title: Is obesity a barrier to physician screening for cervical cancer?
abstract: OBJECTIVE
  To determine if obese and morbidly obese women are as likely to receive Papanicolaou (Pap) smears as nonobese women.
  
  
  METHODS
  A secondary analysis was conducted of data collected during a prospective, controlled trial of computer-generated reminders to improve preventive care. The site was a large, academic general medicine practice providing primary care to an urban population at a university-affiliated municipal teaching hospital. Data were analyzed from 15 faculty and 77 resident physicians who delivered care to 1,321 women who were eligible for Pap smears. Patient data were obtained from a computerized medical record system.
  
  
  RESULTS
  Outcomes were physician reports of Pap smear performance and reasons for nonperformance of Pap smears in eligible women. Pap smear performance was 21% for nonobese women, 20% for obese women, and 20% for morbidly obese women (P = NS). After adjusting for age and race, odds ratios for omission of Pap smear were 1.20 for both obese (95% confidence interval [CI] 0.86 to 1.67; P = NS) and morbidly obese women (95% CI, 0.58 to 2.47; P = NS). A significant dose-response relationship was found between increasing patient weight and physician responses that the Pap smear was delayed due to patient's acute illness, vaginitis, or menstruation (odds ratios [OR] 1.73 for obese, OR 4.59 for morbidly obese women; P < 0.005).
  
  
  CONCLUSIONS
  In our general medicine practice, obesity does not appear to be associated with less Pap smear performance. Physicians are more likely to report delaying obese patients' Pap smears due to acute illness, vaginitis, or menstruation.
authors.affiliation: Division of General Internal Medicine, Regenstrief Institute for Health Care, Indianapolis, Indiana 46202, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Lubitz
authors.forename: D K
authors.initials: DK
authors.lastname: Litzelman
authors.forename: R S
authors.initials: RS
authors.lastname: Dittus
authors.forename: W M
authors.initials: WM
authors.lastname: Tierney
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009765:Obesity; D009767:Obesity, Morbid; D016017:Odds Ratio; D065006:Papanicolaou Test; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears