title: Why do men opt out of prostate-cancer screening? Attitudes and perception among participants and non-participants of a screening trial.
abstract: OBJECTIVE
  To evaluate attitudes to prostate cancer screening with prostate-specific antigen (PSA) of men who complied with offered screening and those who declined it within the Finnish randomized population-based screening trial, and to compare general health-related quality of life (HRQL) between participants and non-participants.
  
  
  METHODS
  Self-administered questionnaires were sent to 500 men randomized into the screening arm in 1996-99 within the Finnish component of the European Randomized Study on Screening for Prostate Cancer. A similar survey was conducted among 500 non-participants.
  
  
  RESULTS
  Response proportions among the screening participants and non-participants were 59% and 28%, respectively. Current smoking was less frequent (P < 0.05) among the participants. In terms of attitude, the participants regarded the prostate cancer study as more important and the invitation letter as more informative than the non-participants (P < 0.001). There was no clear difference in worry about treatment consequences. The most commonly given reasons for not participating included previous PSA testing (41%), forgetting the invitation (51%), or not wanting to think of prostate cancer (39%) and regarding possible further diagnostic examinations as unpleasant (28%). The non-participants had a lower mental health score (P < 0.001) than the participants in the RAND-36 Survey.
  
  
  CONCLUSIONS
  Most men who chose not to attend screening had a positive attitude, but did not participate due to practical reasons. However, two-thirds of the non-participants indicated a willingness to participate in the next screening round.
authors.affiliation: Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland. hanna.malmi@helsinki.fi
authors.forename: Hanna
authors.initials: H
authors.lastname: Malmi
authors.forename: Mirja
authors.initials: M
authors.lastname: Ruutu
authors.forename: Liisa
authors.initials: L
authors.lastname: Määttänen
authors.forename: Ulf-Håkan
authors.initials: UH
authors.lastname: Stenman
authors.forename: Harri
authors.initials: H
authors.lastname: Juusela
authors.forename: Teuvo L J
authors.initials: TL
authors.lastname: Tammela
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: D000368:Aged; D001294:Attitude to Health; D055088:Early Detection of Cancer / Q000523:psychology*; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010465:Perception; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D017430:Prostate-Specific Antigen