This study compared cancer screening and stage between people with and without mental health disorders in Taiwan. It linked national insurance claims to Cancer Registry data covering over 99% of the population. Mental health disorders were linked to slightly higher screening (aOR 1.04 breast, 1.12 bowel) and less metastatic disease (0.72, 0.93). People with severe disorders screened less (aOR 0.81 breast, 0.88 bowel), though 61.8% and 60.8% were top-quartile outpatient users. Their odds of metastatic breast cancer stayed lower (aOR 0.79), with no advantage for bowel cancer (aOR 1.04). Claims data lacked symptom severity, education, smoking and family support, and model discrimination was low (ROC about 0.53–0.60).
Why it is interesting: Frequent contact with an open-access health system did not close screening gaps for people with severe mental illness. The gap appeared both for clinic-based mammography and for the faecal immunochemical test (FIT) people complete at home.
Abstract — the authors' own words, CC BY
People with pre-existing mental health disorders (PMHD) often have lower cancer screening uptake and later-stage diagnoses. It remains unclear whether these disparities persist within highly accessible universal healthcare systems without strict gatekeeping. We simultaneously investigated the associations between PMHD and both screening participation and stage at diagnosis of breast and bowel cancers within the Taiwan health service. Using nationwide National Health Insurance and Cancer Registry data covering over 99% of the population, we compared outcomes between individuals with and without PMHD. Propensity score matching was applied for the screening cohort. Adjusted odds ratios were estimated using logistic regression, with subgroup analyses for severe PMHD. Overall, PMHD was associated with higher screening participation (adjusted odds ratios [aOR]: breast = 1.04, bowel = 1.12) and reduced odds of metastatic disease at diagnosis (breast = 0.72, bowel = 0.93), although the magnitude of these associations was modest, particularly for bowel cancer. Conversely, individuals with severe PMHD had significantly lower odds of screening (breast = 0.81, bowel = 0.88) despite high outpatient use. Furthermore, while the severe group retained reduced odds of metastatic breast cancer at diagnosis (aOR = 0.79), they showed no staging advantage for bowel cancer. While Taiwan's highly accessible universal healthcare system may contribute to a surveillance effect benefiting the general PMHD population, significant disparities persist for individuals with severe illnesses. Targeted interventions, procedural simplifications for self-administered tests, and multidisciplinary person-centred care models, may be needed to ensure health equity.
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