Setting

This audit is relevant to all female patients over 25 years of age in any hospital. It will be particularly relevant in long-stay wards, such as forensic settings.

Background

Women with mental health problems may be at increased risk for developing breast and cervical cancer (Miller et al, 2007), probably because of their underutilisation of preventative services, decreased access to treatment, effects of mental illness and its treatment on the development of cancer, and risk factors common to both mental illness and cancer (Follette & Cummings, 1967; Xiong et al, 2008).

Standards

Routine screening methods are recommended by the Department of Health (2007) to detect breast cancer and to identify cervical pathology in preventing cervical cancer. The screening programmes for cervical and breast cancer run by the National Health Service (NHS) have a target standard of 100% (National Institute for Health and Clinical Excellence, 2003). The NHS breast screening programme provides free breast screening every 3 years for all women in the UK aged 50–70 (50–64 in Northern Ireland). Women between the ages of 25 and 64 are eligible for free cervical screening (25–49 years, 3 yearly; 50–64 years, 5 yearly).

Method

Data collection

All female patients aged over 25 years currently admitted to a medium-secure unit were considered for inclusion in the audit. Patients under 25 years were excluded as they were not eligible for screening for either breast cancer or cervical cancer. Information regarding the patient's age, duration of stay and cervical and breast cancer screening was collected from the medical records.

Data analysis

Data were analysed using spreadsheet software. The proportions of patients who had been screened were calculated:

ᐅ cervical screening for those aged 25–49

ᐅ breast and cervical screening for those aged 50–70

Resources required

People

Three people were involved in undertaking the audit.

Time

It took almost 3 months to complete this audit.

Results

ᐅ Of the women aged 25–49 years, 30% were not screened for cervical cancer.

ᐅ Nearly 30% of those aged over 50 were not screened for cervical cancer.

ᐅ For more than 50% of the women aged over 50, for whom breast cancer screening is essential, it was not done. In one case, a mammogram was done because an abnormality was detected by physical examination.