Abstract
BACKGROUND AND HYPOTHESIS: Breast and cervical cancer remain a significant cause of morbidity and mortality for women worldwide. To combat these high mortality rates, numerous countries have implemented national screening programs. While the relationship between mental illness and screening participation has been examined in past systematic reviews, this is the first systematic review specifically on women with severe mental illness (SMI), referring to women experiencing bipolar affective disorder (BPAD), schizophrenia (SCZ), or associated psychotic disorders. We hypothesized that in comparison to the general population, women with SMI would have lower screening rates and higher mortality relating to breast and cervical cancer. STUDY DESIGN: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. Relevant articles were identified by searching electronic databases including PsycINFO, Ovid MEDLINE, and Embase. A quality assessment was undertaken using the Newcastle-Ottawa Scale. STUDY RESULTS: Thirty-five articles were identified. Twenty-one articles demonstrated lower screening rates in women with SMI for breast or cervical cancer, with adjusted odds ratios (AORs) between 0.33 and 0.81; AORs were lower among women with SCZ and related psychotic disorders than women with BPAD. Eleven articles examined cancer-related mortality and determined women with SMI had higher risks of breast cancer, with conflicting findings for cervical cancer-specific mortality. CONCLUSIONS: This review found reduced screening rates and higher mortality in women with SMI, suggesting a future focus on understanding the specific barriers and developing targeted screening programs for women with SMI.