In a country with world-class cancer screening, some women are left behind
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A world-first review of breast and cervical screening on women with severe mental illness has found that these women are globally less likely to seek screening for these significant diseases and often fall between the cracks necessary for an early diagnosis and effective treatment, leading to a higher mortality.
The study, led by Professor Megan Galbally from the School of Clinical Sciences at Monash Health and published in the journal Schizophrenia Bulletin, conducted a global review of screening programs and their use by women experiencing bipolar affective disorder, schizophrenia or associated psychotic disorders. Of the 35 articles identified, twenty-one articles demonstrated lower screening rates in women with severe mental illness for breast or cervical cancer.
According to Professor Galbally, severe mental illness is associated with poorer physical health, “and this remains a significant cause of lower life expectancy when compared to the general population,” she said.
Breast and cervical cancer remain a significant cause of morbidity and mortality for women globally. In 2020, 685,000 women died from breast cancer and 342,000 from cervical cancer worldwide. In Australia, more than 3,200 women die from breast cancer and more than 250 die from cervical cancer.
“In Australia, we have fantastic screening programs like BreastScreen, which have lowered mortality from this disease,” Professor Galbally said. “However, there needs to be better follow-up for participation of people from at-risk populations.”
While the question of why women with severe mental illness participate less in breast and cervical cancer screening remains complex and multifactorial, the authors hypothesise that these illnesses may diminish an individual’s and a health service’s ability to prioritise screening in the context of the need for acute care and make these women more vulnerable to unemployment and homelessness, which further complicates their engagement in screening. Many psychotropic medications can also have debilitating side effects, such as sedation and weight gain, which diminish motivation to engage with other healthcare practices like screening, and these women are also more likely to have experienced childhood and current trauma and violence, including sexual violence, which may be an additional barrier to accessing an intimate form of screening.