The impact of anxiety and affective disorders on breast cancer screening in women in Puerto Rico

BACKGROUND: Breast cancer is the most common cancer among women globally. Early detection using mammography is crucial for improving outcomes and reducing aggressive treatment. Factors such as age, comorbidities, insurance coverage, and mental health conditions may influence screening behavior. Limited research exists on the relationship between mental health and breast cancer screening in Puerto Rico. This study examines factors associated with early detection among women aged 50 and older diagnosed with breast cancer and coexisting anxiety or affective disorder. METHODS: We conducted a retrospective cohort study using data from the Puerto Rico Central Cancer Registry linked with the Health Insurance Linkage Database. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) to describe the relationship between having anxiety or affective disorder with the use of mammography and the stage at diagnosis. Cox proportional hazards model was used to assess the association between mental health diagnosis and risk of death, respectively. RESULTS: Among 4,708 eligible women, 376 (8.0%) had an anxiety or affective disorder. Overall, 90.0% received a mammogram within 24 months prior to diagnosis, and 35.1% were diagnosed at a late stage. Women with anxiety or affective disorder were 57.0% more likely to have undergone screening (AOR 1.57, 95% confidence interval [CI]: 1.01-2.43; p = 0.046). These disorders were not significantly associated with cancer stage at diagnosis (AOR 0.86, 95% CI 0.68-1.09; p = 0.208) and did not increase the risk of death within 5 years (Adjusted Hazard Ratio [AHR] 1.01, 95% CI: 0.76-1.35; p = 0.094). CONCLUSION: In our study, anxiety or affective disorders were associated with increased mammography use but not with earlier cancer stages. Further research is needed on severe mental illness and the bidirectional relationship between cancer and mental health.