Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study

Abstract Background We examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults. Methods The study is based on health insurance claims data of the Helsana Group. The Helsana Group is one of the largest health insurers in Switzerland, insuring approximately 15% of the entire Swiss population across all regions and age groups. We assessed proportions of the eligible populations receiving colonoscopy/fecal occult blood testing (FOBT), mammography, or prostate-specific antigen (PSA) testing in the years 2014, 2016, and 2018, and calculated average marginal effects of individual, temporal, regional, insurance-, supply-, and system-related variables on testing utilization using logistic regression. Results Overall, 8.3% of the eligible population received colonoscopy/FOBT in 2014, 8.9% in 2016, and 9.2% in 2018. In these years, 20.9, 21.2, and 20.4% of the eligible female population received mammography, and 30.5, 31.1, and 31.8% of the eligible male population had PSA testing. Adjusted testing utilization varied little between 2014 and 2018; there was an increasing trend of 0.8% (0.6–1.0%) for colonoscopy/FOBT and of 0.5% (0.2–0.8%) for PSA testing, while mammography use decreased by 1.5% (1.2–1.7%). Generally, testing utilization was higher in French-speaking and Italian-speaking compared to German-speaking region for all screening types. Cantonal programs for breast cancer screening were associated with an increase of 7.1% in mammography utilization. In contrast, a high density of relevant specialist physicians showed null or even negative associations with screening utilization. Conclusions Variation in cancer screening utilization was modest over time, but considerable between regions. Regional variation was highest for mammography use where recommendations are debated most controversially, and the implementation of programs differed the most.

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Prostate Cancer Screening in the Workplace

AAOHN Journal ◽

10.1177/216507999804600803 ◽

1998 ◽

Vol 46 (8) ◽

pp. 379-384 ◽

Cited By ~ 6

Author(s):

Claire Snyder ◽

Peggy N. Schrammel ◽

Claudia B. Griffiths ◽

Robert I. Griffiths

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Screening Tests ◽

Test Results ◽

Total Cost ◽

Screening Programs ◽

Psa Testing ◽

The Cost

Recognition of the mortality and morbidity associated with prostate cancer has resulted in employer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at high risk. Data related to the health care and lost productivity costs of screening and referrals for abnormal test results were collected and analyzed. The total cost of screening was $44,355, or approximately $56 per screening encounter (788 DREs; 437 PSAs). Abnormal screening tests resulted in 52 referrals. Upon further evaluation, 42% were found to have an enlargement, 29% a node, and 12% benign prostatic hyperplasia. Only one malignancy was found. The total cost of additional referrals was $31,815, or 42% of the cost of screening plus referrals. As the cost per screening encounter was low, prostate cancer screening in the workplace is an efficient alternative.

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Prostate-Specific Antigen Test Utilization in a Major Canadian City

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa003 ◽

2020 ◽

Vol 153 (6) ◽

pp. 776-780

Author(s):

Qunfeng Wang ◽

Fang Chen ◽

Depeng Jiang ◽

Amin Kabani ◽

AbdulRazaq A H Sokoro

Keyword(s):

Prostate Specific Antigen ◽

Demographic Data ◽

Specific Antigen ◽

Age Groups ◽

Male Population ◽

Relative Percentage ◽

Prostate Specific Antigen Test ◽

Psa Testing ◽

Canadian City ◽

Almost All

Abstract Objectives To review the utilization of prostate-specific antigen (PSA) testing in Winnipeg, a major Canadian city, and to compare PSA testing rates between Winnipeg and Calgary, another major Canadian city of comparable size. Methods PSA testing results were reviewed by year and age group. We focused our studies in years 2011 and 2016, for which census demographic data are available. Results In Winnipeg, the PSA testing rates (patients with one or two PSA tests divided by the male population) showed a declining trend over years from 2008 to 2017. For almost all age groups, PSA testing rates in 2016 decreased in comparison to those in 2011. For age older than 40 years, the relative percentage decreases were 14% to 20%. In 2011, Winnipeg PSA testing rates were consistently higher than those in Calgary for all age groups. For age older than 40 years, the relative percentage differences were 36% to 50%.In addition, 41% and 40% of patients in Winnipeg who underwent PSA testing were younger than 50 years or older than 69 years in 2011 and 2016, respectively. Conclusions PSA testing utilization may be falling short of optimal rates. There is a need to reinforce the optimal use of clinical recommendations.

