A preventive health check that changes with your age

Preventive testing fails in two opposite ways. One is the annual panel done out of habit, filed unread, that was never going to answer a question anybody had asked. The other is the first test done at 52, in a consulting room, because something has already started to go wrong.

A useful health check sits between them, and what belongs in it changes as you age.

What screening is actually for

A test earns a place in a routine check when three things are true: the condition is common enough to plausibly find, it is silent in its early stages, and finding it early changes what happens next. Diabetes, high blood pressure, disordered lipids, anaemia, thyroid disease and early kidney damage all qualify. Most of them announce nothing at all for years.

One number frames the rest of this article. India's national programme screens everyone aged 30 and above for diabetes, high blood pressure and three cancers, through primary health centres and Ayushman Arogya Mandirs. Whatever schedule you follow privately, the age at which this becomes worth doing in this country is 30, not 45.

In your twenties: establish a baseline

The point at this age is rarely to find disease. It is to know what your own normal looks like, so that a value at 40 can be compared to something.

• A complete blood count. Anaemia is common and frequently silent, particularly in menstruating women. Add ferritin if there is tiredness, hair fall or heavy periods, because stores empty before haemoglobin does. Our note on finding the cause of a low haemoglobin explains why the two are not the same test.
• Vitamin D and vitamin B12. Deficiency in both is widespread in India across every income group, and the symptoms are easy to dismiss. See vitamin D and B12.
• TSH if there are symptoms, a family history, or you are planning a pregnancy.
• A haemoglobin study before marriage or a first pregnancy, which is the one test in this list that is done for the next generation rather than for you.
• Blood pressure, weight and waist measurement. None of these come from a laboratory, and at this age they predict more than the blood tests do.

Repeat every two to three years if everything is normal and nothing changes.

In your thirties: the decade metabolic problems start

This is when the numbers begin to move, quietly, and when catching it is still cheap.

• Fasting glucose and HbA1c. International guidance suggests screening from 35, and earlier at a BMI of 23 or above for people of Asian ancestry, a lower threshold than for other populations because risk starts at a lower weight. A parent or sibling with diabetes moves it earlier still. HbA1c or fasting sugar explains what each of them can see.
• A lipid profile. Read the non-HDL figure and not only the LDL, for the reasons set out in reading a lipid profile.
• Liver and kidney panels. Fatty liver is now the commonest cause of a mildly abnormal enzyme in a well adult, and it is reversible at this stage.
• Thyroid, particularly in women, and particularly around pregnancy.
• Pre-conception and antenatal testing where relevant.

Annually if there is a risk factor, otherwise every two years. This is also the decade to start keeping the reports somewhere you can find them.

In your forties: the decade Indian hearts declare themselves

Coronary disease appears in South Asians roughly ten years earlier than in Western populations, which makes the forties the wrong decade to start thinking about it for the first time.

• Lipid profile annually, and Lp(a) once in your life. It is genetically set, about one in four South Asians carries a raised level, and knowing it changes how aggressively everything else is treated.
• HbA1c annually, whether or not fasting sugar has ever been abnormal.
• Liver, kidney, uric acid and thyroid as a standing set.
• Urine albumin from the moment diabetes or high blood pressure enters the picture, not years later.
• An eye examination, a dental review, and the cancer screening conversation. Which cancer screening applies to you, and when, is a decision for your doctor based on your history and family history. It is not something to select from a menu.

Fifty and beyond

• Everything above, annually.
• Kidney function with a urine albumin test, which is where early damage shows first.
• Vitamin D, calcium and bone health, especially for women after menopause.
• Any new anaemia deserves a cause. After fifty, a falling haemoglobin without an obvious explanation is investigated rather than supplemented.
• Monitoring for the medicines you are already on. Thyroid, diabetes, blood pressure and cholesterol treatments all have their own follow-up schedules, and those matter more than adding new tests.
• A PSA discussion for men is exactly that: a discussion with a doctor about whether the test helps you, not a line item to tick.

What is not on any laboratory menu

It would be convenient for a diagnostics laboratory to imply that testing is the whole of prevention. It is not, and the things that are not tests carry more weight than the ones that are: blood pressure measured properly and repeatedly, waist circumference, sleep, physical activity, tobacco in every form, alcohol, and what you actually eat on an ordinary Tuesday. A perfect report does not cancel any of them, and an imperfect one is often fixed by them.

Making the results worth having

• Use the same laboratory where you can, so a trend is a trend and not a change of method.
• Test under the same conditions, at a similar time of day, fasting or not fasting consistently.
• Keep the reports and carry the old ones to the appointment. Your own previous values are the most useful reference range you have.
• Take the report to a doctor, including when everything is normal, so that the next interval is decided rather than assumed.

Our health packages are grouped along these lines: broad preventive panels such as Swasthya-1, age and gender specific checks including Men's Wellness, Women's Wellness and the Senior Citizen profiles, and condition-focused panels for anyone already being followed for something. Individual tests can be searched by name on the test list, samples can be collected at home, and our collection centres are listed with their timings.

The best schedule is the one you will actually keep. Testing every five years and acting on the results beats testing every year and filing them unopened.