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Breast cancer is the second leading cause of cancer death among women in the US. Mammography screening has been proven to reduce the number of deaths from breast cancer; current guidelines recommend that women over the age of 40 undergo a mammography every couple of years. Obesity is also an important risk factor for both the development of, and death from, postmenopausal breast cancer.
Maruthur and colleagues conducted a systematic review and meta-analysis of 17 studies comprising over 276,000 participants, to look at whether overweight and obese women are less likely to have had a recent mammography than normal weight women. They also looked at the differences in mammography take-up between white and black obese women in three of the studies. They found that severely obese women were 20 percent less likely to have had a recent mammography than normal weight women. However, this was not the case among black women.
The authors highlight a number of reasons why obese women may not be undergoing breast cancer screening, including a delay in taking up medical care because of poor self-esteem and body image, embarrassment, a perceived lack of respect from their health care providers and unwanted weight loss advice. According to the authors, obesity may be a marker for sub-optimal health behavior in general, of which mammography is simply one element. The authors also suggest that there are racial differences in obesity-related body image which may explain the difference in take-up of mammography between white and black women.
The authors conclude that “the main implication of our study is that a lack of routine screening mammography may explain some of the increased breast cancer mortality in obese postmenopausal women. Clinicians should be aware of this disparity in evaluating their own practices.”
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