May 1, 2000 -- For overweight and obese women, there's a double jeopardy in screening for cancer of the breast and cervix. These women have an increased risk of getting these cancers. Yet they are less likely to have the recommended screenings -- mammography and Pap smears -- than women of normal weight.
The authors of a recent study suggest that physicians' negative attitudes toward these patients may mean they are offered screening less frequently. Also, the patients' own poor self-perceptions may keep them from seeking preventive care, the authors write in a study published in the journal Annals of Internal Medicine.
"We can only speculate on the reasons for this discrepancy," researcher Christina C. Wee, MD, MPH, tells WebMD. "Because both of these tests are personal, patients' poor self-esteem may affect their willingness to come in." Wee cautioned that the study might have some inaccuracies because the information was self-reported. She is an instructor at Harvard Medical School in Boston and a general internist at Beth Israel Deaconess Medical Center.
Among almost 8,400 women 18 to 75 years old who had not had a hysterectomy, 78% of overweight women and 78% of obese women had received Pap smears in the previous three years. Among women of normal weight, 85% had Pap smears during that time.
The investigators observed a similar pattern for mammography to screen for breast cancer. Of the women who were eligible for mammography and for whom height and weight data were available, 65% overall had been screened in the past two years. The rate was 64% for overweight women and 62% for obese women, while for women of normal weight, the mammography rate was 68%.
Because obesity has fewer stigmas in black culture, the authors wanted to see if these differences in screening held true in black women. For these women, excess weight and obesity "was not a significant correlate of Pap smear screening in any weight category," the researchers write. They found similar results for mammography.
"These findings raise concern that obesity may be an unrecognized barrier to preventive care," the researchers write. "Because overweight and obese women are at increased risk for death from breast and cervical cancer, they should be targeted for increased screening."
Does this study show that overweight women are woefully underserved in getting screening for these cancers? Probably not, Kamran Torbati, MD, tells WebMD. He says the way the study was designed was not ideal for looking at this issue. "Additionally, the differences in rates between the overweight and normal women weren't that drastic. ... I don't think there's a huge conclusion to be made from this study." He is an ob-gyn in private practice in Encino, Calif., and was not involved in the study.
"Future studies should tell us more than how many women received mammography and Pap smears," writes Russell Harris, MD, MPH, in an editorial accompanying the study that urged physicians to take a new approach in patient-physician education. "They should also examine ... how we can reach 100% in effective communication with all of our patients." He is affiliated with the University of North Carolina School of Medicine in Chapel Hill.
- Overweight and obese women are at higher risk for getting breast and cervical cancers, but new research shows that these same women are less likely to receive Pap smears and mammograms, the recommended screening tests.
- The authors of the study speculate that physicians may have negative attitudes toward their overweight patients, or the patients' low self-esteem may prevent them from seeking care.
- Among black women, obesity did not affect the rate of Pap smears or mammography, perhaps because weight is less of a stigma in black culture.