Cancer Screening Among Adults With and Without Serious Mental Illness

Abstract

Background: Persons with serious mental illness (SMI) die 10–20 years earlier than the general population; cancer is the second leading cause of death. Differences in cancer screening between SMI and the general population are not well understood. Objectives: To describe receipt of cancer screening among individuals with versus without SMI and to explore clinicians’ perceptions around cancer screening for people with SMI. Methods: Mixed-methods study using 2010–2017 MarketScan commercial insurance administrative claims data and semi-structured clinician interviews. In the quantitative analyses, we used multivariate logistic regression analyses to calculate the likelihood of receiving cervical, breast, colorectal, or prostate cancer screening among people with versus without SMI, defined as schizophrenia or bipolar disorder. We conducted semi-structured interviews with 17 primary care physicians and 15 psychiatrists. Interview transcripts were coded using a hybrid deductive/inductive approach. Results: Relative to those without SMI, individuals with SMI were less likely to receive screening for cervical cancer [adjusted odds ratio (aOR): 0.80; 95% confidence interval (CI): 0.80–0.81], breast cancer (aOR: 0.79; 95% CI: 0.78–0.80), colorectal cancer (aOR: 0.90; 95% CI: 0.89–0.91), and prostate cancer (aOR: 0.85; 95% CI: 0.84–0.87). Clinicians identified 5 themes that may help explain the lower rates of cancer screening in persons with SMI: access to care, available support, prioritization of other issues, communication, and patient concerns. Conclusions: People with SMI were less likely to receive 4 common types of cancer screening. Improving cancer screening rates in the SMI population will likely require a multidisciplinary approach to overcome barriers to screening.

Predictors of cancer screening among Black and White Maryland Medicaid enrollees with serious mental illness

“…[3][4][5] Relative to commercially insured adults with SMI, annual screening rates rates in this Medicaid-enrolled population were lower. 3 Primary care utilization, medical comorbidity, and substance use disorder were factors associated with cancer screening and offer potential intervention points. Rurality of residence was also a significant predictor.…”

“…2 People with SMI receive cancer screening at lower rates than the general population. 3 It is important to identify factors that promote or hinder cancer screening and to determine whether these factors differ by race, given racial inequities in cancer mortality. 1 Research on the SMI population and racial disparities in cancer screening has been limited and mixed.…”

Clinicians’ perceptions of barriers to cervical cancer screening for women living with behavioral health conditions: a focus group study

“…Despite success in lowering the cervical cancer mortality rate, disparities in cervical cancer mortality continue to persist among underserved populations [ 4 , 5 ]. Growing research also demonstrates that women living with chronic conditions are less likely to be up to date with cervical cancer screening [ 6 – 8 ].…”

Applying Care Coordination Principles to Reduce Cardiovascular Disease Risk Factors in People With Serious Mental Illness: A Case Study Approach

“…People with SMI often face significant challenges accessing quality healthcare, including high rates of poverty, housing instability, unemployment, and interactions with the criminal justice system (6)(7)(8). Moreover, people with SMI are less likely to receive guideline-concordant care compared with the general population (9)(10)(11). For example, they are less likely to receive annual screenings for diabetes-related complications or recommended medications after a myocardial infarction (12)(13)(14)(15).…”