title: Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities.
abstract: BACKGROUND
  Despite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators.
  
  
  METHODS
  We used multivariable Poisson regression to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and use of healthcare.
  
  
  RESULTS
  The study included 12,034 men aged ≥50 years (mean age: 63.9). Between 1992 and 2012, ever use of PCa screening increased from 55.3% to 70.0% and its use within the last two years from 32.6% to 42.4% (p-value <0.05). Income, education, and occupational class were independently associated with PCa screening. PCa screening within the last two years was greater in men with the highest (>$6,000/month) vs. lowest income (≤$2,000) (46.5% vs. 38.7% in 2012, PR for overall period =1.29, 95%CI: 1.13-1.48). These socioeconomic disparities did not significantly change over time.
  
  
  CONCLUSIONS
  This study shows that about half of Swiss men had performed at least one PCa screening. Men belonging to high socioeconomic status are clearly more frequently screened than those less favored. Given the uncertainty of the usefulness of PCa screening, men, including those with high socioeconomic status, should be clearly informed about benefits and harms of PCa screening, in particular, the adverse effect of over-diagnosis and of associated over-treatment.
authors.affiliation: Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Emory University, Department of Epidemiology, Atlanta, GA, USA; Division of chronic diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: idris.guessous@hcuge.ch.
authors.forename: Idris
authors.initials: I
authors.lastname: Guessous
authors.affiliation: Unit of population epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Cullati
authors.affiliation: Emory University, Department of Epidemiology, Atlanta, GA, USA; American Cancer Society, Atlanta, GA, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Fedewa
authors.affiliation: Department of sociology, University of Geneva, Geneva, Switzerland.
authors.forename: Claudine
authors.initials: C
authors.lastname: Burton-Jeangros
authors.affiliation: Division of quality of care, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Courvoisier
authors.affiliation: School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Manor
authors.affiliation: Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Bouchardy
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000639:trends*; D008875:Middle Aged; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013557:Switzerland
keywords: Disparities; PSA; Socioeconomic status; Switzerland; Trends