Obesity and breast cancer screening.
BACKGROUND
Compared to normal weight women, women with obesity have higher mortality from breast cancer but are less often screened.


OBJECTIVE
To examine the relation between mammography use and weight category and to examine the influence of race, illness burden, and other factors on this relationship.


METHODS
The 1998 National Health Interview Survey, a U.S. civilian population-based survey.


METHODS
Five thousand, two hundred, and seventy-seven women ages 50 to 75 years who responded to the Sample Adult and Prevention questionnaires.


METHODS
Mammogram use in the preceding 2 years.


RESULTS
Among 5277 eligible women, 72% reported mammography use. The rate was 74% among white women and 70% among black women. Among white women, mammogram use was lowest in women with a body mass index (BMI) greater than 35 kg/m(2) (64% to 67%). After adjusting for sociodemographic factors, health care access, medical conditions, hospitalizations, and mobility status, higher BMI was associated with lower screening among white women, P =.02 for trend; the relative risk (RR) for screening in moderately obese white women (BMI, 35 to 40 kg/m(2)) was 0.83 (95% confidence interval [CI], 0.68 to 0.96) compared to normal weight white women. Compared to normal weight black women, mammography use was similar or higher in overweight (BMI, 25 to 30 kg/m(2); RR, 1.19; 95% CI, 1.01 to 1.32), mildly obese (BMI, 30 to 35 kg/m(2); RR, 1.22; 95% CI, 0.98 to 1.39), and moderately obese black women (RR, 1.37; 95% CI, 1.37 to 1.50) after adjustment. The P value for the race-BMI interaction was.001. Results for white and black women were unchanged after additional adjustment for psychological functioning and health habits.


CONCLUSIONS
Among white women, those with higher BMI were less likely to undergo breast cancer screening than normal weight women. This relationship was not seen in black women. Our findings were not explained by differences in sociodemographic factors, health care access, illness burden, or health habits. More research is needed to determine the reasons for these disparities so that appropriate efforts can be made to improve screening.
Wee
Christina C
CC
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. cweekuo@bidmc.harvard.edu
McCarthy
Ellen P
EP
Davis
Roger B
RB
Phillips
Russell S
RS
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care; D014481:United States; D044465:White People / Q000706:statistics & numerical data