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.

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.

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).

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.

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.