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Impact of a pre-existing diagnosis of mental illness on stage of breast cancer diagnosis among older women

  • Epidemiology
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Having a mental illness increases risk of mortality for women with breast cancer, partly due to barriers to accessing recommended care (e.g., cancer screening). Early detection is one important factor in breast cancer survival. To further understand this disparity in survival, we examined whether older women with mental illness are more likely to be diagnosed with later-staged breast cancers compared to women without mental illnesses.


We used 2005–2015 SEER-Medicare data to identify AJCC stage I–IV breast cancer patients with and without a history of mental illness prior to cancer diagnosis. We used generalized ordinal regression to examine associations between mental illness diagnoses and stage at diagnosis, controlling for age, race/ethnicity, income, comorbidities, primary care use, rurality, and marital status.


Among 96,034 women with breast cancer, 1.7% have a serious mental illness (SMI), 19.9% depression or anxiety, and 7.0% other mental illness. Those with SMI have 40% higher odds of being diagnosed with AJCC Stages II, III than Stage I; women with depression/anxiety have 25% lower odds of being diagnosed with Stage IV cancer than Stage I; and women with other mental illnesses have similar odds of being diagnosed in later stages.


Women with SMI have higher odds of being diagnosed at later stages, which likely contributes to higher mortality after breast cancer. Surprisingly, women with depression and anxiety have a lower risk of being diagnosed with Stage IV cancer. Earlier breast cancer diagnosis in women with SMI is an important goal for reducing disparities breast cancer survival.

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Data availability

The datasets analyzed during the current study are not publicly available nor are they able to be shared by the corresponding author due to the data use agreement. Access to this data is managed through the SEER-Medicare program through the National Cancer Institute. These data are available by request through the SEER-Medicare program (


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Authors thank Drs Jeylan Mortimer and Nathan Shippee for their contributions to this work. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.


This research was supported by the National Cancer Institute of the National Institutes of Health [Award Number: T32CA163184 (Michele Allen, MD, MS, PI)] and the University of Minnesota’s Consortium of Law and Values, the Human in the Data MN-Drive Award, and the Minnesota Population Center Development Award.

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MB and DM worked on all parts of this project, from conceptualization to submission. DM additionally supervised this work. HP assisted in data curation, formal analysis, methodology, and writing. HP, AB, and KC assisted in conceptualization and writing.

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Correspondence to Manami Bhattacharya.

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Bhattacharya, M., Parsons, H., Call, K. et al. Impact of a pre-existing diagnosis of mental illness on stage of breast cancer diagnosis among older women. Breast Cancer Res Treat 197, 201–210 (2023).

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