Concurrent utilisation of cancer screening tests in the general population aged 50–69: an analysis of the 2017 Swiss Health Survey

Abstract

Objectives:

This study assessed the extent and factors of concurrent utilisation of cancer screenings in Switzerland.

Methods:

Data from the 2017 Swiss Health Survey, representing 1,091,813 females and 1,072,940 males aged 50–69, were analysed. Weighted descriptive analyses estimated sex-specific proportions of individuals concurrently up to date with recommended screening for cervical, breast, colorectal, prostate and skin cancer. Multivariable binomial weighted logistic regressions examined associations between concurrent utilisation and sociodemographic, lifestyle, health, health services utilisation, security and social support factors.

Results:

Approximately one in three Swiss residents were concurrent screening users. Concurrent utilisation increased with age and frequent medical visits. Among females, concurrent utilisation was positively associated with living in French- or Italian-speaking Switzerland and having tertiary education, and negatively associated with being divorced, separated or widowed, and with non-European origin. Among males, concurrent utilisation was positively associated with income, and negatively associated with unhealthy lifestyles, low health concern, and higher health insurance deductibles.

Conclusion:

Further research is needed to clarify the factors underlying differences in screening behaviours. Given the temporal instability of these behaviours, the findings should be interpreted cautiously.

Introduction

The health and economic burden associated with cancer, such as potential years of life lost (PYLL), loss of productivity, or costs of treatment, represents a major public health problem in many countries [1–3].

In Switzerland, cancer accounts for the highest number of PYLL before age 70 [4](p.17) and is the second leading cause of death [5]. Prostate and breast cancers are the most commonly diagnosed cancers among men and women, respectively, followed by lung cancer, colorectal cancer, and melanoma [6]. Cervical cancer, although less common, remains a health concern, particularly among women who do not participate in Human Papillomavirus (HPV) vaccination and screening. While age-standardised incidence rates for most cancers are expected to stabilise by 2025, a large increase in the number of new cases across all cancer types is predicted, driven by population aging and growth [7].

Screening is an effective means to reduce the burden of several common cancers [8–12]. Current screening recommendations for the most common cancer types in Switzerland are outlined hereafter. For breast cancer, biennial mammography screening is recommended for women aged 50–74 [13]. Colorectal cancer screening is recommended for women and men aged 50–74, using either colonoscopy every 10 years or biennial faecal occult blood test (FOBT) [14]. Cervical cancer screening with a Papanicolaou (Pap) smear is recommended from age 21, and HPV testing from age 30, with screening continued every 3 years until age 70 [15, 16]. For prostate cancer screening, there is no consensus in Switzerland; however, some experts and the Swiss Urology Society recommend offering PSA-guided screening to men aged 50–69 within a shared decision-making process [17, 18], in line with the recommendations of the European Association of Urology [19]. The recommended frequency of screening varies according to risk category but is 2 years for most individuals [20, 21]. Lung cancer screening is recommended with a LDCT for high-risk individuals [22]. Despite its high incidence of melanoma,4(p.43), [23] there is no recommendation for skin cancer screening in Switzerland. However, it has participated in the annual Euromelanoma campaigns since their inception, with a National Skin Cancer Screening Day [24, 25].

In Switzerland, not all recommended screening tests are necessarily reimbursed [26]. The costs of tests for the early detection of cancer in the general population (not high-risk groups) are covered by the universal Swiss health insurance under specific conditions: two annual Pap smear for cervical cancer screening are covered for women aged 21–70, and then in case of normal results, every 3 years; a mammography as part of an organised programme from age 50 is covered without deductible every 2 years, and a colonoscopy or a FOBT between age 50–74 (50–69 at the time of the study) are covered every 10 or 2 years, respectively (if it is part of an organised cantonal programme, no deductible is charged) [27]. (art. 12e) An opportunistic mammography for breast cancer screening is thus not covered (except for high-risk women) while colorectal cancer screening is covered when opportunistic or organised. Population-based, regional programmes exist only for breast and colorectal cancer screening, and participation in these organised programmes is recommended over opportunistic screening. However, as healthcare is primarily organised and delivered by the cantons (i.e., administrative states), the availability of breast and colorectal screening programmes varies from canton to canton [28]. Thus, for most types of cancer, screening occurs opportunistically in the general population.

Studies, in Switzerland and beyond, have found numerous factors associated with cancer screening utilisation, including socioeconomic factors [29–36], ethnic or racial background [29, 36], living in rural areas [30, 32], health behaviours [37], health services utilisation [32, 35], and health insurance coverage [34, 38]. Current evidence on cancer screening behaviour also supports the hypothesis of complementarity between cancer screenings, with individuals undergoing one type of screening being more likely to participate in other cancer screenings [32, 37, 39–42].

Fewer studies have examined the use of concurrent (i.e., multiple) cancer screenings [41, 43–49], reporting wide variations in the proportion of individuals using multiple screenings. Non-utilisation of concurrent cancer screenings has been reported to be associated with socioeconomics factors, such as low education, high social deprivation [45–48], and ethnic background [49], as well as low self-rated health status [45], albeit the association of comorbidities with concurrent utilisation of cancer screenings appears unclear [47, 48]. Overall, these social inequalities in preventive health-seeking behaviours contribute to broader social health inequalities.

