Trends in uptake of cancer screening among people with severe mental illness before and after the COVID-19 pandemic in Japan: A repeated cross-sectional study

Abstract

Aim: The aim of this study was to investigate trends in cancer screening participation among people with severe mental illness (PSMI) from periods before and after the COVID-19 pandemic.

Methods: In this repeated cross-sectional study, we used anonymized datasets on municipal cancer screening participation among PSMI in Okayama City. The data covered fiscal year (FY) 2018 to FY2022; we used the municipal cancer screening database and Medical Payment for Services and Supports for Persons with Disabilities. PSMI were defined as those with schizophrenia or related psychotic disorders (F20-29) or bipolar disorder (F30 or F31), identified using International Classification of Diseases, Tenth Revision, codes. The analysis included men and women aged 40-69 years for colorectal and lung cancer screening; men and women aged 50-69 years for gastric cancer screening; women aged 40-69 years for breast cancer screening; and women aged 20-69 years for cervical cancer screening. Municipal cancer screening rates among PSMI were calculated for each FY.

Results: For all cancer types, cancer screening rates for PSMI in FY2020 (colorectal: 9.0%; lung: 11.6%; gastric: 4.9%; breast: 6.2%; and cervical: 6.1%) were lower than the rates in FY2019 (11.5%, 14.0%, 6.5%, 9.3%, and 8.3%, respectively). In FY2022, the rates (9.9%, 12.9%; 5.3%; 8.0%, and 6.9%, respectively) recovered, but remained low.

Conclusion: This study showed that cancer screening rates among PSMI were very low, both before and after the COVID-19 pandemic. Efforts to encourage participation in cancer screening in this population are urgently needed.

Keywords: COVID‐19; bipolar disorder; cancer screening; healthcare disparities; schizophrenia.

Figure 1

Trends in municipal cancer screening rates among people with severe mental illness (PSMI) for (a) colorectal, (b) lung, (c) gastric, (d) breast, and (e) cervical cancer. ^aCancer screening rates among the general population of Okayama City. We calculated these rates using published official statistics data from the Comprehensive Survey of Living Conditions (CSLC) by the Ministry of Health, Labour, and Welfare (https://www.e-stat.go.jp/). In the CSLC, cancer screening rates are assessed in a large‐scale survey conducted every 3 years. The survey focused on self‐reported participation in cancer screenings, which included municipal cancer screening as well as worksite‐based cancer screening. It should be noted that for breast and cervical cancer screening, participation rates were calculated within the past 2 years. FY = fiscal year.