Sociodemographic and health-related predictors of self-reported mammogram, faecal occult blood test and prostate specific antigen test use in a large Australian study

Marianne F Weber,Dianne O’Connell,Freddy Sitas,Michelle Cunich,David P Smith,Glenn Salkeld

doi:10.1186/1471-2458-13-429

Abstract

BackgroundWhile several studies have examined factors that influence the use of breast screening mammography, faecal occult blood tests (FOBT) for bowel cancer screening and prostate specific antigen (PSA) tests for prostate disease in Australia, research directly comparing the use of these tests is sparse. We examined sociodemographic and health-related factors associated with the use of these tests in the previous two years either alone or in combination.MethodsCross-sectional analysis of self-reported questionnaire data from 96,711 women and 82,648 men aged 50 or over in The 45 and Up Study in NSW (2006–2010).Results5.9% of men had a FOBT alone, 44.9% had a PSA test alone, 18.7% had both tests, and 30.6% had neither test. 3.2% of women had a FOBT alone, 56.0% had a mammogram alone, 16.2% had both and 24.7% had neither test. Among men, age and socioeconomic factors were largely associated with having both FOBT and PSA tests. PSA testing alone was largely associated with age, family history of prostate cancer, health insurance status and visiting a doctor. Among women, age, use of hormone replacement therapy (HRT), health insurance status, family history of breast cancer, being retired and not having a disability were associated with both FOBT and mammograms. Mammography use alone was largely associated with age, use of HRT and family history of breast cancer. FOBT use alone among men was associated with high income, living in regional areas and being fully-retired and among women, being fully-retired or sick/disabled.ConclusionsThese results add to the literature on sociodemographic discrepancies related to cancer screening uptake and highlight the fact that many people are being screened for one cancer when they could be screened for two.

Highlights

While several studies have examined factors that influence the use of breast screening mammography, faecal occult blood tests (FOBT) for bowel cancer screening and prostate specific antigen (PSA) tests for prostate disease in Australia, research directly comparing the use of these tests is sparse
We found that 45 and Up Study participants were more than twice as likely to have a FOBT for bowel cancer if they had had a mammogram or a PSA test [30]
We chose the lower age limit of 50 years because screening for bowel and breast cancer is not recommended for people younger than 50 if they are at normal risk, as is PSA testing for prostate cancer in some Australian guidelines

Summary

Introduction

While several studies have examined factors that influence the use of breast screening mammography, faecal occult blood tests (FOBT) for bowel cancer screening and prostate specific antigen (PSA) tests for prostate disease in Australia, research directly comparing the use of these tests is sparse. There is clear evidence that early detection of breast and bowel cancer via screening reduces the mortality associated with these diseases [2,3,4] and Australia has national, government-funded screening programs for both. Among Australian women, participation in the breast cancer screening program is around 55% (in the target age group of 50–69 years) [9]. In the bowel cancer screening program the participation rate among those invited is around 38.4% (currently only people turning 50, 55 and 65 are invited via a mailed, faecal occult blood test; FOBT) [12]. A nationally representative study ten years ago found that 63% of men aged >50 years had ever had a PSA test [13] and this proportion is likely to have risen significantly since [8,14]

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