Hu Kejia, Wang Jiangrong, Sparén Pär, Herweijer Eva, Sjölander Arvid, Adami Hans-Olov, Valdimarsdóttir Unnur, Sundström Karin, Fang Fang
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Lancet Public Health. 2023 Apr;8(4):e266-e275. doi: 10.1016/S2468-2667(23)00026-9.
WHO aims to eliminate cervical cancer. Whether women with mental illness constitute a group at high-risk and require targeted prevention initiatives remains unknown. We aimed to assess whether women with severe mental illness, psychiatric or neurodevelopmental disorders, have an increased risk of invasive cervical cancer, and an increased risk of precancerous lesions and a lower degree of participation in cervical screening compared with women without severe mental illness.
In this population-based observational study, 4 112 598 women from 1973 to 2018 in Sweden were included to compare the risk of invasive cervical cancer, high-grade precancerous cervical lesions (CIN2+), and degree of participation in cervical screening (defined as the proportion of time covered by screening during a period when cervical screening is recommended) between women with and without mental illness. We focused on severe mental illness (ie, diagnosed in specialised psychiatric care) and also investigated milder mental illness (ie, use of psychotropic medications prescribed in primary care without specialist diagnosis) as secondary exposure. In two nested case-control studies, we defined the cases as women who have a diagnosis of invasive cervical cancer or CIN2+, and randomly selected individually matched controls from women who did not have these diagnoses.
Women with a specialist diagnosis of mental illness had a higher risk of invasive cervical cancer (hazard ratio 2·39, 95% CI 2·22-2·57) and CIN2+ (2·22, 2·18-2·26) and a 5·0% (4·8-5·2) lower cervical screening participation compared with matched controls. The risk increment of invasive cervical cancer and CIN2+ was greatest for substance misuse, whereas the screening reduction was greatest for intellectual disability and autism. In contrast, women who used prescribed psychotropic medications without specialist diagnosis had slightly higher screening participation and higher risk of CIN2+ but lower risk of invasive cervical cancer than women with neither specialist diagnosis nor medication use.
Women with severe mental illness participate less in screening and experience a higher risk of cervical neoplasia. Refined approaches are needed to better target these women in the elimination agenda of cervical cancer.
Swedish Cancer Society.
世界卫生组织旨在消除宫颈癌。患有精神疾病的女性是否构成高危群体以及是否需要针对性的预防措施尚不清楚。我们旨在评估患有严重精神疾病、精神或神经发育障碍的女性与没有严重精神疾病的女性相比，患浸润性宫颈癌的风险是否增加，癌前病变的风险是否增加以及宫颈筛查的参与度是否较低。
在这项基于人群的观察性研究中，纳入了1973年至2018年瑞典的4112598名女性，以比较患有和未患有精神疾病的女性患浸润性宫颈癌、高级别癌前宫颈病变（CIN2+）的风险以及宫颈筛查的参与度（定义为在建议进行宫颈筛查的时间段内筛查覆盖的时间比例）。我们重点关注严重精神疾病（即在专门的精神科护理中诊断），并将轻度精神疾病（即在初级保健中开具的无专科诊断的精神药物使用）作为次要暴露因素进行调查。在两项嵌套病例对照研究中，我们将病例定义为被诊断为浸润性宫颈癌或CIN2+的女性，并从没有这些诊断的女性中随机选择个体匹配的对照。
与匹配的对照相比，有精神疾病专科诊断的女性患浸润性宫颈癌（风险比2.39，95%置信区间2.22 - 2.57）和CIN2+（2.22，2.18 - 2.26）的风险更高，宫颈筛查参与度低5.0%（4.8 - 5.2）。物质滥用导致的浸润性宫颈癌和CIN2+的风险增量最大，而智力残疾和自闭症导致的筛查减少最大。相比之下，使用无专科诊断的处方精神药物的女性与既无专科诊断也未使用药物的女性相比，筛查参与度略高，CIN2+风险较高，但浸润性宫颈癌风险较低。
患有严重精神疾病的女性筛查参与度较低，患宫颈肿瘤的风险较高。在宫颈癌消除议程中，需要更精细的方法来更好地针对这些女性。
瑞典癌症协会。
