Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake

Abstract

BackgroundThere is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening.AimsTo conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health.MethodMajor electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety.ResultsWe identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715 705). An additional 5 studies investigating screening for those with distress (n = 21 491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66–0.77), mood disorders (OR = 0.83, 95% CI 0.76–0.90) and particularly SMI (OR = 0.54, 95% CI 0.45–0.65). No disparity was evident among women with distress alone.ConclusionsRates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.