title: Determinants of participation in prostate cancer screening: a simple analytical framework to account for healthy-user bias.
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.
authors.affiliation: Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Urban Research Plaza, Osaka City University, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tabuchi
authors.forename: Tomio
authors.initials: T
authors.lastname: Nakayama
authors.forename: Wakaba
authors.initials: W
authors.lastname: Fukushima
authors.forename: Ichiro
authors.initials: I
authors.lastname: Matsunaga
authors.forename: Satoko
authors.initials: S
authors.lastname: Ohfuji
authors.forename: Kyoko
authors.initials: K
authors.lastname: Kondo
authors.forename: Eiji
authors.initials: E
authors.lastname: Kawano
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fukuhara
authors.forename: Yuri
authors.initials: Y
authors.lastname: Ito
authors.forename: Akira
authors.initials: A
authors.lastname: Oshima
mesh_terms: D000328:Adult; D015982:Bias; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010358:Patient Participation; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology
keywords: Determinants of participation; Japan; healthy-user bias; prostate cancer screening; prostate-specific antigen test