Breast cancer screening disparities among women with schizophrenia

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A recent study reveals disparities in breast cancer screening rates among female patients with schizophrenia in Ontario, Canada, prompting a call for expanded access to team-based primary care to address this health inequity.

Breast cancer screening disparities among women with schizophrenia | Image Credit: © Pixel-Shot - © Pixel-Shot - stock.adobe.com.

Breast cancer screening disparities among women with schizophrenia | Image Credit: © Pixel-Shot - © Pixel-Shot - stock.adobe.com.

Rates of breast cancer screening completion are reduced among female patients with schizophrenia compared to those without schizophrenia, according to a recent study published in JAMA Network Open.

Takeaways

  1. Women with schizophrenia in Ontario, Canada, have lower rates of completing breast cancer screenings compared to those without schizophrenia.
  2. Individuals with schizophrenia face a 31% increased risk of breast cancer, contributing to their higher mortality rates, which are observed 10 to 25 years earlier than those without schizophrenia.
  3. Schizophrenia is identified as one of the top 5 mental health conditions associated with significant implications for the population of Ontario, contributing to the mortality disparity observed in individuals with schizophrenia.
  4. The study conducted a retrospective matched case-control analysis involving 11,631 cases (women with schizophrenia) and 115,959 controls (women without schizophrenia) in Ontario, focusing on females aged over 50.
  5. The investigators suggest widening the availability of team-based, capitated primary care payment models to enhance breast cancer screening rates among women with schizophrenia in the region.

Individuals with schizophrenia often experience mortality 10 to 25 years before those without schizophrenia, with cancer identified as an important factor associated with this disparity.Schizophrenia is also 1 of the top 5 mental health conditions with significant implications for the population of Ontario, Canada.

Breast cancer risk may also be greater in patients with schizophrenia, with 1 study reporting a 31% increased risk. Cancer screening is associated with reduced mortality, making it recommended by Cancer Care Ontario and the Canadian Task Force on Preventive Health Care. This indicates a need to evaluate breast cancer screening among high-risk populations.

To compare breast cancer screening completion among female patients aged over 50 years with and without schizophrenia, investigators conducted a retrospective matched case-control study. Data was obtained from the ICES, which provides housing and faculty to evaluate health administrative data in Ontario.

All Ontario residents recorded as female with continuous Ontario Health Insurance Plan coverage from January 1, 2010, to December 31, 2019, and who turned 50 years old during this period were included in the analysis. Schizophrenia status was determined using outpatient physician visit and hospitalization data.

Exclusion criteria included breast cancer diagnosis before being aged 50 years, mastectomy and breast implants before being aged 50 years, and particularly high risk of breast cancer. Breast cancer screening within 2 years of a patient’s fiftieth birthday was the primary outcome of the analysis, identified using the Ontario Breast Screening Program.

Cases were women with schizophrenia while controls were women without schizophrenia. These women were matched 1:10 based on local health integration network, income quintile, rural residence, birth dates within 180 days of each other, and weighted Aggregated Diagnosis Group score.

There were 11,631 cases and 115,959 controls included in the final analysis, with 8.7% of cases and 8.6% of controls living rural communities, and 34.8% of cases and 34.9% of controls being in the lowest income quintile. A mammogram within 2 years of a patient’s fiftieth birthday was reported by 69.3% of cases and 77.1% of controls.

Most cases were enrolled in a Family Health Groups(FHG) or Family Health Teams(FHT) primary care physician model, at 30.8% and 24.8% respectively. Of cases, 9.5% did not visit a physician during the study period. Patients with schizophrenia were less likely to complete a mammogram if they were in an FHG model vs an FHT model, with an odds ratio of 0.79.

A mammogram before being aged 50 years was reported in 62.5% of participants. This was reported in 55.6% of cases and 63.2% of controls.

These results indicated women with schizophrenia have reduced rates of breast cancer screening in Ontario, Canada. Investigators recommended, “widening the availability of team-based, capitated primary care payment model,” to increase breast cancer screening rates.

Reference

O’Neill B, Yusuf A, Lofters A, et al. Breast cancer screening among females with and without schizophrenia. JAMA Netw Open. 2023;6(11):e2345530. doi:10.1001/jamanetworkopen.2023.45530

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