The Annual Health Check: What Is Worth Testing
A worthwhile annual check for a healthy adult in Pakistan is short and cheap: blood pressure, weight and waist, a blood sugar test, a lipid profile every few years, a haemoglobin for women of reproductive age, and a one-time hepatitis B and C test. Add cervical screening from 30 for women, an eye check from 40, and a dental review. The large commercial "full body" packages sold as fifty or a hundred tests add cost and anxiety rather than years, because a test done in someone with no symptoms and no risk factor produces far more false alarms than real findings. The purpose of a check is to catch the four conditions that are common here, silent for years and treatable when found early — high blood pressure, diabetes, high cholesterol and hepatitis C — and to make sure your immunisations and screening are up to date.
Diabetologist & General Physician · MBBS
What a health check is actually for
The idea behind is narrow and worth stating precisely: it is testing someone who feels well, for a condition that is common, that causes harm silently, and that is easier to treat if it is caught before it announces itself. Every part of that sentence has to be true for a test to earn its place. High qualifies on all four counts. A tumour marker in a person with no symptoms does not qualify on any of them.
The evidence on general health checks is more sober than the advertising suggests. A large Cochrane review of trials involving over 250,000 people found that inviting healthy adults for broad general check-ups did not reduce deaths from any cause, from cancer or from heart disease. What that review did not test — and what does work — is targeted checking of the specific things that are common, silent and treatable. That is the check described below.
There is a second reason a check is worth having, which has nothing to do with tests: it is the one appointment where nobody is in a hurry. It is the time to sort out a repeat prescription, ask about a symptom you have been ignoring, get a tetanus booster or a hepatitis B vaccine, discuss quitting tobacco, and have your family history written down properly for the first time.
What is worth checking, and how often
| Check | From what age | How often if normal |
|---|---|---|
| 18 | Every year | |
| or | 30 — or any age with a family history, a large waist, or previous gestational diabetes | Every year |
| 35 for men, 45 for women; earlier with , obesity or a family history of early heart disease | Every 3 to 5 years | |
| Weight, and waist measurement | 18 | Every year |
| Hepatitis B and C blood test | Once for every adult | Repeat only after a new exposure — surgery, dental work, a transfusion, a shared razor or needle |
| , for | Women of reproductive age; anyone with tiredness or heavy periods | Every year |
| Cervical screening (Pap smear or HPV test) | 30 for women who have been sexually active | Every 3 to 5 years |
| Vision and eye pressure | 40 — or from diagnosis if you have diabetes | Every 2 years; every year with diabetes |
| Dental examination | Any age | Every year |
| , for | Women over 50, or anyone with symptoms or a goitre | Not routine without a reason |
The tests worth having, and why
Blood pressure
The most valuable single measurement in the whole check, and the cheapest. affects between a quarter and a third of Pakistani adults, has no symptoms, and is the largest single cause of . A reading takes two minutes and costs nothing. If it is 140/90 or above, it is repeated on another day before anything is concluded.
Blood sugar
Pakistan has one of the highest rates of in the world — the 2016-17 National Diabetes Survey found roughly a quarter of adults affected, and a large proportion of them undiagnosed. South Asians develop type 2 diabetes younger and at a lower than European populations, which is why the sensible screening age here is 30 rather than 40, and lower still with a family history. A requires an eight-hour fast; does not, which makes it the easier test for most people and the better one for tracking.
Cholesterol
A fasting gives total , , HDL and . On its own the number decides nothing — what matters is your overall cardiovascular risk, which combines it with age, blood pressure, smoking and diabetes. This is why a modestly raised in a 35-year-old non-smoker may need nothing but diet, while the same number in a 60-year-old with diabetes usually needs a .
Weight and waist
Waist circumference predicts metabolic risk better than weight alone, and the thresholds for South Asians are lower than the international ones: 90 cm for men and 80 cm for women, against 102 cm and 88 cm for Europeans. The same applies to — the overweight threshold for South Asians is 23 rather than 25. These are not arbitrary adjustments; they reflect that people from this region carry more visceral fat and develop diabetes at a lower body weight.
