In 2024, 1.4 billion adults worldwide were living with high blood pressure and 44% did not know it. A useful assessment looks first for the risks that are common, silent and treatable, then adds specialist tests only where they can change the decision.
If you want to check your health or make sense of persistent symptoms, Noria Health Hub can arrange a full check-up or a second medical opinion in Brussels, with a report within 24 h, coordinate your care where needed across more than 40 medical pathways in 48 h, then, if your medical condition allows, arrange surgery within 7 days.
What the trials on general health checks actually show
Three bodies of work dominate the literature, and none of the three favours the health check as it is usually sold. Here they are, unsoftened.
| Study | Scale | Main result |
|---|---|---|
| Cochrane review, 2019 | 11 randomised trials, 233,298 participants, 21,535 deaths | All-cause mortality, relative risk 1.00, confidence interval 0.97 to 1.03, high certainty. Cancer mortality, 1.01. Cardiovascular mortality, 1.05, moderate certainty |
| DANCAVAS, 2022 | 46,611 men aged 65 to 74, comprehensive cardiovascular screening with imaging | All-cause mortality at 5.6 years, hazard ratio 0.95, interval 0.90 to 1.00, p equals 0.06. Not significant |
| DANCAVAS II, 2025 | 31,268 men aged 60 to 64 | Mortality, hazard ratio 0.94, not significant. And more major bleeding in the screened group, 6.0% against 5.1%, hazard ratio 1.18 |
DANCAVAS II shows clearly what very broad screening risks: mortality was not significantly reduced, while major bleeding was more frequent in the screened group. A test can therefore lead to treatments and adverse effects with no demonstrated benefit on the primary endpoint.
What these results do not prove
The literal conclusion of the Cochrane authors is that general health checks are unlikely to be beneficial. That is not “a health check is useless”, and the difference between the two is the whole subject of this article.
The scope tested is narrow. The review only includes trials comparing a check with no check, in adults not selected on a disease or a risk factor. An assessment built on a known risk profile falls outside what was tested. The endpoint is mortality, not intermediate results, and the authors claim that deliberately, they wanted to measure what matters to the patient rather than blood pressure and cholesterol.
Why a uniform check shows no benefit
| The mechanism | What objectifies it |
|---|---|
| Dilution | A check applied to everyone dilutes the real benefit in a high-risk minority across a majority with no possible benefit. Aortic ultrasound shows this by contrast, net benefit in men aged 65 to 75 who have smoked, unfavourable balance in women without history |
| The healthy volunteer | In the Danish trial only 62.6% of those invited were screened, and they are not the same people as those who needed it |
| Detecting is not treating | Across 41 countries, only 8% of people eligible for a statin in primary prevention receive one |
| Usual care already captures part of the benefit | Control groups in modern trials are not groups without medicine, which flattens the measurable difference |
| Adverse effects | Excess major bleeding in the screened arm of the 2025 Danish trial, a direct consequence of the treatments prescribed after the check |
The problems that are common, silent and treatable
| What stays invisible | The figure | Source |
|---|---|---|
| High blood pressure | 1.4 billion adults aged 30 to 79 affected, 33% of that age group. 44% do not know it, and only 23% have it controlled | World Health Organization, 2025 |
| Diabetes | 42.8% of adults with diabetes worldwide are undiagnosed, 251.7 million people. 27.6% in the United States | International Diabetes Federation, 2025, and US Centers for Disease Control, 2023 |
| Metabolic fatty liver disease | Global prevalence of 30 to 37.5%. In type 2 diabetes, 15.4% advanced fibrosis and 7.7% cirrhosis | Hepatology 2023, Clinical Gastroenterology and Hepatology 2025, Diabetes Care 2021 |
| Raised lipoprotein(a) | Present in 20 to 25% of the population. Measured once in a lifetime, since the level is essentially genetic | European Atherosclerosis Society, 2022 |
High blood pressure, diabetes and some liver diseases meet several of the conditions that make screening worthwhile: they are common, often silent, and they have treatments of demonstrated benefit. Lipoprotein(a) is different: it mainly serves to estimate cardiovascular risk more accurately, and no specific treatment has yet demonstrated a clinical benefit tied to the screening itself.
The screening tests with demonstrated benefit, in precisely defined populations
| The examination | In whom | The measured benefit |
|---|---|---|
| Screening colonoscopy | General invited population | Colorectal cancer incidence reduced by 18% at 10 years, 455 people to invite to prevent one cancer. Specific mortality does not reach significance. NordICC trial, 2022 |
| Abdominal aortic ultrasound | Men aged 65 to 75 who have smoked | Aneurysm-related mortality reduced by 35%, 305 men to screen to prevent one death. US grade B recommendation, 2019 |
| Low-dose chest CT | 50 to 80 years, at least 20 pack-years | Lung cancer mortality reduced by 24% in men, NELSON trial 2020, and by 20% in the NLST trial 2011 |
| Blood pressure measurement | Every adult | Office measurement alone has a sensitivity of 0.54. Home self-measurement rises to 0.84. How you measure matters as much as whether you measure |
Every demonstrated benefit is attached to a defined population. Outside that population the test loses its value and keeps its drawbacks.
