Prostate cancer screening in Switzerland: 20-year trends and socio-economic disparities

Idris Guessous, Stéphane Cullati, Stacey A Fedewa, Claudine Burton-Jeangros, Delphine S Courvoisier, Orly Manor, Christine Bouchardy.
Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparitiesPreventive Medicine, January 2016, doi: 10.1016/j.ypmed.2015.11.009

Abstract

Background: Despite considerable controversy about its effectiveness, screening for prostate cancer (PCa) has become increasingly popular. Significant socio-economic disparities in screening have been reported. However, trends in PCa screening and social disparities have not been studied in Switzerland, a country at high risk of PCa. We used data from five waves of the population-based Swiss Health Survey (1992-2012) to assess trends in PCa screening and its association with socio-economic indicators.

Methods: We used multivariate Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for demographics, health status, and healthcare utilization.

RESULTS: The study included 12,034 men aged ≥ 50 years (mean age: 63.9 years). Between 1992 and 2012, PCa screening uptake increased from 55.3% to 70.0% and uptake in the last two years from 32.6% to 42.4% (p-value <0.05). Income, education level and occupational class were independently associated with PCa screening. Screening for PCa in the last two years was more common among men with the highest income (>$6,000/month) compared with those with the lowest income (≤$2,000) (46.5% vs 38.7% in 2012, PR for the overall period =1.29, 95% CI: 1.13-1.48). These socioeconomic disparities did not change significantly over time.

Conclusions: This study shows that around half of Swiss men have undergone at least one PCa screening test. Men with a higher socio-economic status are clearly screened more often than those with a lower socio-economic status. Given the uncertainty about the usefulness of PCa screening, men, including those of high socio-economic status, should be clearly informed about the advantages and disadvantages of PCa screening, in particular the adverse effect of over-diagnosis, and the associated effect of over-treatment.

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