Mental Illness Hinders Cancer Screening; Study Suggests

According to a new study from Aarhus University, far too many persons with psychiatric issues refuse offers of colorectal cancer screening. This is a problem, considering that Danes with mental illness have a higher cancer mortality rate.

Every year, approximately 5,000 Danes are diagnosed with colorectal cancer. Because the disease primarily affects people over the age of 50, all Danes aged 50 to 74 are eligible for a free screening to detect this type of cancer early. However, not everyone accepts the offer, and Danes with mental health concerns are especially unlikely to do so. These are the findings of a study from Aarhus University’s Department of Clinical Medicine, which was just published in the journal The Lancet Psychiatry.

The study is the first to look into the impact of mental illness on participation in a national screening program based on stool sample submission. Mette Kielsholm Thomsen, the study’s postdoctoral researcher, is concerned by the findings.

“We found significantly lower participation in colorectal cancer screening among people with severe mental disorders in psychiatric treatment or on antipsychotic medicine. In fact, people with much more common and milder mental disorders and problems are also less likely to participate compared with people without these disorders and problems,” she explains.

Thomsen analyzed data from 2,036,352 Danes over the age of 50 who were offered colorectal cancer screening. According to the study, men with major mental problems are 13.8 percentage points less likely to participate than persons without mental illness, while women are 15.4 percentage points more likely to participate. Furthermore, minor mental problems, such as those requiring antidepressants or psychological treatment but not psychiatric care, determine whether people participate in screening, according to Thomsen.

“We found that people with mild mental illness are also less likely to participate in screening programs. This is a serious problem, because they constitute a relatively large group, and this involves a risk that the cancer will not be detected in time,” she notes.

Serious ramifications
With age, the risk of getting and dying from colorectal cancer rises. This screening program is provided by the government in order to detect cancer early and prevent it from spreading. Previous research has indicated that patients with mental illnesses had the same chance of developing cancer as the general population, but having a higher cancer mortality rate. According to Thomsen, it is critical that screening programs address the barrier posed by mental health issues for many Danes: “The screening program for colorectal cancer should be adapted to meet any needs, e.g. by practitioners in psychiatry or GPs providing the necessary support for people with mental illness to participate in screening programs.”

Citizens provide a stool sample to be analyzed for colorectal cancer screening. If blood is detected in the stool, the citizen is invited to a follow-up endoscopy. According to Thomsen, Danes with mental disorders are less likely to accept the endoscopy: “We can see that when they do participate in the screening, there are more often signs of blood in their stools than for the rest of the population, but fewer of them accept the follow-up endoscopy, and thus they don’t complete the full screening program.”

Thomsen thinks that the study will contribute to a greater emphasis on assisting Danes suffering from mental illnesses to participate in and complete cancer screening programs.

“I hope that the Danish Health Authority and other relevant stakeholders will take the study seriously and consider how we can reduce the barriers for people with mental illness that obstruct them from participating in preventative health services,” she says.

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