Cancer screening

Cancer screening

People with a mental health condition are 1.4 to 2 times more likely to die from cancer, although the overall incidence of cancer is similar to that in the general population (Solmi et al., 2020). International studies suggest that people with any mental illness are almost 25% less likely be screened for cancer compared to the general population (Solmi et al., 2020). A 2018 analysis by Public Health England found that in 2018, eligible people on the SMI register illness in England were (Public Health England, 2021):

  • 18% more likely to have not participated in breast screening.
  • 20% more likely not to have participated in cervical screening.
  • 31% more likely not to have participated in bowel screening.

Cancer screening participation amongst people with SMI is lowest for people living in the most deprived areas and people from ‘Black’ ethnic groups (Kerrison et al., 2023).

What are the barriers to cancer screening faced by people with mental health conditions?

Known barriers to screening for people with severe mental illness include (Syson-Nibbs, 2018):

  • Administrative barriers: for example, people who are long-term residents of mental health providers are often not registered with a GP, so may not be invited to screening.
  • Healthcare barriers: clinical teams not knowing what screening patients are eligible for.
  • Patient barriers: patients may experience anxiety around screening processes.

What is the evidence around improving cancer screening uptake?

National service specifications state that screening services should address health inequalities and people with severe mental illness are identified as key group that may require additional support to access screening (Syson-Nibbs, 2018). A systematic review of interventions to increase the uptake of screening amongst people with severe mental illness identified 22 interventions which all had a positive impact on screening uptake but found that there is a lack of high-quality evidence on this topic (Lamontagne-Godwin et al., 2018).

  • Interventions were either focused on changes to health service delivery or the introduction of tools to facilitate screening. They were delivered in a range of locations, including primary care and mental health services.
  • Only one study focused on cancer screening (Heyding et al., 2005). This involved women who attended an inner-city community health centre, many of whom experienced mental illness and homelessness. Introducing staff accompanied groups to attend breast cancer screening was associated with an increased screening uptake.

Research focused on general physical health checks shows that people are more likely to attend screening after being offered screening when they are already attending a face-to-face consultation for another reason (Tanner et al., 2022).

Additional resources

References

Full list of references is included at the end of this chapter.

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