Health agencies and guidelines have proposed various recommendations regarding breast
and prostate cancer screening intervals for older adults. However, there is limited
data about factors that could impact older individuals' adherence to these guideline-based
intervals. This study emphasized the differences in screening rates between men and
women undergoing screening for breast (mammogram) and prostate (prostate-specific
antigen [PSA] test) cancer. It also investigated the socio-demographic and emotional
factors associated with screening time intervals.
Materials and Methods
This cross-sectional design study used data from the National Social Life Health and
Aging Project Wave 3 (NSHAP-W3, 2015). The outcome measures were screening time intervals
(PSA test or mammogram). Individuals were asked, “About how long has it been since
you last had a screening?” Response categories ranged from 1 = within the past year
to 5 = never. Differences in screening time intervals were evaluated and displayed
by age group (PSA vs. mammogram). The association between the outcome measures and
participants' characteristics was evaluated via ordinal logistic regression.
There were 2320 participants included: 52% women and 48% men. They had a mean age
of 66.9 years old, were mostly White (74%) and college graduates (68%). The average
time interval between screenings was greater for PSA testing than mammography (mean
[M] = 2.28 vs. M = 1.89, p < 0.001). The middle age groups (PSA: 60–79 and mammogram: 65–74), had significantly
more frequent screenings compared to the youngest group (50–54). In contrast, older
(80+) individuals did not display shorter screening time intervals compared to the
youngest group. Furthermore, shorter time intervals between screenings were associated
with higher household income (mammogram: odds ratio [OR] = 0.804; PSA: OR = 0.785,
p < 0.05), African American descent (mammogram: OR = 0.458, p < 0.001), and higher frequency of physical activity (PSA: OR = 0.921, p = 0.030). Lastly, women who responded “yes” to skipping care due to lack of insurance
reported longer periods between mammograms (OR = 1.784, p = 0.002).
Findings from this real-world US population representative database highlight the
role of age, income, and insurance in the timing between screenings; participants
aged between 60 and 79 years old, African American women, and physically active men
are more likely to pursue earlier screening. These results emphasize the importance
of socioeconomic and lifestyle factors when seeking to impact screening timing.