The cost of testing in excess: false positives and needless work-ups
Stacking tests does not raise safety, it raises false positives, and cumulatively.
| What was measured | The result |
|---|---|
| 14 screening tests over 3 years | 60.4% of men had at least one false positive, and 28.5% underwent an invasive diagnostic procedure triggered by it. 68,436 participants |
| Whole-body imaging in asymptomatic people | 32.1% critical or indeterminate incidental findings, against a confirmed cancer rate of 1.57%. Roughly 20 findings to work up for 1 cancer found |
| Low-dose chest CT | 18.5% of the lung cancers detected were overdiagnosis, tumours that would never have caused symptoms |
| General health check, secondary endpoints | The only solidly observed effect is a 20% rise in new diagnoses per participant over 6 years, with no translation into survival |
What the evidence still cannot establish
One screening test has demonstrated a reduction in all-cause mortality, low-dose chest CT, by 6.7% in the American trial. No other, including the best ones, has done so. The modern markers, lipoprotein(a), coronary calcium score, liver elastography, are prognostic and not therapeutic, and no randomised trial shows that measuring them reduces mortality.
One example of the caution this imposes. A calcium score of zero is not a lifetime clearance, 53% of those concerned move to a positive score within 10 years, and the validity window is estimated at 3 to 7 years depending on profile. Repeating annually what does not need repeating produces nothing but false positives.
In practice, if this concerns you
You set out your problem, your symptoms or your question. Reports, test results and images already available can be studied before you arrive, so that the pathway is prepared. The point is not to run every test as a matter of course, but to select those that can genuinely help confirm a hypothesis, rule out a risk or guide the decision. The results are then summarised and the next steps are organised. Follow-up is coordinated from there.
Need medical advice quickly? For a worry that does not call for emergency services, you can ask to speak to a doctor at any time through Noria Health Hub. This on-demand medical consultation is billed separately from the assessment pathway.
Further reading
The companion articles.
How” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/how-we-build-a-health-assessment/”>How we build a health assessment
Waiting” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/what-delay-really-costs-what-the-studies-say/”>Waiting for a diagnosis or a treatment, what the studies actually measure
Sources
Krogsbøll LT, Jørgensen KJ, Gøtzsche PC, General health checks in adults for reducing morbidity and mortality from disease, Cochrane Database of Systematic Reviews, 2019. https://doi.org/10.1002/14651858.CD009009.pub3
DANCAVAS, Five-year outcomes of the Danish Cardiovascular Screening trial, New England Journal of Medicine, 2022. https://doi.org/10.1056/NEJMoa2208681
DANCAVAS II, Outcomes of cardiovascular screening in men aged 60 to 64 years, European Heart Journal, 2025. https://doi.org/10.1093/eurheartj/ehaf704
Bretthauer M et al., NordICC, Effect of colonoscopy screening on risks of colorectal cancer and related death, New England Journal of Medicine, 2022. https://doi.org/10.1056/NEJMoa2208375
de Koning HJ et al., NELSON, Reduced lung-cancer mortality with volume CT screening, New England Journal of Medicine, 2020. https://doi.org/10.1056/NEJMoa1911793
Aberle DR et al., NLST, Reduced lung-cancer mortality with low-dose computed tomographic screening, New England Journal of Medicine, 2011. https://doi.org/10.1056/NEJMoa1102873
Patz EF et al., Overdiagnosis in low-dose computed tomography screening for lung cancer, JAMA Internal Medicine, 2014. https://doi.org/10.1001/jamainternmed.2013.12738
Croswell JM et al., Cumulative incidence of false-positive results in repeated, multimodal cancer screening, Annals of Family Medicine, 2009. https://doi.org/10.1370/afm.942
Kwee RM, Kwee TC, Whole-body MRI for preventive health screening, Journal of Magnetic Resonance Imaging, 2019. https://doi.org/10.1002/jmri.26736
Whole-body MRI for opportunistic cancer detection in asymptomatic individuals, European Radiology, 2026. https://doi.org/10.1007/s00330-025-11976-5
US Preventive Services Task Force, Abdominal aortic aneurysm screening, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening
US Preventive Services Task Force, Hypertension in adults screening, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
World Health Organization, Hypertension fact sheet, 2025. https://www.who.int/news-room/fact-sheets/detail/hypertension
Global, regional, and national estimates of undiagnosed diabetes in adults, Diabetes Care, 2026, from the IDF Diabetes Atlas 2025. https://doi.org/10.2337/dc25-2583
Centers for Disease Control and Prevention, National Diabetes Statistics Report, 2023 data. https://www.cdc.gov/diabetes/php/data-research/index.html
Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries, Lancet Global Health, 2022. https://doi.org/10.1016/S2214-109X(21)00551-9
Kronenberg F et al., Lipoprotein(a) consensus statement, European Atherosclerosis Society, European Heart Journal, 2022. https://doi.org/10.1093/eurheartj/ehac361
Warranty period of a calcium score of zero, comprehensive analysis from MESA, JACC Cardiovascular Imaging, 2021. https://doi.org/10.1016/j.jcmg.2020.06.048
The global epidemiology of NAFLD and NASH, Hepatology, 2023. https://doi.org/10.1097/HEP.0000000000000004
High prevalence of advanced liver fibrosis among adults with type 2 diabetes, Diabetes Care, 2021. https://doi.org/10.2337/dc20-1778