Factors Influencing Cancer Screening in Black Patients with Serious Mental Illness

A study evaluated predictors of cancer screening uptake among Medicaid enrollees with serious mental illness, including differences in uptake between Black and White patients. These findings were published in Psyho-Oncology.

“Cancer is the second leading cause of death for people with serious mental illness, such as schizophrenia and bipolar disorder. People with serious mental illness receive cancer screenings at lower rates than the general population,” wrote the study authors. “We sought to identify factors associated with cancer screening in a publicly insured population with serious mental illness and stratified by race, a factor itself linked with differential rates of cancer screening.”

The investigators utilized the Medicaid administrative claims database from the state of Maryland between 2010 through 2018 to examine screening rates for eligible Black and White enrollees with serious mental illnesses. Screening assessments included:

  • cervical cancer (n = 40,622)
  • breast cancer (n = 9818)
  • colorectal cancer (n = 19,306)
  • prostate cancer (n = 4,887)

The researchers aimed to identify individual-level sociodemographic and clinical factors associated with screening uptake. Factors assessed included co-occurring substance use disorder, medical comorbidities, psychiatric diagnosis, obstetric-gynecologic and primary care utilization. The team also evaluated the impact of geographic-level characteristics, including metropolitan status, mean household income, and primary care workforce capacity.

The results showed that Black patients with mental illness were more likely to undergo screening for cervical cancer (adjusted odds ratio [AOR]=1.18; 95% confidence interval [CI], 1.15-1.22), breast cancer (AOR=1.27; 95% CI, 1.19-1.36), and colorectal cancer (AOR=1.07; 95% CI, 1.02-1.13). Rates of screening for prostate cancer were comparable between White and Black patients (AOR=1.06; 95% CI, 0.96-1.18).

The factors most positively associated with screening uptake were regular primary care utilization and longer-term Medicaid enrollment. Conversely, patients with co-occurring substance abuse disorders were negatively associated with cancer screening uptake.

According to the authors, the study’s clinical takeaway is that, “Improving cancer screening rates among populations with serious mental illness should focus on facilitating continuous insurance coverage and access to primary care.”