Silent doctors, invisible patients: Systemic barriers to cancer screening in 835 patients with severe mental disorders in rural Turkey
1
Department of Public Health, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
2
Department of Psychiatry, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
Popul. Med. 2026;8(Supplement Supplement 1):A2909
ABSTRACT
INTRODUCTION:
Individuals with severe mental disorders (SMD) face a mortality gap of 15-20 years compared to the general population, primarily due to preventable physical illnesses1. While low cancer screening rates are documented globally, the specific contribution of provider-level versus patient-level barriers remains unclear in the Turkish context. This study analyzed screening adherence gaps and identified determinants of non-participation among patients followed at a Community Mental Health Center (TRSM).
METHODS:
This cross-sectional study included 835 registered patients (Mean age: 52.7±11.7 years; 63.5% male) in Rize, Turkey. Screening history for breast, cervical, and colorectal cancers was extracted retrospectively from the national e-Health system and compared with national benchmarks2 using one-sample binomial tests. Additionally, a structured face-to-face interview assessed perceived barriers and history of provider recommendations. Multivariate logistic regression was used to identify predictors of screening adherence.
RESULTS:
Mammography screening rates among eligible women (n=228) were 8.9%, significantly lower than the Turkish national average of 14.6% (p=0.012). Similar deficits were observed for colorectal (5.5%) and cervical (12.2%) screenings. A significant disconnect was found in provider activity: only 6.5% of patients reported receiving a screening recommendation from their psychiatrist, compared to 23.7% from their family physician (p<0.001). The primary barrier cited by unscreened patients was "My doctor never told me" (42.3%), exceeding "Logistical challenges" (29.8%) and "Fear" (10.2%). Patients who received a doctor's recommendation were 19.3 times more likely to undergo screening (OR: 19.3, 95% CI: 6.7–65.6, p<0.001), regardless of disease severity.
CONCLUSIONS:
The disparity in cancer screening among patients with SMD is driven primarily by provider silence rather than patient refusal. The mental health system currently fails to integrate physical prevention. Mandating screening reminders within psychiatric consultation protocols is an urgent, high-impact intervention to bridge this equity gap.
Individuals with severe mental disorders (SMD) face a mortality gap of 15-20 years compared to the general population, primarily due to preventable physical illnesses1. While low cancer screening rates are documented globally, the specific contribution of provider-level versus patient-level barriers remains unclear in the Turkish context. This study analyzed screening adherence gaps and identified determinants of non-participation among patients followed at a Community Mental Health Center (TRSM).
METHODS:
This cross-sectional study included 835 registered patients (Mean age: 52.7±11.7 years; 63.5% male) in Rize, Turkey. Screening history for breast, cervical, and colorectal cancers was extracted retrospectively from the national e-Health system and compared with national benchmarks2 using one-sample binomial tests. Additionally, a structured face-to-face interview assessed perceived barriers and history of provider recommendations. Multivariate logistic regression was used to identify predictors of screening adherence.
RESULTS:
Mammography screening rates among eligible women (n=228) were 8.9%, significantly lower than the Turkish national average of 14.6% (p=0.012). Similar deficits were observed for colorectal (5.5%) and cervical (12.2%) screenings. A significant disconnect was found in provider activity: only 6.5% of patients reported receiving a screening recommendation from their psychiatrist, compared to 23.7% from their family physician (p<0.001). The primary barrier cited by unscreened patients was "My doctor never told me" (42.3%), exceeding "Logistical challenges" (29.8%) and "Fear" (10.2%). Patients who received a doctor's recommendation were 19.3 times more likely to undergo screening (OR: 19.3, 95% CI: 6.7–65.6, p<0.001), regardless of disease severity.
CONCLUSIONS:
The disparity in cancer screening among patients with SMD is driven primarily by provider silence rather than patient refusal. The mental health system currently fails to integrate physical prevention. Mandating screening reminders within psychiatric consultation protocols is an urgent, high-impact intervention to bridge this equity gap.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
