Main examinations for disease screening

High-risk factors and potential complications related to early cancer and precancerous lesions, chronic diseases, and high-incidence infectious/regional-specific diseases. I have worked in a public physical examination center for 8 years, and I have seen too many people choose blindly from the project list, either spending money to add a bunch of useless high-end projects, or missing high-risk must-check items, which just happens to be useful information.

Last month, I met a 42-year-old freight driver who had smoked for 20 years. He only dared to take chest X-rays for physical examinations every year because he was afraid of radiation from CT. This year, I spent ten minutes persuading him to get a low-dose CT for 199 yuan. The result was an 8mm mixed ground-glass nodule, which was pathologically diagnosed as early-stage lung adenocarcinoma. He could go to bed the next day after the operation, and he didn’t even need to undergo chemotherapy. I have to mention that there is a lot of quarrel on the Internet right now. One group says that "chest X-rays are completely useless to detect lung cancer and a waste of money." Another group of grassroots public health doctors feel that in many counties where the per capita physical examination budget is less than 200 yuan, chest X-rays are still the most cost-effective way to screen out mid- and late-stage lung cancer. , in fact, both sides are right. In the final analysis, it still depends on your own budget and risk level - if you have smoked for more than 10 years and have a family history of lung cancer, don't hesitate and go directly to low-dose CT. If you are in your twenties and do not smoke and have no family history, you really can't afford to do CT every year and take radiation.

Many people are preoccupied with “cancer screening” when doing screenings, but they ignore the chronic disease-related projects that account for the highest proportion and benefit the most from ordinary people. Instead, they suffer a loss. Last week, a 28-year-old Internet operator came for a physical examination. He was 180 pounds fat. He stayed up late and drank milk tea every day. He had never had a serious physical examination before. His fasting blood sugar was 6.8, and his glycated hemoglobin had reached the critical value. He would develop type 2 diabetes in a year or two, and he would have to take medicine for the rest of his life. This is also controversial now. Many nutrition doctors advocate lowering the screening age for hypertension and diabetes to 20 years old. After all, the living habits of young people nowadays are too poor, and a lot of people in their twenties suffer from gout and hypertension. However, there are also experts in evidence-based medicine who object, saying that this will lead to over-medication. Many young people with high indicators just stay up late and drink alcohol, and then go back after two weeks of adjustment. There is no need to order a bunch of tests right away. The current practice in the industry is also very compromise: if the index is found to be abnormal for the first time, you will be asked to go back and adjust your work, rest and diet first, and then re-examine half a month later. Only if the index is still high will follow-up intervention be carried out. This will neither miss the diagnosis nor make a fuss.

In addition to these general items, people from different regions and with different living habits must also undergo targeted screening for infectious and endemic diseases, which many assembly-line physical examination packages do not take into account at all. Two years ago, I went to Qinghai to support public health for half a year. The routine screening there will definitely include osteoarthritis and hydatid disease. If you live on the eastern coast, you will never encounter these diseases in your life. It is a waste of money to check. ； But on the other hand, raw pickled seafood is often eaten in coastal areas, so screening for hepatitis A antibodies and blood uric acid must be arranged. For friends in Guangdong and Guangxi, it is best to get EB virus antibody screening every year, which can detect nasopharyngeal cancer early. If you live in a dry area in the north, there is no need to spend this money.

People often ask me, is the more expensive the screening, the better? I laugh every time. A young man whose family runs a business came here and asked for a package of PET-CT and full genetic testing, which cost less than 20,000 yuan in total. I directly persuaded him to go back. You are only 29 years old, have no family history of cancer, and do not have any uncomfortable symptoms. The radiation dose of PET-CT is equivalent to 20 chest X-rays. You are more likely to be harmed by this radiation than you are to detect problems. As for those genetic tests that cost thousands of dollars, except for BRCA, which corresponds to breast cancer and has clear clinical guidance, other test results are "your risk of contracting a certain disease is 10% higher than ordinary people." There is no actual guidance, and it is purely an IQ tax.

To put it bluntly, disease screening is like an annual mine clearance for the body. It is not about digging out all the mines, big and small. The focus is on those problems that can be fatal if missed, and can be completely cured if detected early. There is really no need to follow the "National General Screening List" on the Internet. Before going for a physical examination, spend two minutes thinking about your bad habits and the genetic diseases of your family elders. Ask your doctor for his opinion. The selected items will be the most suitable for you.