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Psychiatr Serv. 2019 Nov 14:appips201900318. doi: 10.1176/ [Epub ahead of print]

Breast Cancer Screening in Women With Schizophrenia: A Systematic Review and Meta-Analysis.

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Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent).



Women with schizophrenia appear to receive breast cancer diagnoses at later stages of the disease compared with the general population. To study this disparity, this report reviewed and quantified the differences in rates of mammography screening for women with schizophrenia and other psychotic disorders compared with the general population.


A systematic literature search was conducted in PubMed, Embase, Web of Science, and PsycINFO databases. Each database was searched from inception to September 14, 2018. The search strategy included search terms for breast cancer, mammography, schizophrenia, and psychosis. Two reviewers independently screened and evaluated eligible studies. The main outcome measure was the rate of mammography screening among women with schizophrenia and psychotic disorders versus a comparable population of women without these diagnoses. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for abstracting data, and the Newcastle-Ottawa Scale was used for assessing data quality. A meta-analysis with a random-effects model was performed.


From a total of 304 abstracts reviewed, 11 studies met the inclusion criteria, representing 25,447 women with diagnoses of schizophrenia or psychosis across four countries. The meta-analysis showed that women with schizophrenia were less likely than women without schizophrenia to receive mammography screening (pooled OR=0.50, 95% confidence interval=0.38-0.64, p<0.001). In subgroup analysis, this association was not significantly affected by quality of the study.


Women with schizophrenia and other psychotic disorders were about half as likely as the general population to receive mammography screening. Further research is needed to determine causes of this disparity.


Breast cancer; Medical morbidity and mortality in psychiatric patients; mammography screening disparity; schizophrenia


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