March 25, 2009
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Morbidly obese postmenopausal women less likely to have mammogram

Obese white women have lower rates of screening that obese black women.

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Lower routine mammography screening rates may partially explain the higher breast cancer mortality among morbidly obese postmenopausal women.

New data reveal that morbidly obese women were significantly less likely to undergo mammography than normal-weight women, especially if they are white.

“It is known that obese women have increased mortality from postmenopausal breast cancer. Overall, we found that most obese and morbidly obese women reported less mammography screening,” Nisa M. Maruthur, MD, MHS, post-doctoral fellow in the division of general internal medicine at Johns Hopkins University School of Medicine, told Endocrine Today.

Systematic review, metaanalysis

The researchers reviewed data from 17 previously published studies that included more than 276,000 participants to examine the relationship between body weight and mammography.

Compared with normal weight women, morbidly obese women (BMI ≥40) were 20% less likely to report recent mammography in the previous two years (OR=0.79; 95% CI, 0.68-0.92). Mammography rates were also lower among overweight (OR=1.01; 95% CI, 0.95-1.08) and obese women with a BMI of 30-39 (OR=0.93; 95% CI, 0.83-1.05) and 35-39.9 (OR=0.90; 95% CI, 0.78-1.04).

White women had a stronger relationship between body weight and mammography compared with black women.

“The metaanalysis revealed an association between BMI and less mammography screening for breast cancer among morbidly obese white women, but we did not see the same association among black women. Also, when looking at studies that included non-white women, across the board, we saw no relationship between BMI and mammography,” Maruthur said.

Barriers to mammography

There are several reasons why obese women may not be undergoing breast cancer screening, including poor self-esteem and body image, embarrassment, perceived lack of respect from health care providers and unwanted weight loss advice. The researchers said that racial differences in obesity-related body image could explain the difference in mammography rates between white and black women.

“Clinicians should be aware of this disparity in evaluating their own practices,” the researchers wrote. – by Katie Kalvaitis

Maruthur NM. J Gen Intern Med. 2009;doi:10.1007/s11606-009-0939-3.