However, practices of cancer screening differ considerably between countries. In Switzerland, studies have reported temporal and mainly regional variations in utilisation of breast, colorectal and prostate cancer screenings [50–52]. However, to date, no information is available on the extent and factors associated with concurrent screening among Swiss residents.

Using data from the nationwide 2017 Swiss Health Survey (SHS), we aimed to determine the proportion of concurrent utilisation of cancer screenings and identify factors associated with it. Understanding patterns of multiple screening could identify gaps in preventive care delivery and population groups who may benefit from targeted interventions, guiding the development of effective strategies to optimise cancer screening utilisation and ultimately reduce social health inequalities.

Methods

Data source

The SHS is a cross-sectional, nationwide, population-based quantitative survey conducted every 5 years by the Federal Statistics Office (FSO), using a random sample of the permanent resident population aged 15 [53]. The FSO stratifies the sample by canton and weights the results by region of residence, age, sex, nationality, marital status, and household size in order to have a representative sample of the Swiss population across all linguistic regions. Information is collected through a telephone interview or, in case of difficulties to answer, through a face-to-face or a proxy interview, followed by a written questionnaire (except for proxy interviews). In 2017, 22,134 of 43,769 (51%) contacted individuals participated in a telephone (21,205), face-to-face (20) or proxy (909) interview between 16 January and 22 December 2017. Of the 21,225 individuals invited to fill the written questionnaire, 18,832 (89%) completed it. The interview and written questionnaires are available on the FSO website [54].

The analysis was restricted to participants aged 50–69 who completed both the telephone interview and written questionnaire. This restriction ensured alignment with the target age range of most cancer screening guidelines [55], allowed inclusion of security support data (available in the written questionnaire), and minimised potential bias from face-to-face or proxy interviews.

Concurrent utilisation of cancer screenings

The 2017 SHS collected screening information for breast, colorectal, prostate, cervical and skin cancers. In order to target the profiles of regular users more accurately, the utilisation of a cancer screening was defined as the last self-reported preventive test performed within recommended intervals in Switzerland: a mammography within the past 2 years for breast cancer [13]; a colonoscopy or faecal occult blood test (FOBT) within the past 10 or 2 years for colorectal cancer [14]; a prostate-specific antigen (PSA) test or digital rectal exam within the past 2 years for prostate cancer [17, 33]; a Pap test within the past 3 years for cervical cancer [15]. As there is no recommendation about frequency of visual inspection for skin cancer in the Swiss general population, a limit was set arbitrarily at 5 years.

In the absence of a standard definition, concurrent utilisation was defined as the maximum number of recommended screening tests minus one, avoiding overly restrictive criteria given the lack of formal skin cancer screening recommendations. Concurrent utilisation is thus a proxy for multiple utilisation patterns. For females, the primary outcome measure was concurrent utilisation of breast, colorectal, cervical, and skin cancer screenings (two or fewer screenings as reference; three or four screenings as concurrent utilisation). For males, the primary outcome measure was concurrent utilisation of colorectal, prostate, and skin cancer screenings (one or fewer screenings as reference; two or three screenings as concurrent utilisation).

Statistical analyses

Five sets of covariates, identified from the available literature as potentially associated with cancer screening utilisation, were included: sociodemographic, lifestyle, health, health services utilisation, and social security and support factors.

All analyses were performed separately by sex assigned at birth (female/male). Age was centred on the mean, and other continuous variables were categorised according to their distribution. For each covariate, missing values (22.8% and 18.7% in total across all covariates for females and males, respectively) were included as a separate category (not displayed) in multivariable analyses.

Multicollinearity between all pairs of variables was assessed using Spearman rank correlation test (cut-off 0.5) before model fitting. When two highly correlated variables measured the same underlying dimension, the most informative variable (e.g., number of medical visits rather than having ever had one medical visit in the past year) was retained in multivariable analyses to keep models parsimonious and maximise statistical power.

The sampling weight of the written survey, as recommended by the FSO, was applied in all analyses to ensure proportional representation of the Swiss population in terms of region of residence, age, sex, and socioeconomic status[53] (p.20). Descriptive statistics are presented as unweighted counts, weighted counts, and weighted percentages with 95% confidence intervals (CI).

Multivariable binomial weighted logistic regression models were first performed separately for each set of covariates to examine the association between concurrent utilisation and each set-specific covariates. For each set-specific model, a backward stepwise selection procedure was applied. Variables showing a significant association with the outcome at the Akaike information criterion threshold (p < 0.157) [56–58] were retained in the set-specific model. For each variable removed by this procedure, a Wald test was performed to assess whether its inclusion would improve model fit. Variables showing a significant improvement (p < 0.05), were retained in the set-specific model.

All variables retained in the set-specific models were included to build a final combined model encompassing the five set of covariates. Multivariable binomial weighted logistic regression models were performed separately for females and males to examine the associations between concurrent utilisation and each covariate, following the same methodology described above for the set-specific models. In addition, all variables removed at the initial step (set-specific models) were reassessed using a Wald test, and included in the final model if they showed a significant effect [56]. For each model, adjusted odds ratios (aORs) and 95% CI were calculated. Data were analysed using Stata 17.

