Determinants of participation in prostate cancer screening: A simple analytical framework to account for healthy‐user bias

Cancer Science

Takahiro Tabuchi²  Tomio Nakayama²  Wakaba Fukushima¹  Ichiro Matsunaga¹  Satoko Ohfuji¹  Kyoko Kondo¹  Eiji Kawano³  Hiroyuki Fukuhara⁴  Yuri Ito² 

[1] Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan;Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan;Department of Sociology, Osaka City University, Osaka, Japan;Department of Economics, Osaka City University, Osaka, Japan

关键词: Determinants of participation;    healthy‐user bias;    Japan;    prostate cancer screening;    prostate‐specific antigen test;   

DOI  :  10.1111/cas.12561

来源: Wiley

【 摘 要 】

Abstract

In Japan at present, fecal occult blood testing (FOBT) is recommended for cancer screening while routine population-based prostate-specific antigen (PSA) screening is not. In future it may be necessary to increase participation in the former and decrease it in the latter. Our objectives were to explore determinants of PSA-screening participation while simultaneously taking into account factors associated with FOBT. Data were gathered from a cross-sectional study conducted with random sampling of 6191 adults in Osaka city in 2011. Of 3244 subjects (return rate 52.4%), 936 men aged 40–64 years were analyzed using log-binomial regression to explore factors related to PSA-screening participation within 1 year. Only responders for cancer screening, defined as men who participated in either FOBT or PSA-testing, were used as main study subjects. Men who were older (prevalence ratio [PR] [95% confidence interval (CI)] = 2.17 [1.43, 3.28] for 60–64 years compared with 40–49 years), had technical or junior college education (PR [95% CI] = 1.76 [1.19, 2.59] compared with men with high school or less) and followed doctors' recommendations (PR [95% CI] = 1.50 [1.00, 2.26]) were significantly more likely to have PSA-screening after multiple variable adjustment among cancer-screening responders. Attenuation in PR of hypothesized common factors was observed among cancer-screening responders compared with the usual approach (among total subjects). Using the analytical framework to account for healthy-user bias, we found three factors related to participation in PSA-screening with attenuated association of common factors. This approach may provide a more sophisticated interpretation of participation in various screenings with different levels of recommendation.

【 授权许可】

CC BY-NC   
© 2014 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.

Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.