EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

Uptake of screening for breast cancer in patients with mental health problems

Ursula Werneke¹, Oded Horn², Alan Maryon-Davis³, Simon Wessely², Stuart Donnan⁴ and Klim McPherson⁵

¹ Centre for the Economics in Mental Health, Institute of Psychiatry, King’s College School of Medicine and Dentistry, London, UK
² Academic Department of Psychological Medicine, King’s College School of Medicine and Dentistry and Institute of Psychiatry
³ Southwark Primary Care Trust and Division of Health and Social Care Research, King’s College School of Medicine and Dentistry
⁴ Epidemiology and Public Health, University of Manchester, UK
⁵ Department of Obstetrics and Gynaecology, Oxford University, John Radciffe Hospital, Oxford, UK

Correspondence to:
Correspondence to:
Dr U Werneke
Homerton Hospital, East Wing, Department of Psychiatry, Homerton Row, London E9 6SR, UK; Ursula.Werneke{at}elcmht.nhs.uk

Objectives: Mental illness is associated with physical illness and mortality from a variety of causes including cancer. There is little information on screening attendance among the mentally ill population. An audit was conducted of a breast screening service in inner London to determine uptake rates in women with mental illness.

Design: Cross sectional data linkage study of the local screening register and patients of the local psychiatric units. Screening uptake rates in all patients, those with a history of multiple detentions in hospital, and those with psychosis were compared with the local reference population.

Setting: Women in three inner London boroughs.

Participants: Screening records for 933 psychiatric patients and 44 195 women without mental health problems aged 50 to 64 years.

Main results: Overall, psychiatric patients were as likely as the reference group to attend breast screening. Patients with a history of multiple detention were significantly less likely to attend (OR = 0.40, 0.29 to 0.55; p<0.001), as were patients with a diagnosis of psychosis (OR = 0.33, 0.18 to 0.61; p<0.01). Increasing age, a history of detention in hospital, and social deprivation remained independent predictors for non-attendance.

Conclusion: Women with severe mental health problems may be less likely to attend national screening programmes such as breast screening, and action should be taken to overcome the barriers to attendance.

Keywords: breast screening; uptake; mammography; cancer; mental illness; psychosis

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