Prostate cancer screening practices in the Republic of Ireland: the determinants of uptake.
OBJECTIVE
The objectives of this paper are to analyse the determinants of prostate cancer screening uptake in the Republic of Ireland and to compare the role of non-need factors in uptake of screening among those in and outside the age range recommended as cost-effective for screening according to the European Randomised Study of Screening for Prostate Cancer (ERSPC).


METHODS
The investigation combined a logistic regression analysis of uptake, with an estimation of income-related concentration indices and decomposition of the indices using data collected as part of the Survey of Lifestyle and Nutrition (SLAN) 2007. Comparisons were made across groups differentiated by age in terms of the expected value of the prostate cancer screening.


RESULTS
Uptake of prostate screening in men 40 years and over in the preceding 12 months was approximately 24%. Uptake was higher among those in age groups that are perceived to receive most benefit from a Prostate Specific Antigen (PSA) test based on the findings of the ERSPC trial. Screening is highest in those with highest socioeconomic status and educational attainment, and who also hold private insurance cover. The largest socioeconomic inequality is observed for men over 70 years of age (0.2298). The smallest inequality was observed for those aged 55-69 (0.1573). Decomposition of the concentration indices shows that possession of private insurance is the largest determinant of inequality among those aged 55-69 (36%) and remains a significant determinant for those aged 40-54 (26%) and those aged 70 and over (17%).


CONCLUSIONS
There are high levels of prostate cancer screening uptake and significant income-related inequality in uptake in the Republic of Ireland. Given that the merits of prostate cancer screening overall and across different age groups are the subject of debate, the high levels of screening and income-related inequalities in uptake warrant closer attention and identification of potential policy responses.
J.E. Cairnes School of Business and Economics, National University of Ireland Galway.
Richéal
R
Burns
Brendan
B
Walsh
Linda
L
Sharp
Ciaran
C
O'Neill
D000328:Adult; D000367:Age Factors; D000368:Aged; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000517:prevention & control*; D012959:Socioeconomic Factors