Screening for Cervical and Breast Cancer: Is Obesity an Unrecognized Barrier to Preventive Care?

2 May 2000 | Volume 132 Issue 9 | Pages 697-704

Background: Compared with thinner women, obese women have higher mortality rates for breast and cervical cancer. In addition, obesity leads to adverse social and psychological consequences. Whether obesity limits access to screening for breast and cervical cancer is unclear.

Objective: To examine the relation between obesity and screening with Papanicolaou (Pap) smears and mammography.

Design: Population-based survey.

Setting: United States.

Participants: 11 435 women who responded to the "Year 2000 Supplement" of the 1994 National Health Interview Survey.

Measurements: Screening with Pap smears and mammography was assessed by questionnaire.

Results: In women 18 to 75 years of age who had not previously undergone hysterectomy (n = 8394), fewer overweight women (78%) and obese women (78%) than normal-weight women (84%) had had Pap smears in the previous 3 years (P < 0.001). After adjustment for sociodemographic information, insurance and access to care, illness burden, and provider specialty, rate differences for screening with Pap smears were still seen among overweight (–3.5% [95% CI, –5.9% to –1.1%]) and obese women (–5.3% [CI, –8.0% to –2.6%]). In women 50 to 75 years of age (n = 3502), fewer overweight women (64%) and obese women (62%) than normal-weight women (68%) had had mammography in the previous 2 years (P < 0.002). After adjustment, rate differences were –2.8% (CI, –6.7% to 0.9%) for overweight women and –5.4% (CI, –10.8% to –0.1%) for obese women.

Conclusions: Overweight and obese women were less likely to be screened for cervical and breast cancer with Pap smears and mammography, even after adjustment for other known barriers to care. Because overweight and obese women have higher mortality rates for cervical and breast cancer, they should be targeted for increased screening.

Author and Article Information

From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Presented in part at the 22nd Annual Meeting of the Society of General Internal Medicine, San Francisco, California, May 1999.

Disclaimer: The analyses, interpretations, and conclusions in this paper are those of the authors and do not reflect those of the National Center for Health Statistics.

Acknowledgments: The authors thank the National Center for Health Statistics for providing the initial data and Erin Hartman for editorial comments.

Grant Support: Dr. Wee and this investigation were supported in part by a grant from the Medical Foundation, Inc. (Boston, Massachusetts), and a National Research Service Award (#1 F32 HS00137-01) from the Agency for Healthcare Research and Quality.

Requests for Single Reprints: Christina C. Wee, MD, MPH, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Libby 330, Boston, MA 02215; e-mail, cweekuo{at}caregroup.harvard.edu.

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Current Author Addresses: Drs. Wee, McCarthy, Davis, and Phillips: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Libby 330, Boston, MA 02215.

Author Contributions: Conception and design: C.C. Wee, R.S. Phillips.

Analysis and interpretation of the data: C.C. Wee, E.P. McCarthy, R.B. Davis, R.S. Phillips.

Drafting of the article: C.C. Wee, R.S. Phillips.

Critical revision of the article for important intellectual content: C.C. Wee, E.P. McCarthy, R.B. Davis, R.S. Phillips.

Final approval of the article: C.C. Wee, E.P. McCarthy, R.B. Davis, R.S. Phillips.

Statistical expertise: C.C. Wee, E.P. McCarthy, R.B. Davis.

Obtaining of funding: C.C. Wee, R.S. Phillips.

Administrative, technical, or logistic support: C.C. Wee, E.P. McCarthy, R.S. Phillips.