ASPO Abstracts
Examination of PSA screening in military and civilian men: Analysis of the 2018 Behavioral Risk Factor Surveillance System to characterize shared decision-making and screening uptake
Category: Early Detection & Risk Prediction
Conference Year: 2021
Abstract Body:
Purpose: To determine whether military men report different rates of prostate-specific antigen (PSA) screening
than civilian men and if shared decision-making (SDM) is associated with PSA screening.
Methods: We used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). This study included
102,169 men (26,422 military and 75,747 civilian men). We conducted binomial logistic regression analyses to
determine associations between military status and receiving a PSA test in the last 2-years. We then added
patient-reports of SDM (if the provider discussed both positives and negatives of receiving a PSA test with the
respondent) to the model. Finally, we added an interaction term between military status and shared decision-
making to determine if military and civilian men had different associations between SDM and PSA testing.
Results: Unadjusted results of our analysis showed that military men have 1.6 times the odds of PSA testing
compared to civilian counterparts (95% CI: 1.5, 1.7). This significant finding was still present after adjusting for
sociodemographic and health covariates (OR: 1.2, 95% CI: 1.1, 1.2) and after adding SDM to the model (OR: 1.1,
95% CI: 1.1, 1.2). Military men were also significantly more likely to report SDM than civilian men (22.7% and
18.2% respectively, p<0.0001). When examining the interaction between military status and SDM, both military
and civilian populations have over 2 times the odds of receiving a PSA test in the last two years if they had
reported SDM and the impact of SDM on PSA testing was greater in civilian men (OR: 2.5, 95% CI: 2.3, 2.6 and
OR: 2.8, 95% CI: 2.7, 2.9 respectively; p-value for interaction=<0.0001).
Conclusions: To our knowledge, this is the first study that examined differences in PSA screening between a
nationally representative sample of military and civilian men. Our study found that military men are more likely to
report engaging in SDM for PSA testing and receiving a PSA test in the last 2-years compared to civilian men. In
addition, results show that SDM plays a role in the receipt of a PSA test in both populations. These findings can
serve as a foundation for tailored interventions to promote appropriate SDM for PSA screening in civilian, active
duty, and veteran healthcare systems.
Keywords: Cancer, Screening, Military