Weight Comes Between Women and Cancer Screenings
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
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
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