Results

Three thousand four hundred and thirty-six females and 3,081 males aged 50–69 completed both the telephone interview and written questionnaire, representing 1,091,813 and 1,072,940 Swiss female and male residents, respectively. Table 1 summarises the characteristics of each target population. The most represented categories were being aged 50–54, married, employed and Swiss, having achieved secondary education and an annual deductible of 300 Swiss Francs (CHF), and living in German-speaking Switzerland, in an urban area, as a couple without children. Most females and males were relatively healthy, which was consistent with the higher proportion of individuals who reported paying attention to their lifestyle to maintain health and who perceived their health as very good or good. Most females and males reported having had at least one medical visit and no hospitalisation in the past year, as well as moderate or high social support. Differences between the sexes were also observed. The most frequently reported equivalised disposable income (EDI) (i.e., net monthly income adjusted for household size) was CHF 3,000–4,499 among females and CHF 6,000 or higher among males (1 CHF ≈1.07 Euro ≈1.25 US Dollar as of January 2026). Females more frequently reported consuming 3-4 portions of fruit and/or vegetables per day, whereas intake was lower among males. Most females had a normal weight, whereas the most represented category among males was overweight.

Most females had undergone a screening test within recommended intervals for cervical cancer (69.9%, 95% CI: 68.0–71.7), whereas slightly fewer than half had undergone screening for breast (49.0%, 95% CI: 47.0–51.0) and colorectal (44.6%, 95% CI: 42.7–46.6) cancers (Figure 1). Less than half of males had undergone colorectal (43.9%, 95% CI: 41.8–46.0) and prostate (39.4%, 95% CI: 37.4–41.4) cancer screening within the recommended intervals. Approximately one in three females (35.7%, 95% CI: 33.8–37.6) and males (31.7%, 95% CI: 29.8–33.7) had a skin examination in the last 5 years.

FIGURE 1

The proportion of concurrent screening was similar between females (34.4%, 95% CI: 32.6–36.3) and males (35.6%, 95% CI: 33.6–37.6) (Figure 2).

FIGURE 2

Table 2 shows results from the multivariable models. Concurrent utilisation of cancer screenings among females increased with age (OR per year = 1.03). Females living in French- or Italian-speaking Switzerland were approximately 2.3 times more likely to concurrently use cancer screenings than those living in the German-speaking region. Females with tertiary education and those with several medical visits in the past year were also more likely to report concurrent utilisation. The odds of concurrent utilisation increased 2.7 times for females with 2-3 medical visits, and approximately 4.7 times for those with 4 or more visits.

Divorced or separated females (aOR=0.72, 95% CI: 0.56–0.92) and widows (aOR=0.56, 95% CI: 0.38–0.81) were less likely to report concurrent utilisation than married females. Non-European females were also less likely to report concurrent utilisation (aOR=0.06, 95% CI: 0.00–0.65) compared with Swiss females, albeit this finding was based on a small number of non-European participants (Table 1). Concurrent utilisation was approximately 20% lower among females consuming 0–2 portions of fruits and/or vegetables per day compared with those consuming 3-4 portions (aOR=0.79, 95% CI: 0.63–0.99), and among smokers compared with non-smokers (aOR=0.79, 95% CI: 0.63–1.00). Females with an EDI below CHF 3,000 were less likely to be concurrent screening users than those with an EDI above CHF 6,000. Concurrent utilisation also tended to be lower among those who had been hospitalised in the past year and among those with lower levels of social support.

Among males, concurrent utilisation of cancer screenings increased markedly with age (OR per year = 1.07). Household type was associated with concurrent utilisation with suggestive evidence that males living alone, as a single parent, or in a multi-family household were less likely concurrent users, whereas those living as a couple with children were more likely to be concurrent users. Males with an EDI of CHF 4,500 or higher were more likely to use cancer screening concurrently than those with an EDI of CHF 3,000–4,499. The odds of concurrent utilisation increased approximately two-to-three-fold among those with several medical visits in the past year.

Males who reported no concern for their health had lower odds of concurrent utilisation (aOR=0.62, 95% CI: 0.45–0.85). Regarding lifestyle factors, concurrent utilisation was 34% lower among physically inactive males compared with those who were sufficiently active (aOR=0.66, 95% CI: 0.45–0.97), and among those with moderate or high-risk alcohol consumption compared with those at low risk (aOR=0.65, 95% CI: 0.43–1.00). There was also suggestive evidence that males with a chronic disease were less likely to use cancer screening concurrently (aOR=0.82, 95% CI: 0.67–1.01). Compared with those with the lowest annual deductible of CHF 300, males with a higher deductible were less likely to be concurrent users.

Discussion

We estimated that one in three Swiss individuals reported concurrent utilisation of recommended cancer screenings. Previous nationwide studies investigating concurrent utilisation of cancer screenings have reported a range from 27% to 55% of individuals being up-to-date with all recommended screenings [41, 45, 46, 48, 49], likely reflecting differences in study design, screening culture, and screening delivery. Overall, studies based on data from organised programmes reported higher proportions of concurrent screenings, up to 55% in Denmark [41, 49]. Most previous studies focused on females, and the full utilisation of breast, cervical, and colorectal cancer screenings. Although our outcome reflected near-complete concurrent utilisation, the results are largely comparable, as skin cancer screening, which is rarely included in international studies, has no formal recommendation in Switzerland. The proportion of concurrent utilisation in Switzerland was comparatively lower than in countries with more extensive organised cancer screening programmes, but aligns with recent national surveys investigating opportunistic and organised cancer screening, reporting 27% in Japan [45] and 42% among females and 29% among males in the United States [49].

