Interventions to encourage cancer screening uptake in severe mental illness.

Cancer is a leading cause of death worldwide, accounting for approximately 13% of all deaths in 2007. Some studies have reported an increased incidence of cancer in people with mental health problems. The Schizophrenia Commission reports that people with schizophrenia who develop cancer are three times more likely to die than those in the general population with cancer.

Mental illness is associated with certain health problems, including: obesity; smoking; drinking alcohol; and poor diet, all of which increase risk of cancer. It has been estimated that approximately one‐third of cancer deaths could be prevented with early detection, of which cancer screening is the most effective method. However, people with mental illness are less likely than others to take up available cancer screening. Reasons for non‐uptake include: low income; increasing age; lack of transport; embarrassment; lack of reminders; and lack of familiar care providers.

In the general population, telephone invitations, telephone counselling, prompts following the initial invitation and opportunistic screening are good at increasing uptake of cancer screening. Reducing financial barriers (i.e. providing free screening tests, bus passes or postage) may also help. GPs have also been offered incentives under the Quality and Outcomes Framework to provide regular physical health checks to people with mental illness. People with mental illness may require more individualised care, such as more intense counselling, to encourage screening.

A comprehensive search showed that currently there is no trial evidence for any method of encouraging uptake of cancer screening for people with mental illness. No specific approach can therefore be recommended. Early detection of cancer through screening is effective in improving patient outcomes, including death. Given that people with mental illness are at greater risk of cancer but less likely than others to take up available screening, better approaches that encourage uptake of cancer screening are needed urgently. Further research is required to ensure that people with mental illness do not miss out on cancer screening.

From a service user perspective (SUPER), it has been found that people with mental illness die on average 20 years younger than the general population, often from preventable diseases (such as cancer, heart disease and diabetes). Rethink Mental Illness is campaigning to ensure that the physical health needs of people with mental health problems are not neglected and calling for physical health champions.

Of chief concern is ‘diagnostic overshadowing’. This is where a diagnosis of mental illness overshadows and makes invisible any physical health problems. There is a need for health professionals, especially in primary care and GP surgeries, to be more aware of the physical health problems of people with mental illness. Mental illness is associated with certain health problems, including: obesity or being overweight; smoking; drinking alcohol; and poor diet, all of which increase risk of cancer. These unhealthy behaviours can often be prevented by GPs and nurses in primary care with information and advice about stopping smoking, eating a healthier diet and the need to take regular exercise. However, these behaviour changes are often very difficult for people with mental illness, so more intense and individual care is required for people to make and maintain a healthier lifestyle.