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Racial and Ethnic Variation in PSA Testing and Prostate Cancer Incidence Following the 2012 USPSTF Recommendation

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa171 ◽

2020 ◽

Author(s):

Kevin H Kensler ◽

Claire H Pernar ◽

Brandon A Mahal ◽

Paul L Nguyen ◽

Quoc-Dien Trinh ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Cancer Incidence ◽

Race And Ethnicity ◽

Task Force ◽

Prostate Cancer Screening ◽

Disease Incidence ◽

Specific Antigen ◽

Prostate Cancer Incidence ◽

Psa Testing

Abstract Background The 2012 US Preventive Services Task Force recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race and ethnicity remains unclear. Methods The proportion of 40- to 74-year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (2012-2018). Odds ratios (ORs) of undergoing screening by race and ethnicity were estimated, adjusting for healthcare–related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race and ethnicity were estimated using Surveillance, Epidemiology, and End Results registry data (2004-2017). Results PSA testing frequencies were 32.3% (95% confidence interval [CI] = 31.7% to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3% to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9% to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1% to 21.3%) among Asian and Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity = .005), driven by a larger decline among NHB men ages 40-54 years. The NHB to NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial and ethnic groups. Conclusions The frequency of prostate cancer screening varies by race and ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB to NHW IRR for localized prostate cancer modestly increased following 2012.

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Prostate-specific antigen testing and opportunistic prostate cancer screening in England (1998-2017): a cohort study

British Journal of General Practice ◽

10.3399/bjgp20x713957 ◽

2020 ◽

pp. bjgp20X713957

Author(s):

Ashley Kieran Clift ◽

Carol Coupland ◽

Julia Hippisley-Cox

Keyword(s):

Prostate Cancer ◽

Cohort Study ◽

Cancer Screening ◽

Prostate Specific Antigen ◽

Prostate Cancer Screening ◽

Randomised Trial ◽

Specific Antigen ◽

Opportunistic Screening ◽

Psa Screening ◽

Psa Testing

Abstract Background: Prostate cancer is a leading cause of cancer-related death. Interpretation of results from trials of screening with prostate-specific antigen (PSA) are complex in terms of defining optimal prostate cancer screening policy. Aims: Assess the rates of, and factors associated with the uptake of PSA testing and opportunistic screening (PSA test in absence of symptoms) in England between 1998 and 2017. Estimate the likely rates of pre-randomisation screening and contamination (unscheduled screening in ‘control’ arm) of the UK-based Cluster Randomised Trial of PSA Testing for Prostate Cancer (“CAP”). Design and Setting: Open cohort study of men aged 40-75 years at cohort entry (1998-2017) undertaken using the QResearch database. Method: Eligible men were followed for up to 19-years. Rates of PSA testing and opportunistic PSA screening were calculated and Cox regression was used to estimate associations. Results: The cohort comprised 2,808,477 men, of whom 631,426 had a total of 1,720,855 PSA tests. We identified that 410,751 men had opportunistic PSA screening. Cumulative proportions of uptake of opportunistic screening in the cohort: 10% at 5yrs, 23% at 10yrs, and 44% at 19yrs of follow-up. The potential rate of contamination in the CAP control arm was estimated at 24.5%. Conclusions: A substantial number of men in England opt-in to opportunistic prostate cancer screening despite uncertainty regarding the efficacy and harms. The rate of opportunistic prostate cancer screening in the population is likely to have contaminated the CAP trial making it difficult to interpret the results.

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Obesity and Cancer Screening according to Race and Gender

Journal of Obesity ◽

10.1155/2011/218250 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Heather Bittner Fagan ◽

Richard Wender ◽

Ronald E. Myers ◽

Nicholas Petrelli

Keyword(s):

Cancer Screening ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Negative Association ◽

Race And Gender ◽

Crc Screening ◽

Psa Testing ◽

And Gender ◽

Obesity And Cancer ◽

The Relationship

The relationship between obesity and cancer screening varies by screening test, race, and gender. Most studies on cervical cancer screening found a negative association between increasing weight and screening, and this negative association was most consistent in white women. Recent literature on mammography reports no association with weight. However, some studies show a negative association in white, but not black, women. In contrast, obese/overweight men reported higher rates of prostate-specific antigen (PSA) testing. Comparison of prostate cancer screening, mammography, and Pap smears implies a gender difference in the relationship between screening behavior and weight. In colorectal cancer (CRC) screening, the relationship between weight and screening in men is inconsistent, while there is a trend towards lower CRC screening in higher weight women.

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Update on PSA Testing

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2007.0065 ◽

2007 ◽

Vol 5 (7) ◽

pp. 737-742 ◽

Cited By ~ 10

Author(s):

Mark L. Gonzalgo ◽

H. Ballentine Carter

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Cost Effective ◽

The Past ◽

Psa Testing ◽

Screening Strategies ◽

Total Psa ◽

Over Time

The use of prostate-specific antigen (PSA) testing for prostate cancer screening has increased dramatically over the past decade. Determining the most efficient way to use PSA testing and how to interpret total PSA levels and changes in PSA values over time remain challenging. Guidelines for early detection of prostate cancer have a direct impact on the number of unnecessary tests performed and are critical for developing a successful screening approach for prostate cancer. The age at which PSA screening should begin, PSA testing intervals, and the importance of understanding fluctuations in PSA values over time are discussed in the framework of recent discoveries in the field. Results from ongoing randomized trials will confirm whether prostate cancer screening is an effective method for reducing deaths from prostate cancer and what approaches will provide the most cost-effective screening strategies.

