Breast and cervical cancer screening specific effects of depression and obesity.
BACKGROUND
Obesity and depression may each be associated with lower rates of cervical and breast cancer screening. Studies have examined obesity or depression alone, but not together, despite the established link between them.


OBJECTIVE
This article aims to disentangle the effects of depression and obesity on receipt of breast and cervical cancer screening.


METHODS
A stratified sampling design was used to recruit women aged 40-65 years with information on BMI from an integrated health plan in Washington State in 2003-2005. A telephone survey included the Patient Health Questionnaire-9 for depression, weight, and height. Automated data assessed Paps for 3097 women over a 3-year period and screening mammograms over a 2-year period for 2163 women aged > or =51 years. Logistic regression models (conducted in 2008) examined the association between obesity and depression and receipt of screening tests.


RESULTS
In univariate logistic regression models, women were less likely to receive a Pap if they were obese (OR=0.53, 95% CI=0.41, 0.69) or depressed (OR=0.60, 95% CI=0.42, 0.87). Further, women were less likely to receive a screening mammogram if they were depressed (OR=0.45, 95% CI=0.30, 0.67). In multivariable models, only obesity remained significantly associated with a lower likelihood of Pap screening (OR=0.67, 95% CI=0.0.49, 0.93), and only depression remained significantly associated with lower rates of screening mammography (OR=0.49, 95% CI=0.31, 0.76). Obesity and depression did not interact significantly in either model.


CONCLUSIONS
Obesity and depression appear to have specific effects on receipt of different cancer-screening tests.
Ludman
Evette J
EJ
Group Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA. ludman.e@ghc.org
Ichikawa
Laura E
LE
Simon
Gregory E
GE
Rohde
Paul
P
Arterburn
David
D
Operskalski
Belinda H
BH
Linde
Jennifer A
JA
Jeffery
Robert W
RW
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003863:Depression / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000523:psychology; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000523:psychology*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000523:psychology; D014861:Washington