title: Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake.
abstract: BACKGROUND
  There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening.
  
  
  OBJECTIVE
  To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health.
  
  
  METHODS
  Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety.
  
  
  RESULTS
  We identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715,705). An additional 5 studies investigating screening for those with distress (n = 21,491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66-0.77), mood disorders (OR = 0.83, 95% CI 0.76-0.90) and particularly SMI (OR = 0.54, 95% CI 0.45-0.65). No disparity was evident among women with distress alone.
  
  
  CONCLUSIONS
  Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.
authors.affiliation: Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK.
authors.forename: Isabel Espirito Santo
authors.initials: IE
authors.lastname: Pereira
authors.affiliation: Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK.
authors.forename: Motahare
authors.initials: M
authors.lastname: Yadegarfar
authors.affiliation: Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK.
authors.forename: Shingai
authors.initials: S
authors.lastname: Pepereke
authors.affiliation: Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK.
authors.forename: Vongai
authors.initials: V
authors.lastname: Mugadza
authors.affiliation: Alex J. Mitchell, MD, Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester; Isabel Espirito Santo Pereira, Motahare Yadegarfar, Shingai Pepereke, Vongai Mugadza, University of Leicester Medical School, Leicester; Brendon Stubbs, MSc, MCSP, Faculty of Education and Health, University of Greenwich, London, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration / Q000523:psychology; D001523:Mental Disorders / Q000175:diagnosis / Q000503:physiopathology; D011314:Preventive Health Services; D011569:Psychiatric Status Rating Scales