One of the main findings was that factors associated with concurrent utilisation differed between sexes. The few common factors were increasing age, higher income and several medical visits in the past year. A substantially greater increase per year of age was observed in males than in females aged between 50–69. Younger individuals, particularly males, may perceive themselves as being at lower risk of cancer due to their age, or they may be harder to sensitise because of less frequent contact with healthcare providers. Income was significantly associated with concurrent utilisation, especially among males, suggesting that preventive health services may be a lower priority for males and are more likely to be used only by those with higher salaries. However, these results should be interpreted with caution because of the large number of missing income values. Of other sociodemographic factors, higher education, marital status, nationality, and linguistic region were all positively associated with concurrent utilisation, but only among females. In the Netherlands, higher levels of participation were observed among females with higher median household income [46]. Previous studies have also shown that full utilisation of cancer screenings was associated with higher educational attainment [45, 49]. Concurrent utilisation of screening tests was also associated with household type among males. This suggests that males may be more inclined to undergo screening when living with someone who does, especially a female, who is more likely to engage in cancer screening [59–61]. Additionally, a recent U.S. study reported a positive association between living with someone and being up-to-date with screening recommendations [62]. Regarding regional variations, higher utilisation of cancer screening in French- and Italian-compared with German-speaking Switzerland was observed separately for colorectal, breast and prostate cancer screening [50, 51, 63]. Greater use of health services and the broader availability of organised screening programmes (breast, colorectal) in Latin-speaking Switzerland likely contributed to these regional differences.

Among lifestyle factors, higher consumption of fruits and/or vegetables and current non-smoking status were suggestively associated with concurrent utilisation among females, whereas higher levels of physical activity and low-risk alcohol consumption were associated with concurrent use of cancer screening among males. In Japan, female smokers were also less likely to participate in cancer screening [45]. In a regional study in France, lower concurrent utilisation of organised breast and colorectal cancer screenings, as well as opportunistic cervical cancer screening, were associated with low levels of physical activity and smoking [43]. The association between unhealthy lifestyle factors and lower concurrent utilisation may reflect a low degree of health concern. Indeed, males without concern for their health were less likely to use cancer screening concurrently in Switzerland. Furthermore, having a chronic disease or a long-term health problem was associated with an 18% reduction (95%CI: −33%, +1%) in the odds of concurrent utilisation among males. In England, a nationwide case-control study among females reported that concurrent participation in all three recommended cancer screening programmes was higher in areas where general practices had more patients with a chronic disease [48]. In contrast, a regional study found that participation, although not concurrent, in all three programmes was more likely to be higher in females with few comorbidities or a history of benign neoplasms [47]. Overall, these results highlight the potentially ambivalent effect of chronic conditions on preventive care. Although individuals with chronic diseases have more frequent interactions with the healthcare system and may thus be more exposed to cancer screening recommendations, the demands of managing their illness can create competing priorities that reduce their likelihood of participating in screening. Accounting for the severity and type of comorbidity in future studies may help clarify the association between comorbidities and concurrent cancer screening use.

Several medical visits in the past year were strongly associated with concurrent utilisation in both sexes. Our findings corroborate those from a French survey, which reported that females who visited a gynaecologist or general practitioner in the past year were more likely to participate in at least two of three screenings for breast, colorectal and cervical cancer [43]. This underscores the key role of healthcare providers in promoting cancer screening and aligns with our observation of higher concurrent utilisation in the Latin Swiss regions, where general practitioners and gynaecologists facilitate access to organised screening programmes. As most cancer screenings involve medical visit(s), the observed association between visit frequency and concurrent screening utilisation may be artificially amplified, despite considering only visits in the past year.

Our results indicated that low social support may reduce the likelihood of concurrent screening among females, echoing recent findings of a positive association between social support and cancer screening participation in the U.S. [62]. An annual deductible above the legal minimum of CHF 300 was associated with decreased odds of concurrent utilisation among males. In contrast, an earlier Swiss study using 2012 SHS data reported no differences in patterns of screening utilisation for prostate, colorectal, or skin cancer according to annual deductible [32]. However, among females, higher deductibles were associated with lower odds of undergoing breast and cervical cancer screening, but not colorectal or skin cancer screening [32]. Higher annual deductibles are likely correlated with higher income and socioeconomic status.

In Switzerland, concurrent utilisation of cancer screening appears to be primarily influenced by sociodemographic factors among females and lifestyle and health factors among males. These findings have potentially important implications for cancer prevention. Interventions targeting females with persistently low screening rates due to sociodemographic characteristics and males with unhealthy lifestyle, might enhance screening uptake. Furthermore, sensitizing younger age groups (i.e., around 50 years) about benefits of regular cancer screening is important, as cancer risk strongly increases with age.

Strengths

Our study provides the first insights into patterns of concurrent cancer screening utilisation in the Swiss population aged 50–69 and explores multiple multidimensional factors likely to be associated with screening practices, including rather rare variables that approximate individuals’ health preferences and attitudes toward their health. Results from this randomly selected, nationwide, stratified sample are representative of the Swiss population, and weighting reduces potential selection bias due to non-response. Finally, structured interviews conducted by trained professionals ensure the quality and consistency of SHS data.

