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The classic checkup is blood pressure, a blood count, cholesterol and glucose. Next to it a separate industry of “deep diagnostics” has grown: extended lipid panels, whole-body MRI, blood tests for dozens of cancers from one tube, genetic reports. Some of this has genuinely improved prevention, and some is still more product than medicine. Let us separate them.
What to know first
ApoB and Lp(a). LDL cholesterol measures the cholesterol carried in particles, while ApoB counts the atherogenic particles themselves, so for some people it reflects risk better. Lipoprotein(a) is largely genetic and changes little over a lifetime; a European consensus statement recommends measuring it at least once in adults. These tests are inexpensive and can change a treatment decision.
HbA1c and blood pressure. Dull, but these catch prediabetes and hypertension early. A home cuff validated against a clinic reading gives more information than a single measurement a year.
Coronary artery calcium score. A non-contrast CT shows calcified plaque in the heart’s arteries. The result helps a doctor decide whether a person at intermediate risk should take a statin. It does not replace a discussion of risk factors and is not for everyone.
What is debated
Whole-body MRI in healthy people. The method finds many incidental findings, lesions that pose no threat but trigger further tests. Professional societies do not recommend it as screening for people without symptoms; benefit has been shown only in certain high-risk groups, such as hereditary syndromes.
Multi-cancer early detection (MCED) blood tests. Tests that read DNA shed by tumors into the blood are one of the most visible technology trends in oncology. But large randomized trials have not yet shown that such screening lowers mortality, and sensitivity for early stages is limited for some methods. Treat them as an addition to proven screening (colonoscopy, mammography, HPV testing), not a replacement.
Genetic reports on “aging risks”. Polygenic risk scores are advancing quickly, but their accuracy depends on ancestry, and the step from score to recommendation is often weaker than the report implies.
How to build a plan
- Start with a physician and baseline labs, not with a service package.
- For every test ask: what decision will change depending on the result?
- Keep results in one place and compare trends rather than single numbers; wearables help here if you remember their limits.
- From “biological clocks” choose what you can repeat yearly and compare with lifestyle changes; see our guide to epigenetic clocks .
- If a finding is unexpected, do not be afraid to repeat the test and discuss the interpretation with a doctor.
A good checkup does not increase the number of tests. It lowers the chance of a surprise in ten years.
