title: The impact of obesity on follow-up after an abnormal screening mammogram.
abstract: BACKGROUND
  Effective breast cancer screening and early detection are crucial for obese women, who experience a higher incidence of the disease and present at later stages.
  
  
  METHODS
  We examined the association between body mass index (BMI) and timeliness of follow-up after 241,222 abnormal screening mammograms carried out on 201,470 women in the Breast Cancer Surveillance Consortium. Each mammogram had one of three recommendations for follow-up: short-interval follow-up, immediate additional diagnostic imaging, and biopsy/surgical consultation. We used logistic regression to estimate the adjusted effect of BMI on any recorded follow-up within 270 days of the recommendation; linear regression was used to model the mean follow-up time among those with recorded follow-up.
  
  
  RESULTS
  As compared with normal-weight women, higher BMI was associated with slightly increased odds of follow-up among women who received a recommendation for short-interval follow-up (ORs: 1.03-1.10; P = 0.04) or immediate additional imaging (ORs: 1.03-1.09; P = 0.01). No association was found for biopsy/surgical consultation recommendations (P = 0.90). Among those with recorded follow-up, higher BMI was associated with longer mean time to follow-up for both short-interval (3-10 days; P < 0.001) and additional imaging recommendations (2-3 days; P < 0.001) but not biopsy/surgical consultation (P = 0.06). Regardless of statistical significance, actual differences in days to follow-up across BMI groups were small and unlikely to be clinically significant.
  
  
  CONCLUSIONS
  Once obese women access screening mammography, their follow-up after abnormal results is similar to that of normal-weight women.
  
  
  CONCLUSIONS
  Efforts to improve early detection of breast cancer in obese women should focus elsewhere, such as improving participation in screening mammography.
authors.affiliation: Corresponding Author: Ellen A. Schur, Department of General Internal Medicine, Box 359780, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA. ellschur@uw.edu
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Schur
authors.forename: Joann E
authors.initials: JE
authors.lastname: Elmore
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000706:statistics & numerical data; D008403:Mass Screening; D008875:Middle Aged; D009765:Obesity / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology