Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study

Abstract

Background 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. Methods The 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. Results Overall, 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. Conclusions Variation 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.

Ten-year changes in colorectal cancer screening in Switzerland: The Swiss Health Interview Survey 2007, 2012 and 2017

“…Spaeth et al looked at the 2007 SHIS data and found no difference in FOBT rate, though colonoscopy was more common in French-speaking regions ( Spaeth and Zwahlen, 2013 ). Based on health insurance claims data, Bähler et al found CRC testing rate was higher overall in Italian-speaking regions between 2014 and 2018 ( Bahler et al, 2021 ). Our results suggest that the decrease of FOBT rate was much less pronounced in French-speaking regions, as we found a small increase in the FOBT testing rate between 2012 and 2017.…”

“…The European Commission’s (EC) recommend a minimum screening rate of 45% by the 50–74 years-old, with a goal for screening rate of 65% ( Moss et al, 2012 ). Organized screening programs could enable Switzerland to meet this goal of 65% screening in the eligible population ( Bahler et al, 2021 ). Data about the efficacity of such programs on CRC testing in Switzerland are emerging (Bissig et al, Hempel-Bruder et al manuscripts in preparation, 2021) (2021a).…”