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Does shared decision making increase prostate screening uptake in countries with a low prevalence of prostate cancer?

African Health Sciences ◽

10.4314/ahs.v20i4.43 ◽

2020 ◽

Vol 20 (4) ◽

pp. 1870-4

Author(s):

Hussein Saad Amin ◽

Mostafafa Ahmed Arafa ◽

Karim Hamda Farhat ◽

Danny Munther Rabah ◽

Abdulaziz Abdullah Altaweel ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Cancer Screening ◽

Shared Decision Making ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Shared Decision ◽

Advantages And Disadvantages ◽

Psa Testing ◽

Low Prevalence

Background: Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors. Objectives: To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening prac- tices among Saudi men. Methods: This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed. Results: In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate exam- ination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing. Conclusion: Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process. Keywords: Decision making; prostate cancer screening; low prevalence countries.

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Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey

West Indian Medical Journal ◽

10.7727/wimj.2016.312 ◽

2018 ◽

pp. 334-343

Author(s):

AL Patrick ◽

JB Nelson ◽

JL Weissfeld ◽

R Dhir ◽

RJ Phillips ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

African Descent ◽

Specific Antigen ◽

Age Groups ◽

Radical Retropubic Prostatectomy ◽

Survival Curves ◽

All Cause Mortality

Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40–79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10–12 years of follow-up (p > 0.36). In contrast, among men first screened at age 50–59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50–59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50–59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.

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Factors Related to Prostate-Specific Antigen–Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years (Preprint)

10.2196/preprints.10352 ◽

2018 ◽

Author(s):

Cédric Rat ◽

Heloise Schmeltz ◽

Sylvain Rocher ◽

France Nanin ◽

Aurélie Gaultier ◽

...

Keyword(s):

Prostate Cancer ◽

Chronic Disease ◽

Cancer Screening ◽

Low Income ◽

Screening Test ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Psa Testing ◽

Younger Men

BACKGROUND International guidelines recommend avoiding prostate-specific antigen (PSA)-based prostate cancer screening in the elderly when life expectancy is less than 10 years. For younger men, most recommendations encourage a shared decision-making process taking into account patient comorbidities. OBJECTIVE The objective was to assess the performance of PSA-based prostate cancer screening in men older than 74 years and assess whether the presence (vs absence) of comorbidities was related to the performance of PSA testing in younger men aged 50 to 74 years who were eligible for screening. METHODS We analyzed data from the French national health care database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014, to March 31, 2016: 22,480 men aged over 74 years and 98,107 men aged 50 to 74 years. We analyzed whether these patients underwent PSA testing after 2 years of follow-up and whether PSA testing performance was related to the following patient-related variables: age, low income, proxy measures indicative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, taking 5 or more drugs per day), or proxy measures indicative of specific comorbidities (cancer diseases, cardiovascular diseases, or psychiatric disorders). Statistical analysis was based on a multivariate mixed-effects logistic regression. RESULTS The proportion of patients who underwent a PSA-based screening test was 41.35% (9296/22,480) among men older than 74 years versus 41.05% (40,275/98,107) among men aged 50 to 74 years. The following factors were associated with less frequent PSA testing in men older than 74 years—age (odds ratio [OR] 0.89, 95% CI 0.88-0.89), low income (OR 0.18, 95% CI 0.05-0.69), suffering from a chronic disease (OR 0.82, 95% CI 0.76-0.88), repeated ambulance transportation (OR 0.37, 95% CI 0.31-0.44), diabetes requiring insulin (OR 0.51, 95% CI 0.43-0.60), dementia (OR 0.68, 95% CI 0.55-0.84), and antipsychotic treatment (OR 0.62, 95% CI 0.51-0.75)—whereas cardiovascular drug treatment was associated with more frequent PSA testing (OR 1.6, 95% CI 1.53-1.84). The following factors were associated with less frequent PSA testing in men aged 50 to 74 years—low income (OR 0.61, 95% CI 0.55-0.68); nonspecific conditions related to frailty: suffering from a chronic disease (OR 0.80, 95% CI 0.76-0.83), repeated ambulance transportation (OR 0.29, 95% CI 0.23-0.38), or chronic treatment with 5 or more drugs (OR 0.89, 95% CI 0.83-0.96); and various specific comorbidities: anticancer drug treatment (OR 0.67, 95% CI 0.55-0.83), diabetes requiring insulin (OR 0.55, 95% CI 0.49-0.61), and antiaggregant treatment (OR 0.91, 95% CI 0.86-0.96)—whereas older age (OR 1.07, 95% CI 1.07-1.08) and treatment with other cardiovascular drugs (OR 2.23, 95% CI 2.15-2.32) were associated with more frequent PSA testing. CONCLUSIONS In this study, 41.35% (9296/22,480) of French men older than 74 years had a PSA-based screening test. Although it depends on patient comorbidities, PSA testing remains inappropriate in certain populations.

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