The relationship between disease screening and physical examination

Routine health check-ups are broad-spectrum basic health inspections, while disease screening is a precise screening for specific high-risk groups and specific diseases. The two are complementary rather than substitutes for each other. There is no absolute saying that "if you do one, you don't need to do the other."

Last year, when I accompanied my elders to the physical examination center to get the report, I met a 36-year-old young man who worked in Internet operations. All the indicators in the annual physical examination were green, and he didn't even have mild fatty liver. I was about to leave happily, but the doctor who treated me stopped him and said - "Do you smoke two packs of cigarettes a day? Did your dad die of lung cancer before? No appointment for low-dose spiral CT this year? Don’t save a few hundred dollars and add a lung cancer screening option. ”The results showed that there was a 6mm ground glass nodule in the right lung. Further biopsy revealed carcinoma in situ. After the operation, there was no need for chemotherapy. Now I have returned to work.

In fact, to use an inappropriate analogy, a routine physical examination is like the basic annual inspection you do for your car every year. Checking the brakes, tire pressure, engine oil, and lights can identify most common minor problems, such as filling in air when the tire pressure is low, and changing the engine oil when it is running out. It can solve 90% of daily problems. But if your car runs on mountain roads every day, and the engine keeps making noises, the regular annual inspection will definitely not be able to find the root cause. You will have to do special engine tests, which corresponds to disease screening - focus on the places where you are most likely to have problems, and conduct in-depth checks, without making meaningless attempts to cast a wide net.

Interestingly, in the medical circle, there have always been different voices regarding the boundary between the two. Scholars in the field of public health are more inclined to incorporate screening items for high-risk diseases into routine physical examination packages as much as possible. After all, the early diagnosis rate of high-risk cancers such as lung cancer, gastric cancer, and colorectal cancer in our country is less than 30%. If more high-risk groups can be covered through routine physical examinations, many detours can be avoided. ； But most front-line clinicians have a more cautious attitude. I had dinner with an old classmate from the oncology department a while ago, and he complained that too many people without high-risk factors followed the trend and did a full set of tumor screenings. They took more than a dozen tubes of blood to check dozens of tumor markers. In the end, one indicator was a few tenths higher. I was so scared that I couldn't sleep for half a month. I went back and forth for three biopsies and nothing happened. It was a waste of medical resources and a torment.

Oh, by the way, a fan asked me before, saying that the physical examination package provided by my employer already included the "five cancer screening items". Does this mean that he has undergone cancer screening? In fact, it is not true. The specificity of most tumor marker tests included in routine physical examinations is generally not high. For example, if you have stayed up late recently and have some inflammation, it may cause the indicators to rise. If you really have early-stage cancer, the indicators may still be normal. At most, it can only serve as a reminder and cannot replace targeted imaging and endoscopic screening.

Many people can't figure out the difference between the two. They either think "I have a physical examination every year and there is no way I can get cancer", or they think "routine physical examinations are useless, only a full set of screenings are more reliable." Both of these ideas are quite extreme. There is a distant aunt in my hometown who participates in free physical examinations organized by her work unit every year. Every gynecological examination is fine. Last year, when the community informed her that she needed to be screened for two cancers, she still found it troublesome and refused to go. Later she learned that the gynecological examination in the routine physical examination only checks whether there are any visible abnormalities in the vulva and cervix. It does not perform combined HPV and TCT screening, so early lesions cannot be detected.

In the past few years, I have helped dozens of people around me adjust physical examination packages. Generally speaking, it is not that complicated to choose: the basic items of a regular physical examination must be done every year, and you can understand the basic status of your entire body.； As for screening items, you don’t need to follow the trend and buy expensive ones, just choose according to your own situation - if you have a family history of gastric cancer, you should have a gastroscopy + Helicobacter pylori screening every 2-3 years after the age of 30. ； If you have smoked for more than 10 years, low-dose spiral CT should be done once a year ； After the age of 30, women should undergo HPV+TCT cervical cancer screening every 3-5 years. After the age of 40, add mammography or ultrasound screening every year, which is enough to cover most risks.

To put it bluntly, whether it is a routine physical examination or a disease screening, it is essentially to buy an "advance warning" for your health. You don't have to score high or low, just choose the one that suits you, which is better than anything else.