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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Is Obesity a Barrier to Screening for Cervical and Breast Cancer?
2 May 2000 | Volume 132 Issue 9 | Page 697
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Screening for Cervical and Breast Cancer: Is Obesity an Unrecognized Barrier to Preventive Care?" It is in the 2 May 2000 issue of Annals of Internal Medicine (volume 132, pages 697-704). The authors are C.C. Wee, E.P. McCarthy, R.B. Davis, and R.S. Phillips.
What is the problem and what is known about it so far?
Obese women have higher death rates from cervical and breast cancer than normal-weight women. Many factors could contribute to this problem. Obese women could be less likely than normal-weight women to have screening tests to look for cancer when it is in an early stage and is more easily treatable.
Why did the researchers do this particular study?
To find out whether obese women were actually less likely than normal-weight women to get Papanicolaou (Pap) smears and mammograms to screen for cervical and breast cancer.
Who was studied?
11, 435 women who participated in a 1994 government-sponsored national survey of health issues.
How was the study done?
The National Census Bureau conducted the survey. Participants were asked about personal characteristics, medical conditions, and medical care. The survey also asked women for their height and weight, from which the researchers were able to categorize each woman as obese (heaviest), overweight (less heavy), or normal weight. In addition, a special part of the survey asked about how long it had been since each woman had had a Pap smear and a mammogram. The researchers determined whether women aged 18 to 75 years reported having a Pap smear in the past 3 years and whether women aged 50 to 75 years reported having a mammogram in the previous 2 years. They then compared the rates of Pap smears and mammograms among women who were obese, overweight, and normal weight.
What did the researchers find?
Seventy-eight percent of overweight and obese women reported having had a Pap smear compared to 84% of normal-weight women. These significant differences remained even after the researchers accounted for other patient factors, such as age, education, health insurance, and illness. Obese and overweight women also had lower rates of mammograms than normal-weight women (62%, 64%, and 68%, respectively), but those differences became less obvious after researchers accounted for other patient factors.
What were the limitations of the study?
The study relied on study participants' memory; researchers cannot be sure that women provided correct information about weight, height, and the use of screening tests. The study does not tell us why obesity is associated with less frequent use of the screening tests. For example, obesity could be associated with other barriers to screening, heavy women may be less willing to go for Pap smears or mammograms, or health care providers may be less likely to offer screening tests to heavy women.
What are the implications of the study?
Obesity is a potential barrier to appropriate screening for cervical and breast cancer. The lack of proper screening may contribute to the increased risk for death from these cancers among obese women.
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  C. C. Wee, M. B. Hamel, A. Huang, R. B. Davis, M. A. Mittleman, and E. P. McCarthy Obesity and Undiagnosed Diabetes in the U.S. Diabetes Care, September 1, 2008; 31(9): 1813 - 1815. [Abstract] [Full Text] [PDF]
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 K. B. Michels, K. L. Terry, and W. C. Willett Longitudinal Study on the Role of Body Size in Premenopausal Breast Cancer Arch Intern Med, November 27, 2006; 166(21): 2395 - 2402. [Abstract] [Full Text] [PDF]
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A. Chao, C. J. Connell, V. Cokkinides, E. J. Jacobs, E. E. Calle, and M. J. Thun Underuse of Screening Sigmoidoscopy and Colonoscopy in a Large Cohort of US Adults Am J Public Health, October 1, 2004; 94(10): 1775 - 1781. [Abstract] [Full Text] [PDF]
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 E. E. Calle, C. Rodriguez, K. Walker-Thurmond, and M. J. Thun Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults N. Engl. J. Med., April 24, 2003; 348(17): 1625 - 1638. [Abstract] [Full Text] [PDF]
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 R. A. Hiatt, C. Klabunde, N. Breen, J. Swan, and R. Ballard-Barbash Cancer Screening Practices From National Health Interview Surveys: Past, Present, and Future J Natl Cancer Inst, December 18, 2002; 94(24): 1837 - 1846. [Abstract] [Full Text] [PDF]
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V. M. Mays, A. K. Yancey, S. D. Cochran, M. Weber, and J. E. Fielding Heterogeneity of Health Disparities Among African American, Hispanic, and Asian American Women: Unrecognized Influences of Sexual Orientation Am J Public Health, April 1, 2002; 92(4): 632 - 639. [Abstract] [Full Text] [PDF]
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 Obese Women Are Less Likely to Be Screened for Cancer Journal Watch (General), May 16, 2000; 2000(516): 2 - 2. [Full Text]
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