Cancer Screening Less Likely Among Women With Schizophrenia

Pam Harrison

November 26, 2019

Women with schizophrenia and other psychotic disorders are only half as likely as women without mental illness to receive screening mammography for breast cancer, the first systematic review and meta-analysis of its kind shows.

This finding helps explain why breast cancer is often detected at a more advanced stage in women with serious mental illness, say the meta-analysis authors.

"Evidence suggests that women with serious mental illness may not receive breast cancer preventive services in a timely and appropriate way," Alison Hwong, MD, PhD, University of California, San Francisco, and colleagues observe.

"Lower screening rates could explain why women with schizophrenia and other serious mental illnesses are found to have more advanced breast cancer at [the] time of diagnosis," they suggest.

The study was published online November 14 in Psychiatric Services.

Eleven studies from four countries met the inclusion criteria for the review and meta-analysis.

In total, 25,447 women with a diagnosis of schizophrenia or other forms of psychosis were involved in these studies.

Seven of the 11 studies were considered to be of high quality; three, medium quality; and one, low quality.

Compared to the general population, the pooled odds ratio for women with schizophrenia and other psychotic disorders to undergo mammography was 0.05 (P < .001).

All studies came from Western countries — primarily the United States — so the findings may not apply to non-Western countries, the authors caution.

They also note that they could not determine the severity of mental illness on the basis of diagnoses alone.

"This is important," they suggest, "given the severity of mental illness, not a specific diagnosis, may be the more important factor in accessing preventive care services."

The authors also point out that the low mammography screening rates among this particular patient population might be driven by complex factors such as socioeconomic status or access to primary care.

Having a regular primary care provider appears to promote preventive care practices such as cancer screening, the investigators note, and not having a primary care provider would likely diminish the likelihood that women with a serious mental illness would avail themselves of mammography.

Hwong and colleagues also point out that the main barrier to undergoing mammography for this patient population may simply be that physicians are not telling these patients how important it is to be screened for breast cancer.

Rather, physicians caring for women with psychotic disorders may well have more pressing issues to attend to, such as monitoring patients for metabolic disorders precipitated by antipsychotic medications known to cause glycemic abnormalities, the authors suggest.

"The increased focus on addressing psychiatric symptoms may lead to deferring routine preventive screening discussion for future visits, but the future discussion never occurs," researchers write.

Whatever factors contribute to the low cancer screening rates, women with schizophrenia and other serious mental illnesses appear to have more advanced breast cancer at the time of diagnosis.

Indeed, a recent review of the literature suggests that breast cancer incidence is higher among women with schizophrenia than among women in the general population and that women with schizophrenia are more likely to die from the disease.

Given the high prevalence of breast cancer, the authors suggest that special funding should be allocated to target any disparities in the care that patients with severe mental illness receive and that costs of mammography screening should be lower for such patients than for the general population.

"This review...highlights the need for novel strategies to promote mammography screening for women with schizophrenia," the authors conclude.

Hwong has disclosed no relevant financial relationships.

Psychiatr Serv. Published online November 14, 2019. Abstract

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