Review and special article
Disparities in Breast and Cervical Cancer Screening in Women with Mental Illness: A Systematic Literature Review

https://doi.org/10.1016/j.amepre.2012.12.006Get rights and content

Context

Breast and cervical cancer screening rates have improved substantially in the U.S. during the past decade. Cancer screening and other health outcomes in patients with mental illnesses, such as major depression and schizophrenia, remain suboptimal. Understanding the prevalence and root causes of these disparities is an essential first step toward developing effective interventions. This paper presents a systematic literature review of current evidence on breast and cervical cancer screening disparities in women with mental illness.

Evidence acquisition

A systematic PubMed/MEDLINE and PsycINFO search completed in May 2012 retrieved articles pertaining to cancer screening and mentally ill patients using pertinent search terms. Articles that met the inclusion criteria were appraised critically for evidence quality related to screening disparities using defined criteria. Articles that reported cancer screening rates in patients with mental illness were reviewed to determine whether any barriers to screening or factors that promote screening were identified.

Evidence synthesis

Nineteen studies met the inclusion criteria. Many articles contributed to more than one of the identified areas of interest (i.e., screening utilization, barriers to screening, and factors that encourage screening).

Conclusions

Substantial evidence in the current literature confirms disparities in breast and cervical cancer screening rates among women with mental illness. However, the mentally ill population is more complex and diverse than many studies imply. Using a global functional indicator that measures the overall impact of mental illness may yield a more useful categorization of influences on cancer screening.

Section snippets

Context

In 2012, there will be an estimated 241,230 new cases and 44,140 deaths attributed to breast and cervical cancer.1 To combat this morbidity and mortality, the current national guidelines for breast and cervical cancer screening in women aim to detect cancer at an early stage.2, 3, 4 In 2010, the screening mammography rates within the prior 2 years for women aged ≥40 years ranged from 49.1% to 78.2%. In that same period, 54.1%–77.8% of women aged ≥18 years reported having a Pap for cervical

Evidence Acquisition

A systematic, limited review of the literature was conducted and a critical appraisal was made of selected articles believed to contain material that would provide evidence of cancer screening rates among the mentally ill. The consecutive steps of the methods used during this review process are summarized in Figure 2 and briefly described below.

Evidence Synthesis

Among the articles selected, 15 studies were from the U.S., and four were from Europe, Canada, or Australia. Two articles addressed cervical cancer screening, eight addressed breast cancer screening, and nine addressed both cancers. The sample size of these studies varied from 26 participants to a larger national data set of 335,294 participants. The studies included were prospective (n=9) and retrospective studies (n=10); small clinical practice (n=7) and larger national database analyses (n

Discussion

Substantial primary evidence was found that suggests that important disparities persist in breast and cervical cancer screening utilization among women with chronic mental illness. Cancer screening prevalence for these women lags behind that for women without mental illness, which has improved over the past decade, and that barriers to screening specific to the mentally ill may exist. A few studies investigated specific barriers to or factors that promote screening among women with mental

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