Abstract

Background Breast cancer is an important cause of death in women with severe mental illness. Patient factors, provider factors, and social factors contribute to increased incidence and delayed diagnosis as well as delayed and substandard treatment in this population. Method This narrative review is based on the Google Scholar database from 2009 to the present, using the following search terms in combination with "schizophrenia", "psychosis", or "severe mental illness": Breast cancer, screening, chemotherapy, radiation, mastectomy, oophorectomy, chemoprevention. Findings Patient and treatment factors contribute to increased incidence. Despite the increased risk, breast screening uptake is low in this population, as is preventive surgery and chemoprotection. There are indications of treatment delays and also of treatment that is less thorough than that provided to mentally healthier peers. As a consequence of these factors as well as the prevalence of co-morbidity and low social support in this population, breast cancer mortality rates are high. Barriers to screening have been identified as patient apathy, cognitive deficits, and lack of information about breast cancer risks and options, vulnerability to stress, practical issues, poor communication between patients and care providers, and perceived stigma. Conclusions Based on the findings of this review, cutting the incidence and improving the prognosis of breast cancer in this population is potentially feasible. Information about risk factors for breast cancer needs to be made available to patients and psychiatric care providers. This will help to inform decisions about lifestyle factors and mental health treatments. Monitoring for co-morbidities and enabling screening procedures is essential. A close collaboration between oncology and mental health will help to ensure high quality care for breast cancer in women with severe mental illness.

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