Lower risk of prostate cancer in schizophrenia: fact or artifact?

Abstract

-Background and Objectives: Reduced risk for prostate cancer in persons diagnosed with schizophrenia has been reported repeatedly. While genetic factors and antipsychotic medications were imputed, a methodological hypothesis could be raised: given the reported disparities of health services with regard to service users with schizophrenia these persons may be screened less often compared to schizophrenia-free counterparts resulting in undetected prostate tumors. The study objective was to compare the rates of performance of the prostate specific antigen (PSA) screening test among persons diagnosed with schizophrenia to matched-comparison subjects.Methods: A prospective historical epidemiological study which included service users with and without a diagnosis of schizophrenia (N = 52,131). Linkage was conducted between databases of the nation-wide psychiatric register and Israel's largest health maintenance organization. Annual performance of PSA tests was recorded between the years 2002-2009.Results: Service users with schizophrenia performed the PSA test 23% less than the comparison subjects. However, among service users who were diagnosed with prostate cancer only 44% performed the PSA test during the year prior to diagnosis.Conclusions: In line with our hypothesis, lower rates of PSA screening tests were conducted among service users with schizophrenia. However, the relatively low rate of this test prior to prostate cancer diagnosis ought to be noted.

Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people

“…For instance, increased cancer mortality in mental illness may be due to disparities in care (13), in that people with mental illness are significantly less likely to receive surgical interventions or radiotherapy and to have fewer chemotherapy sessions (10). Additionally, it has been suggested that those with mental illness may be less tolerant of intensive treatment regimens with significant side effect burdens and also that comorbid physical illness may contribute to the increased mortality rates (14).…”