Limitations

The SHS was not specifically designed for the purposes of our research (e.g., questions on prior cancer diagnosis were limited to the past year, with no information on cancer type, preventing any assessment of associations with related cancer screenings). The cross-sectional design poses measurement limitations. Substantial heterogeneity in recommended screening intervals across cancer types - from biennial to decennial - may introduce differential recall bias, such that observed associations may not reflect long-term adherence. Because screening intervals are designed to align with the natural history and biological progression of each cancer, a cross-sectional snapshot may not accurately capture the sustained utilisation required for clinical efficacy. Potential response bias may arise from self-reported data. Social desirability bias could have led to overestimation of healthy behaviours and underestimation of less healthy behaviours. However, the estimated proportion of cancer screenings utilisation closely matched data from organised programmes [64], and numerous indicators of health behaviour corresponded to estimates from other sources [65] (p.30,p.49), [66] (p.35). While male and female results are discussed in relation to one other, direct comparison is limited by differences in recommended screenings, accessibility, statistical models, and definition of concurrency. Under our definition, men can achieve concurrency through two easily accessible screenings conducted during routine medical visits (e.g., prostate and skin), whereas women must complete three screenings, including at least one that requires a scheduled procedure (e.g., breast or colorectal) to meet the criteria for concurrent utilisation. Finally, the results may not be fully representative of the Swiss population for factors unadjusted by survey weights (e.g., income) due to missing data. Multiple imputation was not applied because missingness for key socioeconomic variables was likely not missing at random, suitable auxiliary variables to support robust imputation were limited, and the complex survey design and weighting structure would have required strong reliance on untestable imputation assumptions. Given the absence of a significant association between missing categories and the outcome, except for annual deductible among men, which suggests minimal bias attributable to missing data, missing values were handled as a separate category to ensure transparency and preserve sample size.

Further studies are warranted to better understand the mechanisms underlying different user profile. In particular, reasons for adherence with one screening recommendation but not others, and the mediating pathways linking unhealthy behaviours, chronic disease, and low health concern need to be explored. Given the temporal instability of screening behaviours, findings from a single survey may not fully capture the sustained adherence required for clinical efficacy and should be interpreted with caution when informing policy changes in cancer screenings.

References

• 1.

  National Cancer Institute. Research areas: cancer and public health - NCI (2015). Available online at: https://www.cancer.gov/research/areas/public-health (Accessed April 5, 2023).

  • Google Scholar

• 2.

  HanlyPASharpL. The cost of lost productivity due to premature cancer-related mortality: an economic measure of the cancer burden. BMC Cancer (2014) 14(1):224. 10.1186/1471-2407-14-224

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 3.

  BrustugunOTMøllerBHellandÅ. Years of life lost as a measure of cancer burden on a national level. Br J Cancer (2014) 111(5):1014–20. 10.1038/bjc.2014.364

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 4.

  Federal Statistical Office. Le Cancer En Suisse, Rapport 2021 - Etat Des Lieux Et Évolutions (Cancer in Switzerland, 2021 Report - Current Situation and Trends). Neuchâtel:Office fédéral de la statistique (2021). Available online at: https://www.bfs.admin.ch/asset/en/19305697 (Accessed March 30, 2023).

  • Google Scholar

• 5.

  Office fédéral de la statistique. Causes spécifiques de décès (Specific causes of death) (2022). Available online at: https://www.bfs.admin.ch/bfs/fr/home/statistiques/sante/etat-sante/mortalite-causes-deces/specifiques.html (Accessed October 20, 2022).

  • Google Scholar

• 6.

  National Agency for Cancer Registration. Cancer incidence 1982-2021 (2024). Available online at: https://onec.ch/en/downloads-and-links?cat=33 (Accessed May 1, 2025).

  • Google Scholar

• 7.

  TrächselBRapitiEFellerARoussonVLocatelliIBulliardJL. Predicting the burden of cancer in Switzerland up to 2025. PLOS Glob Public Health (2022) 2(10):e0001112. 10.1371/journal.pgph.0001112

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 8.

  ZielonkeNGiniAJansenEELAnttilaASegnanNPontiAet alEvidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: a systematic review. Eur J Cancer (2020) 127:191–206. 10.1016/j.ejca.2019.12.010

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 9.

  JansenEELZielonkeNGiniAAnttilaASegnanNVokóZet alEffect of organised cervical cancer screening on cervical cancer mortality in Europe: a systematic review. Eur J Cancer (2020) 127:207–23. 10.1016/j.ejca.2019.12.013

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 10.

  GiniAJansenEELZielonkeNMeesterRGSSenoreCAnttilaAet alImpact of colorectal cancer screening on cancer-specific mortality in Europe: a systematic review. Eur J Cancer (2020) 127:224–35. 10.1016/j.ejca.2019.12.014

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 11.

  Giorgi RossiPVicentiniMSacchettiniCDi FeliceECaroliSFerrariFet alImpact of screening program on incidence of colorectal cancer: a cohort study in Italy. Am J Gastroenterol (2015) 110(9):1359–66. 10.1038/ajg.2015.240

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 12.

  SerrainoDGiniATaborelliMRoncoGGiorgi-RossiPZappaMet alChanges in cervical cancer incidence following the introduction of organized screening in Italy. Prev Med (2015) 75:56–63. 10.1016/j.ypmed.2015.01.034

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 13.

