Women with mental illness, neuropsychiatric disability, or substance abuse are less likely to undergo gynecologic smear testing for cervical cancer and are more than twice as likely to develop the disease. The findings are presented in The Lancet Public Health by researchers at Karolinska Institutet, who emphasize the importance of proactively reaching out to these women as a preventative measure against cervical cancer.
In May 2020, the WHO approved a global strategy to eliminate cervical cancer as a women’s health problem. Part of the strategy is a requirement that 70 percent of women be screened for the disease at least once by age 35 and twice by age 45.
According to researchers, inequality in care is one of the main obstacles to this goal.
“Our study identified a high-risk group that needs additional attention if we are to be successful in eliminating cervical cancer,” says one of the study’s first authors, Kejia Hu, a postdoctoral researcher at the Karolinska Institutet Institute of Environmental Medicine. .
The observational study included more than four million women born between 1940 and 1995. From this population, the researchers calculated the risk of cervical cancer and precancerous cervical lesions, as well as participation in cervical cancer screening programs. uterine, comparing women diagnosed by a specialist with mental illness, neuropsychiatric disability, or substance abuse with women without such diagnoses.
“Our results suggest that women with these diagnoses participate less in screening programs while having a higher incidence of cervical lesions,” says Dr. Hu. "Therefore, we found that they have twice the risk of developing cervical cancer."
Elevated risk was observed for all diagnoses, but the greatest association was observed for substance abuse. Women with mental illnesses should be more aware of the need to undergo regular gynecological examinations, according to researchers: “It would reduce their risk of cancer,” says one of the authors of the article, Karin Sundström, senior researcher at the Department of Laboratory Medicine , Karolinska Institutet. "Likewise, if healthcare professionals are more aware of the risk of cancer in these patients, they can intensify preventive measures and consider how they can be administered to potentially underserved patients."
The strength of the study lies in the large size of the cohort and the length of the time period during which the participants were studied. One limitation is that the researchers did not have complete data on other risk factors for cervical cancer, such as smoking, hormonal contraceptives, and sexually transmitted diseases.
The study was funded by the Swedish Cancer Society. One of the researchers has received fees from a pharmaceutical company for other studies. No other conflicts of interest have been reported.
Added value of this study
In this study, we showed that women with severe mental illness had more than double the risk of invasive cervical cancer and high-grade precancerous cervical lesions and a lower degree of participation in cervical screening compared to women without illness. mental.
Implications of all available evidence
Women with serious mental illness participate less in cervical screening and experience a more than doubled risk of cervical neoplasia. Overall, future research is needed to identify other contributors, behavioral or biological factors, to the increased risk of cervical neoplasia. Refined approaches are needed to include women with serious mental illness in the cervical cancer elimination agenda in Sweden and worldwide.
