Obesity and breast cancer screening: Cross‐sectional survey results from the behavioral risk factor surveillance system

Abstract

Background Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross‐sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. Methods Cross‐sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state‐based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5‐24.9 kg/m2), overweight (25‐29.9 kg/m2), obese class I (30‐34.9 kg/m2), obese class II (35‐39.9 kg/m2), and obese class III (>40 kg/m2), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self‐reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. Results Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P < .05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I‐III) when compared individually. There also was no evidence of effect modification by race (P = .53). Conclusions In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight‐related facility‐level barriers over time.

Cancer Screening Prevalence and Preference among Hospitalized Women With and Without Obesity

“…In addition, before hospitalization, patients with and without obesity were equally nonadherent to BRC/CRC outpatient screening. This finding was consistent for BRC/CRC screening in larger studies, noting no differences in adherence between women with and without obesity [35][36][37] ; however, past studies have found morbidly obese Whites, low household income, and tobacco use to be risk factors for nonadherence to mammograms. 5,14,15,31 Furthermore, Denberg and colleagues found that lack of scheduled appointments, female sex, and type of insurance predicted nonadherence to screening colonoscopies.…”

Association Between Obesity and Clinicopathological Profile of Patients with Newly Diagnosed Non-Metastatic Breast Cancer in Saudi Arabia

“…However, some researchers have suggested that obesity is a potential barrier for screening compliance and effectiveness. 41–44 In contrast, other studies have shown no effect of obesity on screening compliance 45 and have reported that mammography use and accuracy are not the reasons for the higher clinical stage in obese patients. 46 Moreover, another study reported that obese women had higher sensitivity for screening mammography with similar specificity, regardless of their BMI group.…”

Association Between Body Mass Index and Cancer Screening Adherence Among Latinas in the United States and Puerto Rico

“… 14 , 42 However, similar to our findings, an analysis using the 2016 BRFSS found no association between obesity and adherence to breast cancer screening. 43 …”