Hepatitis B and C
This is the one test on this list that most Western guidelines do not recommend universally and that every adult in Pakistan should have once. Pakistan carries one of the largest hepatitis C burdens in the world, driven historically by reused syringes, unscreened blood and unsterilised dental and barbering equipment. Both infections are silent for decades and then present as liver disease. Hepatitis C is now curable in most people with a twelve-week course of tablets, and hepatitis B is preventable with a — which makes finding it the entire point.
Haemoglobin, for women
is very common in women of reproductive age here, usually from iron deficiency and heavy periods, sometimes from a diet low in iron. It is easy to miss because the tiredness is attributed to everything else. A within a is inexpensive and settles it.
The tests usually not worth having
The commercial "full body checkup" packages sold in most cities bundle together dozens of tests, and the extra ones are not free of cost even when they are free of charge. Every test done in a person with no symptoms carries a chance of an abnormal result that means nothing, and each of those leads to a repeat test, a scan, sometimes a , and always to months of worry.
- Tumour marker panels such as CA-125, CEA and PSA in people with no symptoms. These are designed for monitoring a known cancer, not for finding one. Used as screening they generate far more false alarms than diagnoses.
- Whole-body or in someone with no symptoms. A CT of the whole body also delivers a meaningful radiation dose for no proven benefit.
- A routine or treadmill test in an adult with no symptoms and no risk factors. It changes no decision, and a false positive leads to an angiogram nobody needed.
- Broad vitamin panels. deficiency is genuinely widespread in Pakistan and testing is reasonable where there are symptoms or risk factors, but a panel of eight vitamins in a well person is not.
- Repeating a normal test every year when the guideline says every three to five years. A lipid profile that was normal last year will almost always be normal this year.
How to prepare
- Ask when you book whether fasting is needed. A and usually need eight to twelve hours with water only; does not.
- Bring every previous report you have, even old and creased ones. Trend beats snapshot.
- Bring your actual medicine boxes, or photograph the strips — including anything bought over the counter, and any herbal or homeopathic preparation.
- Write down your family history first: which relative, which condition, at what age. "Father, heart attack, 52" changes a risk calculation; "heart problems in the family" does not.
- Avoid heavy exercise the day before a blood test, which can raise several enzyme levels transiently.
- Write your questions down. Three specific ones are worth more than an hour of general reassurance.
Reading the report without frightening yourself
A laboratory reference range is defined so that about 95 per cent of healthy people fall inside it, which means one healthy person in twenty falls outside it on any given test by definition alone. Run twenty tests on a perfectly well person and, on average, one will come back flagged. This is why a single mildly abnormal value on a large panel is usually nothing, and why running fewer tests produces better medicine.
Reference ranges also differ between laboratories, because they depend on the machine and the method. Comparing a from one lab against the range printed by another is not meaningful. And some values are expected to be outside the printed range: a at the top of normal in a muscular young man is normal for him, and a at the lower end is normal in pregnancy.
Take the report to the doctor who ordered it rather than to a search engine, and ask three questions: does this number need anything done about it, does it need repeating, and when. Most flagged values need only the second and third.
Immunisations for adults
An annual check is the natural place to sort out adult , which is easy to let slip once the childhood EPI schedule is finished. Worth asking about: a tetanus booster every ten years, particularly for anyone doing farm or construction work; hepatitis B for any adult never vaccinated and found not to be immune; influenza vaccine each autumn for people over 65, pregnant women, and anyone with diabetes, heart, kidney or lung disease; and typhoid conjugate vaccine, which is part of Pakistan's routine schedule for children and is worth discussing for adults in high-transmission areas.
When to see a doctor
Book a check if you are over 30 and have not had your blood pressure and blood sugar measured in the past year, if you have never been tested for hepatitis B and C, or if you have a first-degree relative who developed diabetes or heart disease before the age of 60. Book a consultation rather than a check — sooner, and separately — if you have any symptom at all, and use the emergency list near the top of this page for the ones that should not wait even a day. If you are already being treated for a condition, your existing follow-up schedule replaces this one rather than being added to it.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
