New research, published today in the British Journal of Cancer, has found that adults with severe mental illness (SMI) are less likely to attend cancer screening than those who do not have such conditions.
Researchers found that screening participation was lower for people with SMI for all three national cancer screening programmes – breast, bowel and cervical. The biggest disparity was seen in bowel cancer screening participation (42% of people with SMI vs 59% of people without).
They suggested that this lower attendance at screening may be a contributing factor as to why people with severe mental illness are more likely to die prematurely from cancer.
“People with severe mental illness are two and a half times more likely to die prematurely from cancer than their peers,” said Dr Robert Kerrison, lead author of the study and co-lead of the Cancer Care group at the University of Surrey.
“Their cancer is often diagnosed at an advanced stage, which limits the treatment options available to them. Increasing early diagnosis, through screening, could help save lives from cancer and reduce inequalities in cancer outcomes.
“We now need to learn more about why participation rates are lower for these individuals, so that medical professionals can tailor support and make it easier for people with severe mental illness to attend.”
What did they find?
The study, from the University of Surrey and the Office for Health and Improvement and Disparities (OHID) at the Department of Health and Social Care, included data from the Clinical Practice Research Datalink (CPRD).
The CPRD is a database comprised of medical records from patients registered at over 1,000 General Practices in England.
It’s a reliable way to identify both who participates in cancer screening and whether they have a severe mental illness. That can lead to new insights, as mental health information isn’t routinely collected as part of the national cancer screening programme databases.
Cancer screening involves testing apparently healthy people for signs of the disease.
Screening can save lives by finding cancers at an early stage, or even preventing them. It is not the same as the tests a person may have when doctors are diagnosing or treating cancer.
The frequency with which you will be invited for screening and the eligibility age varies between UK nations. You can find out more about the three screening programmes in the UK and their eligibility criteria below:
Patients in the study were assigned an SMI status and an SMI group. SMI status was either SMI or no SMI, whereas SMI was split into four groups: schizophrenia, bipolar disorder, other psychoses, and no SMI.
In addition, data on their ethnicity and area-level deprivation, derived from their postcode, was included in the analysis to determine whether these characteristics impacted on the effect of SMI on screening participation.
The analysis observed the most pronounced disparities for those diagnosed with schizophrenia, followed by those diagnosed with other psychoses and bipolar disorder.
What’s more, it showed that disparities in participation between those with SMI and those without persist across age and sex groups. Inequality in participation for breast cancer screening increased with age, while for bowel and cervical screening it increased with area-level deprivation.
Intersectionality, mental health and cancer screening
Researchers also found further inequalities in the data. Amongst adults with SMI, people from some ethnic minority backgrounds were less likely to attend cancer screening appointments.
The data showed that that participation in bowel cancer screening was lower among Black adults with SMI, compared with White adults (35% vs 44%), and that the same was true for Black adults without severe mental illness, compared to White adults (48% vs 62%).
“This research not only exposes concerning barriers to participating in cancer screening faced by people with severe mental illness, it also crucially shows where these disparities persist across ethnic minority groups and in more deprived areas,” said Dr Ian Walker, Cancer Research UK’s executive director of policy and information.
“We need to delve further into this area of research to properly understand why these gaps exist. It’s vital that we work with individuals and communities to build targeted interventions that ensure everyone benefits equally from programmes that diagnose cancer early and, ultimately, save lives.”
The need for more research
The Government currently has some guidance on improving access to screening for people with SMI. Recommendations include ensuring that residents in long-term care are registered with a GP and that screening providers work with local mental health services to share information, resources and procedures.
But if we’re to eliminate these inequalities, we also need more research.
“There are many reasons that people are unable to, or choose not to, attend cancer screening.,” said Karis Betts, senior health information manager at Cancer Research UK.
“These barriers to screening are complex and can be emotional, cultural or practical. We need to see more research into this area that will guide action from the Government, the NHS and local authorities to tackle health inequalities experienced by different groups.”
If you or someone close to you have been affected by cancer and you’ve got questions, you can call the Cancer Research UK nurses confidentially on freephone 0808 800 4040, Monday to Friday, 9am to 5pm.
Or, for further support related to mental health and cancer:
- Equally Well is a charity initiative promoting equal physical health for people affected by mental illness
- Rethink Mental Illness have issued guidance around physical health checks for people with severe mental illness
- Talk Cancer is a cancer awareness training programme equipping people with the skills and confidence to discuss cancer and health with those around them.
- Mind is a charity that provide advice and support to empower anyone experiencing a mental health problem