  Swiss Cancer Screening. Early detection through mammography. Swiss Cancer Screen (2014): 6. Available online at: https://www.swisscancerscreening.ch/fileadmin/user_upload/Documents/SwissCancerScreening/WWW/Editors/Downloads/Brustkrebs/Downloads_Fremdsprachen_Brustkrebs/Brosch%C3%BCre_englisch_Fr%C3%BCherkennung_Mammografie.pdf.(Accessed April 11, 2023).

  • Google Scholar

• 14.

  Swiss Cancer Sceening. Méthodes De Dépistage Du Cancer Colorectal (Colorectal Cancer Screening Methods). Swiss Cancer Screening (2023). Available online at: https://www.swisscancerscreening.ch/fr/depistage-du-cancer/colon/methodes-de-depistage (Accessed September 22, 2023).

  • Google Scholar

• 15.

  Société Suisse de Gynécologie et d’Obstétrique. Nouvelles recommandations de la SSGO gynécologie suisse pour la prévention du cancer du col de l’utérus (New recommendations from the SSGO Swiss Gynaecology for the prevention of cervical cancer) (2018). Available online at: https://www.sggg.ch/fr/nouvelles/positions/ (Accessed April 5, 2023).

  • Google Scholar

• 16.

  MurtasMRolland-GuillardLHuKWisniakAZwahlenMPetignatPet alAutoprélèvement HPV et dépistage du cancer du col utérin. Rev Med Suisse (2025) 935:1827–31. 10.53738/revmed.2025.21.935.47907

  • CrossRef
  • Google Scholar

• 17.

  PratsinisMEngelerD. Recommandations actuelles pour le dépistage du cancer de la prostate (Current recommendations for prostate cancer screening) (2023). Available online at: https://www.medinfo-verlag.ch/recommandations-actuelles-pour-le-depistage-du-cancer-de-la-prostate/ (Accessed April 11, 2023).

  • Google Scholar

• 18.

  GasserTIselinCJichlinskiPKreienbühlBMerzVReckerFet alDosage du PSA - Recommandations de la Société suisse d’Urologie (SSU) (2012) 12(06):126–8.

  • Google Scholar

• 19.

  EAU Guidelines on Prostate Cancer - Uroweb. Uroweb - European association of urology. (2023). Available online at: https://uroweb.org/guidelines/prostate-cancer (Accessed April 5, 2023).

  • Google Scholar

• 20.

  BosshartABacchettaFBoeschADurandMAValerioMSelbyK. Dépistage du cancer de la prostate: à recommander en 2024. Rev Med Suisse (2024) 894:2043–6. 10.53738/revmed.2024.20.894.2043

  • CrossRef
  • Google Scholar

• 21.

  CornfordPvan den BerghRCNBriersEVan den BroeckTBrunckhorstODarraughJet alEAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate Cancer—2024 update. Part I: screening, diagnosis, and local treatment with curative intent. Eur Urol 1 Août (2024) 86(2):148–63. 10.1016/j.eururo.2024.03.027

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 22.

  Lung Cancer Screening using LDCT. Cancer Screen Committee (2019). Available online at: https://cancerscreeningcommittee.ch/en/topics/lung-cancer-screening-using-ldct/ (Accessed April 10, 2023).

  • Google Scholar

• 23.

  FerlayJColombetMSoerjomataramIDybaTRandiGBettioMet alCancer incidence and mortality patterns in Europe: estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer (2018) 103:356–87. 10.1016/j.ejca.2018.07.005

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 24.

  LieberherrSJafariSMSCazzanigaSBianchiESchlagenhauffBTscharnerGet alEvaluation of the national skin cancer campaign: a Swiss experience of euromelanoma. Swiss Med Weekly (2017) 147(4142):w14511-w14511. 10.4414/smw.2017.14511

  • CrossRef
  • Google Scholar

• 25.

  van der LeestRj. t.de VriesEBulliardJLPaoliJPerisKStratigosAet alThe euromelanoma skin cancer prevention campaign in Europe: characteristics and results of 2009 and 2010. J Eur Acad Dermatol Venereol (2011) 25(12):1455–65. 10.1111/j.1468-3083.2011.04228.x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 26.

  FreundRBulliardJLPlysEDefossezGSelbyK. Dépistages du cancer en Suisse: enjeux et perspectives. Rev Med Suisse (2025) 925:1358–62. 10.53738/revmed.2025.21.925.47414

  • CrossRef
  • Google Scholar

• 27.

  RS 832.112.31 - ordonnance du DFI du 29 septembre 1995 sur les prestations dans l’assurance obligatoire des soins en cas de maladie (Ordonnance sur les prestations de l’assurance des soins, OPAS). (2023) Available online at: https://www.fedlex.admin.ch/eli/cc/1995/4964_4964_4964/fr (Accessed April 10, 2023).

  • Google Scholar

• 28.

  ScreeningSC. Offres dans votre canton (offers in your canton) (2023). Available online at: https://www.swisscancerscreening.ch/fr/offres-dans-votre-canton (Accessed April 10, 2023).

  • Google Scholar

• 29.

  AugustinJSorbeCAugustinMZanderNKisA. Regional variations in the use of statutory skin cancer screenings in Germany: population-based spatial multisource analysis. J Eur Acad Dermatol Venereol (2020) 34(8):1736–43. 10.1111/jdv.16228

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 30.

