Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care?

Ann Intern Med. 2000 May 2;132(9):697-704. doi: 10.7326/0003-4819-132-9-200005020-00003.


Background: Compared with thinner women, obese women have higher mortality rates for breast and cervical cancer. In addition, obesity leads to adverse social and psychological consequences. Whether obesity limits access to screening for breast and cervical cancer is unclear.

Objective: To examine the relation between obesity and screening with Papanicolaou (Pap) smears and mammography.

Design: Population-based survey.

Setting: United States.

Participants: 11 435 women who responded to the "Year 2000 Supplement" of the 1994 National Health Interview Survey.

Measurements: Screening with Pap smears and mammography was assessed by questionnaire.

Results: In women 18 to 75 years of age who had not previously undergone hysterectomy (n = 8394), fewer overweight women (78%) and obese women (78%) than normal-weight women (84%) had had Pap smears in the previous 3 years (P < 0.001). After adjustment for sociodemographic information, insurance and access to care, illness burden, and provider specialty, rate differences for screening with Pap smears were still seen among overweight (-3.5% [95% CI, -5.9% to -1.1%]) and obese women (-5.3% [CI, -8.0% to -2.6%]). In women 50 to 75 years of age (n = 3502), fewer overweight women (64%) and obese women (62%) than normal-weight women (68%) had had mammography in the previous 2 years (P < 0.002). After adjustment, rate differences were -2.8% (CI, -6.7% to 0.9%) for overweight women and -5.4% (CI, -10.8% to -0.1%) for obese women.

Conclusions: Overweight and obese women were less likely to be screened for cervical and breast cancer with Pap smears and mammography, even after adjustment for other known barriers to care. Because overweight and obese women have higher mortality rates for cervical and breast cancer, they should be targeted for increased screening.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Black or African American
  • Body Mass Index
  • Breast Neoplasms / prevention & control*
  • Chi-Square Distribution
  • Female
  • Humans
  • Mammography / statistics & numerical data*
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Obesity*
  • Papanicolaou Test*
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Uterine Cervical Neoplasms / prevention & control*
  • Vaginal Smears / statistics & numerical data*
  • White People