title: Breast cancer in patients with schizophrenia.
abstract: BACKGROUND
  Schizophrenia has a powerful impact on the outcomes of treatment for physical disorders. This study sought to estimate how the presence of schizophrenia disrupts the course of diagnosis and initial treatment of breast cancer.
  
  
  METHODS
  We searched the Patient Treatment File, a comprehensive computer-based system for inpatient data in the Department of Veterans Affairs (DVA) medical system, to identify patients with codes for schizophrenia or schizoaffective disorder who later developed breast cancer. These data were augmented with chart-based clinical data.
  
  
  RESULTS
  There were 56 evaluable patients from 34 DVA facilities; 37 (66%) were female. Delay in diagnosis was common. The mean size of the primary tumor was 4 cm in those for whom these data were recorded. Delay in diagnosis was common and many never received the indicated surgery. Distant metastases were present on diagnosis in 12 (21%) and developed after diagnosis in 14 (25%) others, including 7 who inappropriately delayed or refused indicated surgery and 4 who inappropriately delayed or refused indicated neoadjuvant chemotherapy. Twelve verbally abused or physically attacked caregivers.
  
  
  CONCLUSIONS
  Patients with schizophrenia who later develop breast cancer often deny they have cancer. They often have high-stage disease at diagnosis and often delay or refuse therapy. Breast-conserving multimodality therapy is often not feasible.
authors.affiliation: Department of Surgery, Saint Louis University Medical Center, 3635 Vista Avenue, St. Louis, MO 63110-0250, USA.
authors.forename: Mishel
authors.initials: M
authors.lastname: Farasatpour
authors.forename: Radhakrishna
authors.initials: R
authors.lastname: Janardhan
authors.forename: Campbell D
authors.initials: CD
authors.lastname: Williams
authors.forename: Julie A
authors.initials: JA
authors.lastname: Margenthaler
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Virgo
authors.forename: Frank E
authors.initials: FE
authors.lastname: Johnson
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D016022:Case-Control Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012111:Residence Characteristics; D012559:Schizophrenia / Q000150:complications*; D061665:Time-to-Treatment; D016312:Treatment Refusal; D014754:Violence
keywords: Breast cancer; Outcomes; Schizophrenia; Surgery