Background

Since people with mental illness are more likely to die from cancer, we assessed whether people with mental illness undergo less cancer screening compared with the general population.

Methods

In this systematic review and meta-analysis, we searched PubMed and PsycINFO, without a language restriction, and hand-searched the reference lists of included studies and previous reviews for observational studies from database inception until May 5, 2019. We included all published studies focusing on any type of cancer screening in patients with mental illness; and studies that reported prevalence of cancer screening in patients, or comparative measures between patients and the general population. The primary outcome was odds ratio (OR) of cancer screening in people with mental illness versus the general population. The Newcastle-Ottawa Scale was used to assess study quality and I² to assess study heterogeneity. This study is registered with PROSPERO, CRD42018114781.

Findings

47 publications provided data from 46 samples including 4 717 839 individuals (501 559 patients with mental illness, and 4 216 280 controls), of whom 69·85% were women, for screening for breast cancer (k=35; 296 699 individuals with mental illness, 1 023 288 in the general population), cervical cancer (k=29; 295 688 with mental illness, 3 540 408 in general population), colorectal cancer (k=12; 153 283 with mental illness, 2 228 966 in general population), lung and gastric cancer (both k=1; 420 with mental illness, none in general population), ovarian cancer (k=1; 37 with mental illness, none in general population), and prostate cancer (k=6; 52 803 with mental illness, 2 038 916 in general population). Median quality of the included studies was high at 7 (IQR 6–8). Screening was significantly less frequent in people with any mental disease compared with the general population for any cancer (k=37; OR 0·76 [95% CI 0·72–0·79]; I²=98·53% with publication bias of Egger's p value=0·025), breast cancer (k=27; 0·65 [0·60–0·71]; I²=97·58% and no publication bias), cervical cancer (k=23; 0·89 [0·84–0·95]; I²=98·47% and no publication bias), and prostate cancer (k=4; 0·78 [0·70–0·86]; I²=79·68% and no publication bias), but not for colorectal cancer (k=8; 1·02 [0·90–1·15]; I²=97·84% and no publication bias).

Interpretation

Despite the increased mortality from cancer in people with mental illness, this population receives less cancer screening compared with that of the general population. Specific approaches should be developed to assist people with mental illness to undergo appropriate cancer screening, especially women with schizophrenia.

Funding

None.

中文翻译：

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全球精神疾病患者与普通人群进行癌症筛查的差异：患病率和比较性荟萃分析（包括4 717 839人）。

背景

由于精神疾病患者更有可能死于癌症，因此我们评估了精神疾病患者与普通人群相比是否进行了较少的癌症筛查。

方法

在此系统的回顾和荟萃分析中，我们搜索了PubMed和PsycINFO，而没有语言限制，并从数据库开始到2019年5月5日，手工搜索了包括研究和以前的综述的观察性研究的参考文献，以进行观察性研究。我们纳入了所有已发表的研究专注于精神疾病患者的任何类型的癌症筛查；以及报告患者进行癌症筛查的患病率或患者与普通人群之间的比较指标的研究。主要结果是精神疾病患者与普通人群进行癌症筛查的比值比（OR）。纽卡斯尔-渥太华量表用于评估研究质量，I ²用来评估研究异质性。该研究已在PROSPERO注册，注册号为CRD42018114781。

发现

47篇出版物提供了来自46个样本的数据，包括4 717 839个人（501 559名精神疾病患者和4 216 280名对照患者），其中69％至85％是女性，用于乳腺癌筛查（k = 35； 296 699个人为乳腺癌）。精神疾病，在普通人群中为1 023 288），子宫颈癌（k = 29；精神疾病为295688，在普通人群中为3540408），结直肠癌（k = 12；精神疾病在153283，在人群中为2228966）一般人群），肺癌和胃癌（均为k = 1；精神疾病为420，在普通人群中没有），卵巢癌（k = 1；精神疾病为37，在普通人群中没有）和前列腺癌（k = 6 ； 52 803例患有精神疾病，总人口为2 038 916。纳入研究的中位数质量较高，为7（IQR 6-8）。I ² = 98·53％，Egger's p值= 0·025，出版偏倚，乳腺癌（k = 27； 0·65 [0·60-0·71]；I ² = 97·58％，无出版偏倚），子宫颈癌（k = 23； 0·89 [0·84-0.95]；I ² = 98·47％，无出版偏倚）和前列腺癌（k = 4； 0·78 [0· 70–0·86]；I ² = 79·68％，无发布偏倚），但不适用于结直肠癌（k = 8； 1·02 [0·90-1·15]；I ² = 97·84％而且没有发布偏见）。

解释

尽管精神疾病患者的癌症死亡率增加，但与普通人群相比，该人群接受的癌症筛查较少。应该制定具体的方法来帮助精神疾病患者进行适当的癌症筛查，尤其是精神分裂症妇女。

资金

没有。