National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, Helsinki 00271, Finland.
National Institute for Health and Welfare, Health and Social Systems Research, P.O. Box 30, Helsinki 00271, Finland.
Psychiatry Res. 2020 Apr;286:112801. doi: 10.1016/j.psychres.2020.112801. Epub 2020 Jan 27.
Women with a history of severe mental illness (SMI) have elevated breast cancer mortality. Few studies have compared cancer-specific mortality in women with breast cancer with or without SMI to reveal gaps in breast cancer treatment outcomes. We compared breast-cancer specific mortality in women with or without SMI and investigated effects of stage at presentation, comorbidity, and differences in cancer treatment. Women with their first breast cancer diagnosis in 1990-2013 (n = 80,671) were identified from the Finnish Cancer Registry, their preceding hospital admissions due to SMI (n = 4,837) from the Hospital Discharge Register and deaths from the Causes of Death Statistics. Competing risk models were used in statistical analysis. When controlling for age, year of cancer diagnosis, and comorbidity, breast cancer mortality was significantly elevated in patients with SMI. Relative mortality was highest in breast cancer patients with non-affective psychosis, partly explained by stage at presentation. Mortality was also significantly elevated in breast cancer patients with a substance use disorder and mood disorder. Patients with SMI received radiotherapy significantly less often than patients without SMI. Our findings emphasize the need to improve early detection of breast cancer in women with SMI and the collaboration between mental health care and oncological teams.
患有严重精神疾病 (SMI) 的女性乳腺癌死亡率较高。很少有研究比较过患有乳腺癌和无 SMI 的女性的癌症特异性死亡率，以揭示乳腺癌治疗结果的差距。我们比较了有或无 SMI 的女性的乳腺癌特异性死亡率，并调查了发病时的分期、合并症以及癌症治疗差异的影响。从芬兰癌症登记处确定了 1990 年至 2013 年首次被诊断患有乳腺癌的女性（n=80671），从住院患者登记处确定了她们之前因 SMI 住院的情况（n=4837），并从死因统计中确定了死亡情况。在统计分析中使用了竞争风险模型。在控制年龄、癌症诊断年份和合并症后，患有 SMI 的患者的乳腺癌死亡率显著升高。非情感性精神病患者的相对死亡率最高，部分原因是发病时的分期。有物质使用障碍和情绪障碍的乳腺癌患者的死亡率也显著升高。患有 SMI 的患者接受放疗的频率明显低于没有 SMI 的患者。我们的研究结果强调了需要改善对患有 SMI 的女性乳腺癌的早期检测，以及心理健康护理和肿瘤团队之间的合作。
