Rates of colorectal cancer diagnosis and mortality in people with severe mental illness: results from Australia’s National Bowel Cancer Screening Programme
Bibliographic record
Abstract
AIMS: Studies show that people with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC). These studies mostly predate the introduction of national bowel cancer screening programmes (NBCSPs) and it is unknown if these have reduced disparity in CRC-related mortality for people with SMI. METHODS: We compared mortality rates following CRC diagnosis at colonoscopy between a nationally representative sample of people with and without SMI who participated in Australia's NBCSP. Participation was defined as the return of a valid immunochemical faecal occult blood test (iFOBT). We also compared mortality rates between people with SMI who did and did not participate in the NBCSP. SMI was defined as receiving two or more Pharmaceutical Benefits Scheme prescriptions for second-generation antipsychotics or lithium. RESULTS: Amongst NBCSP participants, the incidence of CRC in the SMI cohort was lower than in the controls (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.61-0.98). In spite of this, their all-cause mortality rate was 1.84 times higher (95% CI 1.12-3.03), although there was only weak evidence of a difference in CRC-specific mortality (HR 1.82; 95% CI 0.93-3.57). People with SMI who participated in the NBCSP had better all-cause survival than those who were invited to participate but did not return a valid iFOBT (HR 0.67, 95% CI 0.50-0.88). The benefit of participation was strongest for males with SMI and included improved all-cause and CRC-specific survival. CONCLUSIONS: Participation in the NBCSP may be associated with improved survival following a CRC diagnosis for people with SMI, especially males, although they still experienced greater mortality than the general population. Approaches to improving CRC outcomes in people with SMI should include targeted screening, and increased awareness about the benefits or participation. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12620000781943).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".