Determinants of participation in prostate cancer screening: a simple analytical framework to account for healthy-user bias.
Bottom Line: 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.
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.Show MeSH
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Mentions: We used a simple analytical framework using only the “responders” sample to explore determinants of cancer screening participation among cancer-screening responders. The separation of “responders” and “non-responders” is important for conceptualization. “Responders” for cancer screening (at least once) may be likely to participate in all kinds of cancer screening and have common shared factors as stated in the introduction. The difference between “total subjects” analysis (usual method) and “among-responders” analysis is only whether the “non-responders” sample is included in the reference category (counterpart of outcome) or not. For cancer screening participation research, a possible combination of outcome and counterpart with responders' definition was the case of PSA test versus only FOBT (among “responders” for at least one of either PSA test or FOBT) (Fig.1). The reason for separating “responders” into outcome and counterpart should be rational: i.e. PSA-based screening was not recommended, regardless of participation in recommended FOBT. To investigate and interpret the applicability and the effectiveness of the framework, we used data from our previous study21 as a case of PSA testing and FOBT among men (Fig.1) according to the population-based cancer screening recommendations.1,2,4,8,10,22 “Cancer-screening non-responders” were defined as men who reported no screening participation in either FOBT or PSA testing. PSA-based screening participation (with or without FOBT) was defined as an “un-recommended” participation in cancer screening. Those who reported receiving only a FOBT (without PSA-based screening) were categorized as men receiving “recommended” modality for cancer screening, because FOBT is an acceptable and recommended screening according to Japanese and worldwide guidelines.2,8
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.