Low Cancer Screening Rates among Japanese People with Schizophrenia: A Cross-Sectional Study

Abstract

Health care disparities among people with schizophrenia is a global concern. Our previous study revealed cancer screening rates in Japanese people with schizophrenia lower than rates of approximately 40% of the general population. However, that study was based on self-reports, which can be inaccurate, and rates did not differentiate the types of cancer screening provider (i.e., municipal screening, collective opportunistic screening, and individual opportunistic screening). This study aimed to investigate recordsbased cancer screening rates, focusing on participation rates of people with schizophrenia who are subject to municipal cancer screening programs. We conducted a cross-sectional study at a psychiatric hospital outpatient clinic from September to November 2016. We randomly extracted 420 potential participants from among 680 eligible patients and asked them to participate. We then selected subgroups of participants living in Okayama city who were enrolled in the National Health Insurance or Public Assistance systems and were subject to colorectal, gastric, lung, breast, or cervical cancer screening provided by Okayama city (n = 97, 96, 97, 42, and 64, respectively). Participation in cancer screenings was assessed based on local government records. Municipal cancer screening rates were as follows: 13.4% (95% confidence interval: 6.6%-20.2%) for colorectal, 7.3% (2.1%-12.5%) for gastric, 16.5% (9.1%-23.9%) for lung, 21.4% (9.0%-33.8%) for breast, and 14.1% (5.6%-22.6%) for cervical cancers. The findings demonstrated extremely low cancer screening rates among people with schizophrenia subject to municipal cancer screenings in Japan. A strategy to promote municipal cancer screening for people with schizophrenia is needed.

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

“…The incidence of cervical cancer has been reported as slightly less than that in the general population (10) but mortality rates are higher, with a high case fatality ratio for women with cervical (1.98, 95% confidence interval [CI] 1.31-2.92) or breast cancer (1.23, 95% CI 1.01-1.51) and an overall cancer mortality rate ratio in women with mental illness of 1.24 (95% CI 1.17-1.32) (11). Original studies have also described increased mortality in colorectal cancer (12).…”

A randomised controlled trial of a case management approach to encourage participation in colorectal cancer screening for people with schizophrenia in psychiatric outpatient clinics: study protocol for the J-SUPPORT 1901 (ACCESS) study

“…According to the results of our previous study,16 the colorectal cancer screening rate in the current study population is 13.4%, and the goal of the intervention is to reach 40% participation, which is equivalent to that for the general population. Considering the effect of cointerventions, the colorectal cancer screening rate for the UI alone group is estimated to be 20%.…”

“…We will examine participants’ records of participation in colorectal cancer screening obtained from the Okayama City Health Center. As in our previous survey,16 we submitted the list of participants (including each participant’s name, date of birth, address and study identification number) to the Okayama City Health Center. This centre subsequently linked the participants’ list with cancer screening records and then returned the list, after removing personally identifiable information.…”

“…Our previous study demonstrated that in Japan the colorectal cancer screening rate in people with schizophrenia was 24.1%, which is much lower than that of the general population at 40.7% 15. In particular, people with schizophrenia who do not have the opportunity to participate in collective opportunistic cancer screening subsidised by insurers demonstrated extremely low colorectal cancer screening rates (13.4%) 16. However, to our knowledge, no interventions for people with severe mental illness have been implemented to increase cancer screening 17…”

End-of-life care among patients with schizophrenia and cancer: a population-based cohort study from the French national hospital database

“…[5][6][7] Mortality from cancer in patients with schizophrenia is between 1•5 and four times higher than that in people without a diagnosis of mental illness, 4,[8][9][10] and patients with schizophrenia are less likely to undergo cancer screening examinations. 11 Although many studies have focused on whether the risk of cancer is increased or decreased in patients with schizophrenia, only a few have investigated end-of-life care in patients with schizophrenia who are diagnosed with terminal cancer. Palliative care specialists improve the quality of life of patients with life-threatening illnesses 12 by preventing, assessing, and treating pain and other symptoms, and by providing psychological, emotional, and spiritual support.…”