患有心理健康状况的妇女可能没有分享乳腺癌筛查和护理的改进。目前没有直接研究患有心理健康状况的妇女在乳腺癌筛查参与度减少和乳腺癌扩散之间的联系。本研究根据澳大利亚新南威尔士州2008年至2017年50至74岁妇女人群乳腺癌登记、乳腺筛查登记和心理健康服务数据的人群联合记录，识别患有侵袭性乳腺癌的个案。使用偏向于局部病变、区域病变和转移性病变的部分比例次数回归方法，考虑年龄、社会经济地位、农村地区和筛查参与模式，分析诊断时扩散程度的预测因素。共识别出29,966例乳腺癌个案，其中686例（2.4%）患有乳腺癌诊断前接受心理健康服务的妇女。超过一半的心理健康服务接受者在诊断时存在区域或转移性扩散（调整后的比值比为1.63，95%置信区间为1.41-1.89）。心理健康服务接受者的筛查参与率较低，即使调整筛查状态，晚期癌症仍较为普遍（调整后的比值比为1.53，95%置信区间为1.32-1.77）。具有严重或持续心理健康状况的妇女晚期癌症更为普遍。仅有较低的筛查参与率不能完全解释心理健康服务使用者乳腺癌晚期化风险的一小部分。需要进一步研究来了解导致患有心理健康状况的妇女乳腺癌晚期化的可能机制。卫生系统需要采取策略，确保患有心理健康状况的妇女享受乳腺癌结果的人群收益。© 2023年，由美国癌症学会代表Wiley Periodicals出版的《癌症》杂志发表。

Women living with mental health conditions may not have shared in improvements in breast cancer screening and care. No studies have directly examined the link between reduced screening participation and breast cancer spread in women using mental health (MH) services.Population-wide linkage of a population cancer register, BreastScreen register, and mental health service data set in women aged 50 to 74 years in New South Wales, Australia, from 2008 to 2017. Incident invasive breast cancers were identified. Predictors of degree of spread (local, regional, metastatic) at diagnosis were examined using partial proportional odds regression, adjusting for age, socioeconomic status, rurality, and patterns of screening participation.A total of 29 966 incident cancers were identified and included 686 (2.4%) in women with MH service before cancer diagnoses. More than half of MH service users had regional or metastatic spread at diagnosis (adjusted odds ratio, 1.63; 95% CI, 1.41-1.89). MH service users had lower screening participation; however, advanced cancer was more common even when adjusting for screening status (adjusted odds ratio, 1.53; 95% CI, 1.32-1.77). Advanced cancer was more common in women with severe or persistent MH conditions.Low screening participation rates explain only small part of the risk of more advanced breast cancer in women who use MH services. More study is needed to understand possible mechanisms contributing to more advanced breast cancer in women living with MH conditions. Health systems need strategies to ensure that women living with MH conditions enjoy population gains in breast cancer outcomes.© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.