  DumontSCullatiSManorOCourvoisierDSBouchardyCMeratRet alSkin cancer screening in Switzerland: cross-sectional trends (1997–2012) in socioeconomic inequalities. Prev Med (2019) 129:105829. 10.1016/j.ypmed.2019.105829

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 31.

  FedewaSACullatiSBouchardyCWelleIBurton-JeangrosCManorOet alColorectal cancer screening in Switzerland: cross-sectional trends (2007-2012) in socioeconomic disparities. PLOS ONE (2015) 10(7):e0131205. 10.1371/journal.pone.0131205

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 32.

  FranchiSBulliardJL. Prévention et dépistage du cancer en Suisse: fréquence et déterminants (Cancer prevention and screening in Switzerland: frequency and determinants) (2013). Available online at: https://serval.unil.ch/resource/serval:BIB_DD5325AB0FA4.P001/REF.pdf (Accessed October 20, 2022).

  • Google Scholar

• 33.

  GuessousICullatiSFedewaSABurton-JeangrosCCourvoisierDSManorOet alProstate cancer screening in Switzerland: 20-year trends and socioeconomic disparities. Prev Med (2016) 82:83–91. 10.1016/j.ypmed.2015.11.009

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 34.

  HarperDMPlegueMHarmesKMJimboMSheinfeldGorinS. Three large scale surveys highlight the complexity of cervical cancer under-screening among women 45–65years of age in the United States. Prev Med (2020) 130:105880. 10.1016/j.ypmed.2019.105880

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 35.

  LoftersAKKoppAVahabiMGlazierRH. Understanding those overdue for cancer screening by five years or more: a retrospective cohort study in Ontario, Canada. Prev Med (2019) 129:105816. 10.1016/j.ypmed.2019.105816

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 36.

  MarlowLAVChorleyAJHaddrellJFerrerRWallerJ. Understanding the heterogeneity of cervical cancer screening non-participants: data from a national sample of British women. Eur J Cancer (2017) 80:30–8. 10.1016/j.ejca.2017.04.017

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 37.

  VenturelliFSampaoloLCarrozziGZappaMGiorgi RossiP. Associations between cervical, breast and colorectal cancer screening uptake, chronic diseases and health-related behaviours: data from the Italian PASSI nationwide surveillance. Prev Med (2019) 120:60–70. 10.1016/j.ypmed.2019.01.007

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 38.

  CarneyPAO’MalleyJBuckleyDIMoriMLiebermanDAFagnanLJet alInfluence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings. Cancer (2012) 118(24):6217–25. 10.1002/cncr.27635

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 39.

  FerrariATranTNHoeckSPeetersMGoossensMVan HalG. Relationship between health-related determinants and adherence to breast and colorectal cancer screening: a population-based study in Flanders, Belgium. Eur J Public Health (2024) 34(2):347–53. 10.1093/eurpub/ckad206

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 40.

  LarsenSHVirgilsenLFKristiansenBKAndersenBVedstedP. Strong association between cervical and breast cancer screening behaviour among Danish women; A register-based cohort study. Prev Med Rep (2018) 12:349–54. 10.1016/j.pmedr.2018.10.017

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 41.

  NjorSHSøborgBTranbergMReboljM. Concurrent participation in breast, cervical, and colorectal cancer screening programmes in Denmark: a nationwide registry-based study. Prev Med (2023) 167:107405. 10.1016/j.ypmed.2022.107405

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 42.

  LabeitAPeinemannFKedirA. Cervical cancer screening service utilisation in UK. Sci Rep (2013) 3(1):2362. 10.1038/srep02362

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 43.

  BertautACoudertJBengrineLDancourtVBinquetCDouvierS. Does mammogram attendance influence participation in cervical and colorectal cancer screening? A prospective study among 1856 French women. PLOS ONE (2018) 13(6):e0198939. 10.1371/journal.pone.0198939

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 44.

  DawidowiczSLe BretonJMoscovaLRenardVBercierSBrixiZet alPredictive factors for non-participation or partial participation in breast, cervical and colorectal cancer screening programmes. Fam Pract (2020) 37(1):15–24. 10.1093/fampra/cmz031

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 45.

  IshiiKTabuchiTIsoH. Combined patterns of participation in cervical, breast, and colorectal cancer screenings and factors for non-participation in each screening among women in Japan. Prev Med (2021) 150:106627. 10.1016/j.ypmed.2021.106627

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 46.

  KregtingLMOlthofEMGBreekveldtECHAitkenCAHeijnsdijkEAMToes-ZoutendijkEet alConcurrent participation in breast, cervical, and colorectal cancer screening in the Netherlands. Eur J Cancer (2022) 175:180–6. 10.1016/j.ejca.2022.08.018

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 47.

  McCowanCMcSkimmingPPapworthRKotzurMMcConnachieAMacdonaldSet alComparing uptake across breast, cervical and bowel screening at an individual level: a retrospective cohort study. Br J Cancer (2019) 121(8):710–4. 10.1038/s41416-019-0564-9

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 48.

  ReboljMParmarDMaroniRBlyussODuffySW. Concurrent participation in screening for cervical, breast, and bowel cancer in England. J Med Screen (2020) 27(1):9–17. 10.1177/0969141319871977

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 49.

