Abstract
BackgroundWe examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults.MethodsThe study is based on health insurance claims data of the Helsana Group. The Helsana Group is one of the largest health insurers in Switzerland, insuring approximately 15% of the entire Swiss population across all regions and age groups. We assessed proportions of the eligible populations receiving colonoscopy/fecal occult blood testing (FOBT), mammography, or prostate-specific antigen (PSA) testing in the years 2014, 2016, and 2018, and calculated average marginal effects of individual, temporal, regional, insurance-, supply-, and system-related variables on testing utilization using logistic regression.ResultsOverall, 8.3% of the eligible population received colonoscopy/FOBT in 2014, 8.9% in 2016, and 9.2% in 2018. In these years, 20.9, 21.2, and 20.4% of the eligible female population received mammography, and 30.5, 31.1, and 31.8% of the eligible male population had PSA testing. Adjusted testing utilization varied little between 2014 and 2018; there was an increasing trend of 0.8% (0.6–1.0%) for colonoscopy/FOBT and of 0.5% (0.2–0.8%) for PSA testing, while mammography use decreased by 1.5% (1.2–1.7%). Generally, testing utilization was higher in French-speaking and Italian-speaking compared to German-speaking region for all screening types. Cantonal programs for breast cancer screening were associated with an increase of 7.1% in mammography utilization. In contrast, a high density of relevant specialist physicians showed null or even negative associations with screening utilization.ConclusionsVariation in cancer screening utilization was modest over time, but considerable between regions. Regional variation was highest for mammography use where recommendations are debated most controversially, and the implementation of programs differed the most.
Highlights
We examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults
While many guidelines consistently recommend the use of some preventive measures, such as colorectal cancer screening in certain age groups [6], other screenings, such as breast cancer screening, continue to be controversial because it is unclear whether lifetime benefits outweigh harms and costs in individuals [7]
Regional variation was highest for mammography use where recommendations are debated most intensively, and the implementation of programs differed considerably
Summary
Breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults. In Switzerland as well as internationally, public health officials and disease advocacy groups have worked hard in the past years to persuade the population of the importance of targeted cancer screening. These efforts have led to an increased uptake of screening, both in Switzerland and internationally, and have yielded intended results. Screening colonoscopy was associated with decreased colorectal cancer incidence and mortality [3, 4]. The proportion of colorectal cancer deaths preventable by colonoscopy use within 10 years has been estimated to be 30.7% in Germany, and 33.9% in the United States [5]. The burden associated with overdiagnosis and overtreatment is becoming an increasingly recognized issue
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