Health Check-ups: Which Tests Are Worth It and at What Age
Preventive health packages are widely marketed in India, usually as a long list of tests at an attractive price. More tests are not the same as better care. Screening is only useful when the condition is common enough, detectable early, and treatable more effectively when found early, and when a positive result leads to a clear action.
Tests that do not meet those conditions carry real costs: false positives, unnecessary follow-up scans, biopsies, anxiety and overdiagnosis of conditions that would never have caused harm.
Screening that has good evidence
Blood pressure
From age 18, at least every one to two years, annually from 40 or if previously borderline. Cheap, quick, and identifies the single largest modifiable cardiovascular risk.
Blood glucose or HbA1c
From around age 30 in Indian populations because of the earlier onset, or younger with obesity, family history, PCOS or a history of gestational diabetes. Every three years if normal.
Lipid profile
From around age 25-30, then every three to five years if normal, earlier and more often with a family history of premature heart disease.
Cervical cancer screening
One of the highest-yield screening tests in existence. HPV testing every five years, or Pap smear every three years, from age 25-30 to 65. HPV vaccination is separately recommended for adolescents.
Breast cancer screening
Mammography every one to two years from 40-50 to about 70, depending on the guideline followed and individual risk. Earlier with a strong family history.
Colorectal cancer screening
From age 45-50 to 75: faecal immunochemical test annually, or colonoscopy every ten years.
Hepatitis B and C
At least once in a lifetime for all adults, given effective treatment for hepatitis C and antiviral management for B.
Tuberculosis
Evaluation for anyone with a cough lasting more than two weeks, weight loss, night sweats or a known contact. Not a routine screening test, but a low threshold for testing matters in India.
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Vision, hearing and dental
Periodic checks, more frequent after 60. Hearing loss is strongly associated with social isolation and cognitive decline and is under-treated.
Bone density
Women from 65, men from 70, earlier with fractures from minor falls, long-term steroids or early menopause.
Tests commonly bundled that usually should not be
- Whole-body scans and full-body MRI in people without symptoms: high rate of incidental findings, no mortality benefit
- Tumour markers such as CA-125 and CEA in routine packages: these are diagnostic and monitoring tools, not screening tests for the general population. PSA has a genuine but genuinely debatable role and should follow a conversation about the trade-offs, not be added silently to a package.
- Routine ECG and treadmill tests in asymptomatic low-risk people: false positives lead to angiography that would not otherwise have happened
- Routine vitamin and mineral panels in people with no risk factors or symptoms
- Routine thyroid screening in asymptomatic adults, which mostly finds mild subclinical changes that resolve
- Chest X-ray as an annual routine in people without symptoms or exposure
Vaccination is part of prevention too
- Tetanus and diphtheria booster every ten years
- Influenza annually for those over 65, pregnant women, and people with chronic heart, lung, kidney or liver disease or diabetes
- Pneumococcal vaccination for older adults and those with chronic conditions
- Hepatitis B for anyone not previously vaccinated
- HPV for adolescents of both sexes
- Shingles vaccination where available for older adults
A practical approach by decade
- 20s: blood pressure, one-time hepatitis screen, cervical screening from 25, vaccination status, mental health
- 30s: add glucose and lipids, maintain cervical screening, discuss family history
- 40s: all of the above more regularly, breast screening discussion, eye check
- 50s: add colorectal screening, review cardiovascular risk formally, vaccination review
- 60s and beyond: add bone density where indicated, hearing and vision, cognitive and falls assessment, medication review
Questions worth asking before any test
- What will change if this result is abnormal?
- What is the chance of a false positive, and what happens next if I get one?
- Is this test recommended for someone with my age and risk, or is it part of a package?
This article is general health information. Screening decisions should be individualised with a doctor who knows your history and risk factors.