Prostate-specific antigen (PSA) screening for prostate cancer remains controversial due to lack of consistent survival benefits reported from clinical trials, and concerns about harms associated with overtreatment. However, it is also clear that certain individuals have higher than expected risks of aggressive disease due to genetic and possibly environmental factors and so understanding potential gaps in access could help better target appropriate screening for men at risk.
Our team recently published an article in Cancer Medicine examining access barriers that may influence receipt of PSA screening. We used data from the nationally representative Behavior Risk Factor Surveillance System in the US. This phone-based survey captures information on lifestyles, preventive care, and access to care and is designed to capture important sociodemographic and geographic variation in the US. We analyzed data from 2006-2020 surveys, using only even years because those were the surveys were questions about PSA were asked. We then organized responses about care seeking into access barriers (affordability – cost and insurance; accommodation – whether they have a regular primary care provider, whether a doctor recommended the test; spatial accessibility – whether they were physically close to a health care facility and had oncology and primary care providers in their city or town). We examined whether these barriers and facilitators were associated with receipt of screening, and whether associations varied by sociodemographic characteristics. The study found that a doctor’s recommendation was far and away the most important predictor of screening, leading to a 14-fold higher odds of receipt of PSA screening. Other barriers including lack of regular PCP, high perceived cost of medical care, and lack of insurance were associated with lower receipt of screening. Interestingly, stronger associations between barriers and screening receipt were observed in White and Asian male respondents compared to Hispanic and Black respondents, and among those with higher compared to lower educational attainment. Limitations of the study include potential selection bias due to the phone-based sampling design, which may have missed responses from certain racial and socioeconomic groups, and lack of small area estimates of residential neighborhoods. However, these findings can inform strategies to promote more appropriate screening by focusing on provider-patient communication.
The study can be accessed here.