Severe mental illness linked to low attendance at cancer screening

People with severe mental illness are less likely to attend cancer screening compared to those who do not have such conditions, according to new research from the University of Surrey and the Office for Health Improvement and Disparities (OHID) at the Department of Health and Social Care. 

Funded by OHID and NHS England, with support from Cancer Research UK, the study found disparity in attendance at cancer screening in people with severe mental illness, with the most pronounced disparities being observed for those diagnosed with schizophrenia, followed by those diagnosed with other psychoses and bipolar disorder.   

The researchers suggested that the lower attendance at screening, seen in these populations, may be a contributing factor as to why people with severe conditions are more likely to die prematurely from cancer. 

The analysis, which included data from the Clinical Practice Research Datalink (CPRD) on over one million people, also showed that: 

• Inequalities were widest for bowel cancer screening (42 percent of people with a severe mental illness attended bowel cancer screening, compared to 59 percent of people without), followed by breast (48 percent vs 60 percent) and cervical screening (64 percent vs 70 percent).   

• Attendance among those with severe mental illness was particularly low for those living in more deprived parts of the country, where the prevalence of severe mental illness is also higher. 

Dr Robert Kerrison, lead author of the study and co-lead of the Cancer Care group at the University of Surrey, said:  

“People with severe mental illness are two and a half times more likely to die prematurely from cancer than their peers. Their cancer is often diagnosed at an advanced stage, which limits the treatment options available to them. Increasing early diagnosis, through screening, could help save lives from cancer, and reduce inequalities in cancer outcomes.  

“We now need to learn more about why participation rates are lower for these individuals, so that medical professionals can tailor support and make it easier for people with severe mental conditions to attend.” 

Researchers also found further inequalities in the data. Amongst adults with severe mental illness, people from some ethnic minority backgrounds were less likely to attend cancer screening appointments.  The data showed that participation in bowel cancer screening was lower among Black adults with severe mental illness, compared with White adults (35 percent vs 44 percent), and that the same was true for Black adults without severe mental illness, compared to White adults (48 percent vs 62 percent). 

Cancer Research UK’s executive director of policy and information, Dr Ian Walker, said:  

“This research not only exposes concerning barriers to participating in cancer screening faced by people with severe mental illness, it also crucially shows where these disparities persist across ethnic minority groups and in more deprived areas.  

"We need to delve further into this area of research to properly understand why these gaps exist. It’s vital that we work with individuals and communities to build targeted interventions that ensure everyone benefits equally from programmes that diagnose cancer early and, ultimately, save lives.” 

This research was published in British Journal of Cancer. 

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Notes to editors  

• Dr Kerrison is available for interview upon request.   

• For more information, please contact the University of Surrey press office via mediarelations@surrey.ac.uk  

• Dr Ian Walker is available for interview upon request. 

• For more information, please contact the Cancer Research UK press office via pressoffice@cancer.org.uk on 020 3469 8300 or, out of hours, 020 3469 8301. 

Data 

Data for this study came from the Clinical Practice Research Datalink (CPRD) a database comprised of medical records from patients registered at over 1,000 General Practices in England. 

Analytic period for bowel screening was March 2017- September 2020 (plus six months leeway to allow for rescheduling of appointments, reminders etc.) 

For breast cancer the screening period was March 2016- September 2020 plus six months leeway 

For cervical screening the analytic period was March 2016- September 2020 for women aged 25-49 and 50-64. 

Support  

• Equally Well is a charity initiative promoting equal physical health for people affected by mental illness 

• Rethink Mental Illness have issued guidance around physical health checks for people with severe mental illness  

• Talk Cancer is a cancer awareness training programme equipping people with the skills and confidence to have conversations about cancer and health with people in your community. 

• If you or someone close to you have been affected by cancer and you’ve got questions, you can call the Cancer Research UK nurses confidentially on freephone 0808 800 4040, Monday – Friday, 9am-5pm.   

Additional Information  
Funding  

This study was funded by the mental health team at NHS England and the Office for Health and Improvement and Disparities (OHID) at the Department of Health and Social Care. 

Dr Robert Kerrison is supported by a Cancer Research UK Population Research Fellowship. 

Paper information:   

Paper title: ‘Inequalities in cancer screening participation between adults with and without severe mental illness: results from a cross-sectional analysis of primary care data on English Screening Programmes’   

DOI: 10.1038/s41416-023-02249-3 

Authors:   

Dr Robert Stephen Kerrison, Alex Jones, Dr Jianhe Peng, Dr Gabriele Price, Professor Julia Verne, 

Professor Elizabeth Barley and Cam Lugton