  SmithRAAndrewsKSBrooksDFedewaSAManassaram-BaptisteDSaslowDet alCancer screening in the United States, 2019: a review of current American cancer society guidelines and current issues in cancer screening. CA: A Cancer J Clinicians (2019) 69(3):184–210. 10.3322/caac.21557

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 50.

  BählerCBrünggerBUlyteASchwenkglenksMvon WylVDresselHet alTemporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study. BMC Public Health (2021) 21(1):23. 10.1186/s12889-020-10079-8

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 51.

  FennerLKässnerABerlinCEggerMZwahlenM. Trends in the use of mammography for early breast cancer detection in Switzerland: swiss health Surveys 2007 and 2012. Swiss Med Weekly (2022) 148:w14603. 10.4414/smw.2018.14603

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 52.

  SchneiderRSyrogiannouliLBissigSScharfTBulliardJLDucrosCet alTen-year changes in colorectal cancer screening in Switzerland: the Swiss Health Interview survey 2007, 2012 and 2017. Prev Med Rep (2022) 27:101815. 10.1016/j.pmedr.2022.101815

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 53.

  Office fédéral de la statistique. L’enquête suisse sur la santé 2017 en bref - Conception, méthode, réalisation (The Swiss Health Survey 2017 in brief - concept, method, production). Off fédéral de la statistique (2020) do-f-14.02-ESS-01: 20. Available online at: https://www.bfs.admin.ch/asset/fr/14839330 (Accessed March 14, 2023).

  • Google Scholar

• 54.

  Enquête suisse sur la santé 2017 - questionnaires téléphonique et écrit (pdf) - | Publication. (2019) Available online at: https://www.bfs.admin.ch/asset/fr/7606610 (Accessed July 10, 2025).

  • Google Scholar

• 55.

  Council of the European Union. Council recommendation of 9 December 2022 on strengthening prevention through early detection: a new EU approach on cancer screening replacing council recommendation 2003/878/EC 2022/C 473/01 (2022). Available online at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32022H1213(01. (Accessed April 10, 2023).

  • Google Scholar

• 56.

  HosmerDWLemeshowS. Applied Logistic Regression. New York: John Wiley & Sons, Inc. (1989).

  • Google Scholar

• 57.

  AtkinsonAC. A note on the generalized information criterion for choice of a model. Biometrika (1980) 67(2):413–8. 10.2307/2335484

  • CrossRef
  • Google Scholar

• 58.

  LindseyJKJonesB. Choosing among generalized linear models applied to medical data. Stat Med (1998) 17(1):59–68. 10.1002/(SICI)1097-0258(19980115)17:1<59::AID-SIM733>3.0.CO;2-7

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 59.

  DavisJLBuchananKLKatzRVGreenBL. Gender differences in cancer screening beliefs, behaviors, and willingness to participate: implications for health promotion. Am J Mens Health (2012) 6(3):211–7. 10.1177/1557988311425853

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 60.

  van StigtBJOlthofEMGde KokIMCMHeijnsdijkEAMLansdorp-VogelaarIvan RavesteynNTet alDecreasing participation in Dutch population-based cancer screening programs: trends from 2018 to 2022. Prev Med (2025) 193:108257. 10.1016/j.ypmed.2025.108257

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 61.

  FranceticIMeacockRSuttonM. Understanding concordance in health behaviours among couples: evidence from the bowel cancer screening programme in England. J Econ Behav & Organ (2022) 201:310–45. 10.1016/j.jebo.2022.08.001

  • CrossRef
  • Google Scholar

• 62.

  BaekerBJLeeHJemalAIslamiF. Associations of social support, living arrangements, and residential stability with cancer screening in the United States. Cancer causes control. févr (2025) 36(2):157–69. 10.1007/s10552-024-01913-0

  • CrossRef
  • Google Scholar

• 63.

  BuclinCPvon ArxMJolidonVSandovalJLBuholzer-MercierFDaverioJEet alLinguistic difference in the effect of organized programs on socioeconomic inequalities in breast cancer screening: ecological study in Switzerland. Eur J Cancer Prev (2025) 34(3):221–30. 10.1097/CEJ.0000000000000914

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 64.

  BrändleKZwahlenMBulliardJL. Monitoring of breast cancer screening programmes in Switzerland. In: Raisons De Santé. Lausanne:Centre universitaire de médecine générale et santé publique (Unisanté) (2024).

  • Google Scholar

• 65.

  GmelGKuendingHNotariLGmelC. Monitorage suisse des addictions: consommation d’alcool, tabac et drogues illégales en Suisse en 2016 (Swiss Addiction Monitoring Survey: alcohol, tobacco and illegal drug use in Switzerland in 2016). Lausanne: Addict Suisse (2017) :30–49. Available online at: https://www.addictionsuisse.ch/wp-content/uploads/library_sumo/gmel_2tl0igxj1e6t.pdf (Accessed September 22, 2023).

  • Google Scholar

• 66.

  BochudMChatelanABlancoJMBeer-BorstS. Anthropometric characteristics and indicators of eating and physical activity behaviors in the Swiss adult population: results from menuCH 2014-2015. Bochud, Murielle; Chatelan, Angéline; Blanco, Juan-Manuel; Beer-Borst, Sigrid (2017):35. Available online at: https://www.blv.admin.ch/blv/de/home/lebensmittel-und-ernaehrung/ernaehrung/menuch/menu-ch-ergebnisse-essverhalten.html (Accessed February 16, 2023).

  • Google Scholar