Patients who have a mental illness, neuropsychiatric disability, or substance use disorder may be less likely to undergo gynecological smear tests and may have over twice the risk of developing cervical cancer, according to a new study published by Hu et al in The Lancet Public Health. The findings revealed the importance of proactively approaching these patients as a preventive measure against cervical cancer.
Background
In May 2020, the World Health Organization approved a global strategy aimed at eliminating cervical cancer. Among the strategy’s goals is to achieve a 70% rate of cervical cancer screening uptake among female patients at least once before 35 years of age and twice before 45 years of age.
According to the researchers, health-care inequities may be one of the major hurdles to this objective.
“Our study identified a high-risk group that needs extra attention if we’re to succeed in eliminating cervical cancer,” stressed co–lead study author Kejia Hu, MD, a postdoctoral research fellow at the Institute of Environmental Medicine at Karolinska Institutet.
Study Methods and Results
In the new observational study, the researchers calculated the risk of developing cervical cancer and precancerous cervical lesions as well as participation in cervical cancer screening programs for over 4 million patients born between 1940 and 1995. They then compared those who had additional diagnoses of a mental illness, neuropsychiatric disability, or substance use disorder with those who didn’t have these additional diagnoses.
“Our results suggest that [patients] with these diagnoses participate more seldom in screening programs at the same time as they have a higher incidence of [cervical lesions],” noted Dr. Hu. “We thus found that they have twice the risk of developing cervical cancer,” she added.
An elevated risk of developing cervical cancer was observed for all three mental health diagnoses, but the greatest association was noted for patients with substance use disorder. The researchers recommended that those with mental illnesses should be made more aware of the need to undergo regular gynecological screenings.
Conclusions
"[Regular screenings] would lower their risk of [cervical] cancer,” highlighted study author Karin Sundström, MD, PhD, a principal researcher in the Department of Laboratory Medicine at the Karolinska Instituet. “Similarly, if health-care professionals are more aware of the cancer risk in these patients, they can step up preventative measures and consider how these could be delivered to potentially underserved patients,” she concluded.
Disclosure: The research in this study was funded by the Swedish Cancer Society. For full disclosures of the study authors, visit thelancet.com.
