Abstract
Background
Globally, more than 2 million women are diagnosed with breast or cervical cancer every year. Depressive symptoms and personality traits have been implicated in cancer-related mortality, but the potential mechanisms through which these associations may operate are not well understood. We aimed to assess how depressive symptoms and neuroticism are associated with participation in breast and cervical cancer screening.
Methods
273 402 women in the UK Biobank cohort who were eligible for breast cancer screening (aged 50-70 years) and/or cervical cancer screening (<65 years) at baseline recruitment (2006-10) and those with follow-up data (2014-March 19) were identified. Depressive symptoms (4 items from Patient Heath Questionnaire) and neuroticism (12 items from Eysenck Personality Inventory Neuroticism Scale) were self-reported at baseline. The primary outcomes were reporting being up to date with breast and cervical cancer screening. For prospective analyses, patterns of screening participation from baseline to follow-up were derived. Logistic regression was used to analyse associations, adjusted for potential confounders.
Results
More severe depressive symptoms (range 0-12) were associated with reduced screening for breast (OR = 0.960, 95% CI: 0.950,0.970) and cervical cancer (OR = 0.958, 95% CI: 0.950,0.966). Prospective analyses revealed higher baseline depressive symptoms were related to decreased cervical cancer screening at follow-up (OR = 0.955, 95% CI: 0.913,0.999; equivalent to a difference of 4.08% between the highest and lowest depressive symptom score), but not with breast cancer screening. Results for overall neuroticism were inconclusive, but individual neuroticism items including anxiety and nervousness were related to increased screening participation.
Conclusions
More severe depressive symptoms may act as a barrier for cancer screening participation and could be an indication for more proactive strategies to improve uptake.
Key messages
Women with more severe depressive symptoms are less likely to be up to date with their breast and cervical cancer screening, which may exacerbate existing health inequalities. Interventions to increase screening participation among women with poor mental health may be merited.
Clinical follow-up practices after cervical cancer screening by co-testing: A population-based study of adherence to U.S. guideline recommendations
