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Women with mental illness miss out on breast cancer screening

More must be done to support vulnerable women called for mammography

Mark Gould

Tuesday, 02 December 2014

Women with a mental illness including depression, anxiety as well as serious mental illnesses, are less likely to be screened for breast cancer, according to new research* which examined the medical history of around 700,000 women.

Researchers, writing ahead of publication in the British Journal of Psychiatry, said that studies have shown there is a higher cancer mortality rate in people with mental illness, perhaps because of high rates of risk factors such as smoking. In addition, it appears cancer is often detected later in those with mental illness. It has also been shown that people with mental illness do not receive the same standards of medical care as the rest of the population.

To find out if a diagnosis of a mental health condition might prejudice receipt of a screening mammogram researchers from the Universities of Leicester and Greenwich, led by Dr Alex J Mitchell, consultant psychiatrist in the Department of Cancer Studies in Leicester, reviewed 24 publications reporting breast cancer screening practices in women with mental illness (around 700,000), and five studies investigating screening for those in distress but who had not been diagnosed with a mental illness (nearly 21,500).

They found that there were significantly reduced rates of mammography screening in women with mental illness, depression and severe mental illness such as schizophrenia. The effect was not present in women with distress alone, suggesting distress was not the explanation.

Dr Mitchell said: “We have previously shown that there are inequalities in medical care for people who happen to have a mental health diagnosis. This is partly explained by poorer attendance but also partly explained by willingness of staff to treat a patient’s medical condition at the same time as a mental health condition. In this study we found that mental ill health was linked with 45,000 missed screens which potentially could account for 90 avoidable deaths per annum in the UK alone. Clearly patients with mental illness should receive care that is at least comparable with care given to the general population. Every effort should be made to educate and support women with mental illness called for screening.”

* Alex J. Mitchell, et al. Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake. The British Journal of Psychiatry (2014) 205: 428-435 doi: 10.1192/bjp.bp.114.147629

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