitals (for men).
- Raise the level of your medical literacy: study the principles of evidence-based medicine, listen to lectures by science popularizers, doctors, and also look for reliable information about common diseases. For example, the “We Need to Talk” project talks in detail about breast cancer.
There are no examinations, be it an extended check-up or medical examination, which would 100% exclude the likelihood of a rapid development of a particular disease. However, annual planned studies are certainly one of the main tools for health and longevity.
“We cannot protect a person from everything. At the same time, scientific data around the world allow us with a high degree of probability to prevent or control such dangerous diseases as cervical cancer, colon cancer, breast cancer, in certain circumstances, stomach and prostate cancer, as well as vascular accidents. It is always worth remembering this, ”says Paramonov.