People with serious mental illness —schizophrenia, bipolar disorder and
disabling depression — are 2.6 times more likely to develop cancer than
the general population, new Johns Hopkins research suggests.
study’s findings, published this month in the journal Psychiatric
Services, raise questions about whether patients burdened with serious
mental illness are receiving appropriate cancer screenings and
preventive care related to risk factors for cancer, such as smoking.
increased risk is definitely there, but we’re not entirely sure why,”
says study leader Gail L. Daumit, M.D., M.H.S., an associate professor
of medicine and psychiatry at the Johns Hopkins University School of
Medicine. “Are these people getting screened? Are they being treated?
Something’s going on.”
In a separate study, published online last
month in the journal Injury Prevention, Daumit found that people with
serious mental illness were nearly twice as likely to end up in a
hospital’s emergency room or inpatient department suffering from an
injury than the general population and about 4.5 times more likely to
die from their injuries.
Daumit says roughly 5 percent of
Americans have a serious mental illness, and this group is known to be
two to three times more likely to die prematurely than those without
disabling psychiatric problems. A small proportion of the higher risk,
she says, can be attributed to the higher risks of suicide and homicide
victimization in this population, but those factors do not account for
most of the disparity. The top causes of death are cardiovascular
disease and cancer, the same top causes of death for those without
serious mental illness.
Daumit, a practicing internist, speculates that this population is “falling through the cracks.”
the first study, Daumit’s team looked at data from 3,317 Maryland
Medicaid beneficiaries with schizophrenia and bipolar disorder,
determining whether they developed cancer between 1994 and 2004 and what
type of cancer they had. They found that patients with schizophrenia,
when compared to the general population, were more than 4.5 times more
likely to develop lung cancer, 3.5 times more likely to develop
colorectal cancer and nearly three times more likely to develop breast
cancer. People with bipolar disorder experienced similarly high risk for
lung, colorectal and breast cancer. There were no racial differences in
who developed cancer in this group, whose average age was between 42
and 43 years.
Daumit says one reason for the elevated risk of
lung cancer could be smoking, which is more prevalent in people with
serious mental illnesses. She also speculates that the breast cancer
risk could be related to the fact that women with schizophrenia and
bipolar disorder are less likely to have children, and childbearing is
believed to reduce breast cancer risk. Also, some psychotropic
medications can increase levels of the hormone prolactin, a factor that
has been linked to breast cancer. The colorectal cancer risk, she says,
could be related to lifestyle issues, such as smoking, lack of physical
activity and a diet lacking fruits and vegetables.
more study is needed on the role of behavioral and pharmacological
factors in increased cancer risk among people with serious mental
illness, and the extent to which this population receives appropriate
cancer screening and treatment. She says mental health providers and
primary care physicians must work together to promote screening as well
as to reduce modifiable risk factors such as smoking among this group.
the second study, Daumit and her colleagues looked at similar Maryland
Medicaid data from 1994 through 2001 in search of other patterns. They
found that over the seven-year period, 43 percent of the 6,234 people
with serious mental illness in the group studied were seen at a hospital
emergency department or admitted with an injury. Among the members of
the study group with any injury, 42 percent were injured once, 23
percent twice, 25 percent three to five times and 10 percent six or more
Superficial injuries, open wounds and sprains were the
types of injuries most frequently experienced by those in the study.
Poisoning and burns were the least frequent types of injuries. Daumit
says the results suggest that people with serious mental illness appear
to be at heightened risk for both intentional and unintentional injury,
and the types of injuries are mostly consistent with falls and minor
People with serious mental illness are more likely to
have substance abuse problems, and being under the influence of drugs or
alcohol can increase injury risk, as can being in a location where
illegal drugs are sold, Daumit says. But substance abuse rates don’t
explain all of the increased risk, she says.
Another factor that
may be at play, she says, is low socioeconomic status, which is also
associated with mental illness and injury risk. She and her team say
that environmental risk factors related to poverty that could put people
with serious mental illness at increased risk of injury include unsafe
housing (without appropriate railings to prevent falls, for example) and
poorly maintained neighborhoods (such as those lacking sidewalks).
as this population has other medical risks, injury requiring acute
medical attention in the emergency department is common and we should
consider this when we are looking at the overall care of the patient,”
Doctors, she says, need to think about injury risk
when counseling patients with serious mental illness and their
caregivers. She recommends caregivers touch on such things such as the
use of bicycle and motorcycle helmets, safe firearm storage and fall
In addition, she says, physicians should evaluate and
address side effects from psychotropic medications such as dizziness,
which may lead to unintentional injury.This article was first published at www.newswise.com