Cancer Screening Among the Overweight and Obese in Canada

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
American Journal of Preventive Medicine (Impact Factor: 4.53). 09/2008; 35(2):127-32. DOI: 10.1016/j.amepre.2008.03.031
Source: PubMed


Despite increased cancer incidence and mortality among overweight and obese men and women, U.S. studies have reported the reduced use of cancer screening among these subjects. We sought to analyze the relationship between overweight/obesity and cancer screening practices using population-based Canadian data.
Responses from adults surveyed in the Canadian Community Health Survey 2003 who provided complete information regarding variables of interest were analyzed. Cancer screening modalities included Pap smear testing, mammography, and fecal occult blood testing, and were based on contemporary recommendations of the Canadian Task Force for Preventive Health. The association between overweight/obesity and cancer screening was explored using logistic regression after adjusting for demographic and socioeconomic factors, health habits, healthcare access, and obesity-related comorbidity. The analysis was conducted in 2007.
Compared to normal-weight controls, overweight and obese women were significantly less likely to have undergone cervical cancer screening. In the fully adjusted model, increasing obesity was associated with decreasing odds of Pap smear testing, with overweight, Class-I, -II, and -III obesity having 95% ORs of 0.87 (0.81, 0.94); 0.79 (0.72, 0.88); 0.62 (0.54, 0.71); and 0.61 (0.53, 0.72), respectively. The prevalence of biennial breast and colorectal cancer screenings was largely unaffected by weight in the adjusted analyses.
Overweight and obesity are associated with markedly lower utilization of cervical cancer screening, despite increased disease risks. This association is independent of sociodemographic factors, comorbidity, and healthcare access. This is consistent with findings in U.S. populations, and suggests that patient and provider factors serve as greater barriers to screening than do healthcare system factors.

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    • "Our findings on the association between being overweight or obese and higher Pap smear screening is in agreement with only one study (Yancy et al. 2010). On the other hand, our findings differ from many other studies where being overweight or obese was associated with lower Pap smear screening (Aldrich & Hackley, 2010; Cohen et al., 2008; Fontaine et al., 1998; Maruthur et al., 2008; Mitchell et al., 2008; Park et al., 2012; Tekkel et al., 2011). Although we do not have explanations on differences across cities, we want to mention some particularities of our findings. "
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    ABSTRACT: To examine the relationship between body mass index and cancer screening utilization, we analyzed data from six cities of the Health, Well-Being and Aging in Latin America and the Caribbean Study on 5,230 women aged 60 and older, from 1999 to 2000. We found that underweight women were less likely to have had a mammogram, a breast self-exam, and a Pap smear, relative to normal-weight women. However, overweight or obese women were more likely to have a breast self-exam and a Pap smear. Thus, being underweight had a role for decreased cancer screening utilization among older women in Latin American cities, but not being overweight or obese, which was associated with decreased cancer screening in most previous studies.
    Journal of Women & Aging 12/2014; 27(1):1-14. DOI:10.1080/08952841.2014.905403 · 0.58 Impact Factor
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    • "We identified one review of research on the relationship of obesity and cervical cancer screening [44] and three additional articles [22] [23] [24]. Twelve studies examined the relationship of obesity and screening for cervical cancer, and all of these studies found an association between increased body weight and decreased utilization of Pap smears [12–15, 25, 27–31, 45, 46]. "
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    ABSTRACT: The relationship between obesity and cancer screening varies by screening test, race, and gender. Most studies on cervical cancer screening found a negative association between increasing weight and screening, and this negative association was most consistent in white women. Recent literature on mammography reports no association with weight. However, some studies show a negative association in white, but not black, women. In contrast, obese/overweight men reported higher rates of prostate-specific antigen (PSA) testing. Comparison of prostate cancer screening, mammography, and Pap smears implies a gender difference in the relationship between screening behavior and weight. In colorectal cancer (CRC) screening, the relationship between weight and screening in men is inconsistent, while there is a trend towards lower CRC screening in higher weight women.
    Journal of obesity 12/2011; 2011:218250. DOI:10.1155/2011/218250
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