title: Perceptions of obesity and cancer risk in female bariatric surgery candidates: highlighting the need for physician action for unsuspectingly obese and high risk patients.
abstract: OBJECTIVE
  To determine: 1) whether obese women perceive themselves to be obese or at risk for malignancy, 2) perceived impact of obesity on cancer risks, 3) compliance with cancer screening, and 4) rates of menstrual dysfunction.
  
  
  METHODS
  Surveys were administered to female patients presenting for bariatric weight loss surgery. Demographics, gynecologic history, perception of cancer risk, and screening history were collected/analyzed. Women were categorized as obese (BMI: 30-39kg/m(2)), morbidly obese (40-49kg/m(2)), super obese (≥50kg/m(2)) and compared.
  
  
  RESULTS
  Ninety-three women (mean age: 44.9 years, mean BMI: 48.7kg/m(2)) participated and 45.7% felt they were in 'good', 'very good', or 'excellent' health despite frequent medical comorbidities. As BMI increased, women were more likely to correctly identify themselves as obese (23% of obese vs. 77% of morbidly obese vs. 85% of super obese; p<0.001) but there were no significant differences in comorbidities. Two-thirds of women correctly identified obesity as a risk factor for uterine cancer, yet 48% of those retaining a uterus perceived that it was "not likely/not possible" to develop uterine cancer. Menstrual irregularities were common as was evaluation and interventions for the same; 32% had prior hysterectomy. Participation in cancer screening was robust.
  
  
  CONCLUSIONS
  Women presenting for bariatric surgery have high rates of menstrual dysfunction. While they perceive that obesity increases uterine cancer risk, they often do not perceive themselves to be at risk. This disconnect may stem from the fact that many failed to identify themselves as obese perhaps because overweight/obesity has become the norm in U.S. society.
authors.affiliation: Stony Brook Medicine, Division of Gynecologic Oncology, Stony Brook, NY, USA. Electronic address: Melissa_duarte@yahoo.com.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Henretta
authors.affiliation: University of Virginia, School of Medicine, Charlottesville, VA, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Copeland
authors.affiliation: University of Virginia, College of Arts and Sciences, Charlottesville, VA, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Kelley
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
authors.affiliation: Gynecologic Oncology Division, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Modesitt
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008599:Menstruation Disturbances / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms; D009765:Obesity; D009767:Obesity, Morbid; D010349:Patient Compliance / Q000706:statistics & numerical data; D010465:Perception; D012306:Risk; D014594:Uterine Neoplasms; D055815:Young Adult
keywords: Compliance with cancer screening; Menstrual dysfunction; Obesity; Perception of cancer risk