Cancer screening in women: BMI and adherence to physician recommendations

While severe obesity can be accompanied by other health problems including cancer, severely obese women are likely to skip clinical breast exams, mammograms and Pap smears, according to a recent analysis.

The study, however, found that physicians are as likely to recommend mammograms and Pap smears to obese as to non-obese women.

While lead study author Jeanne Ferrante, M.D., found the latter finding “reassuring,” she said it is important to figure out why severely obese women aren't getting screened, because “the obese person has an increased risk in developing and dying of cancer.”

Ferrante practices in the family medicine department at the University of Medicine and Dentistry of New Jersey/New Jersey Medical School in Newark. Her study was presented at a meeting of the American Society of Preventive Oncology in March and appears in the June issue of the American Journal of Preventive Medicine .

The study was conducted in 2006 and analyzed data from the 2000 National Health Interview Survey, involving nearly 8,300 women ages 40 to 74.

Up-to-date status on clinical breast exams, mammograms and Pap smears was 9 percent to 10 percent less prevalent among severely obese women, compared to women of normal weight. Severely obese women had 51 percent lower odds of adhering to physician recommendations for mammography and 83 percent lower odds of adhering to Pap recommendations.

A woman is severely obese if she has a body mass index of at least 40. The calculation takes into account height and weight: a 5-foot-5-inch person who weighs 247 pounds has a BMI of 41

As a next step, Ferrante is sending surveys to doctors to determine if there are barriers that may keep severely obese women from getting examined. For example: Is there proper equipment to examine severely obese patients?

Ferrante is also using focus groups to get patients' perspectives. Women have reported they feel embarrassed because of their weight, she said. “They don't like to be examined. They don't like to wear two gowns or have a scale inadequate to weigh them.”

Susan Curry, Ph.D., director of the Institute for Health Research and Policy at the University of Illinois at Chicago, suggested record-keeping methods that flag patients in at-risk groups.

“What might happen is a physicians' group would get a listing of all patients who have a [BMI] of 40 or greater,” Curry said. “Along with it would be mammography and Pap status. If they haven't been in, they might get a postcard saying, ‘You are due for a Pap smear. We'd love to see you. We can accommodate you.'”

Ferrante JM, et al. Cancer screening in women: BMI and adherence to physician recommendations. Am J Prev Med 32(6), 2007.