Disparities in Breast Cancer Screening Uptake for Women With Mental Illness in the United Kingdom

Introduction: Although there is evidence of disparities in breast cancer screening for women with mental illness in the United States (US), there is a dearth of studies examining this association in the United Kingdom (UK) where healthcare is provided free at the point of access. This population-based study examines the influence of mental illness, as assessed by uptake of psychotropic medications, on breast screening uptake in the UK.

Methods: A cohort of 57,328 women identified from 2011 Census records within the Northern Ireland Longitudinal Study (NILS) was followed through one three-year screening cycle (2011-2014) of the National Health Service (NHS) breast screening programme. Mental illness was identified by receipt of psychotropic medication in the three months preceding screening invite. Individual and household-level attributes were derived from Census records. Data were analyzed in 2019.

Results: Over a third of women received at least one prescription for psychotropic medication in the three months preceding screening invite. The odds of attendance in these individuals were reduced by 15% (OR= 0.85; 95% CI 0.81 – 0.88). Attendance was particularly low for women prescribed antipsychotics (OR= 0.63; 95% CI 0.56 – 0.70), anxiolytics (OR= 0.61; 95% CI 0.57 – 0.66), and hypnotics (OR= 0.68; 95% CI 0.63 – 0.72).

Conclusions: These findings confirm the existence of significant disparities in breast screening uptake for women with mental illness. Targeted interventions are warranted to prevent avoidable breast cancer deaths in these individuals, particularly given the increasing prevalence of mental illness.