According to a recent study by researchers in Family and Community Medicine at the Thomas Jefferson University published in the current issue of the Journal of Obesity, obesity is associated with higher rates of prostate cancer screening amongst all races and ethnic differences as well as lower rates of cervical cancer screening predominantly in white women. The study examined the role of obesity in cancer screening rates for prostate, cervical as well as breast and colorectal cancers across race, ethnicity and gender.
Leading author Heather Bittner Fagan, MD, FAAFP MPH, associate professor at the Thomas Jefferson University and director of Health Services Research, department of Family and Community Medicine, Christiana Care Health System commented:
“Numerous studies have suggested that obesity constitutes an obstacle to cancer screening, but a deeper examination also considering the role of race/ethnicity and gender in the equation has not been done before. A greater understanding of the relationship between cancer screening and obesity, race/ethnicity and gender can also help explain the association between obesity and increased cancer mortality.”
After tobacco, obesity is the second highest risk factor for cancer. Obesity is linked to a higher death rate for all cancers combined and also for specific cancers, such as cancer of the colon/rectum, prostate, breast, and cervix cancer.
Researchers established that a higher body weight was consistently linked to lower rates of Pap smear use in cervical cancer screening. According to studies, this was most observed in white women, whilst black women, particularly in those with a high socioeconomic status displayed an absent or weaker association.
Unlike cervical cancer screening, prostate cancer screening levels were consistently observed to increase with weight. According to three out of four studies, obese men had a higher chance of receiving a PSA prostate cancer screening test compared with those of normal weight. The researchers state that the finding appears to be the same amongst all races and ethnic groups.
Study author Richard Wender, MD, professor at the Jefferson Medical College of Thomas Jefferson University and chair of Family and Community Medicine at the Thomas Jefferson University Hospital stated:
“This could be explained by differences in access and utilization of health care; as weight increases so do other comorbid conditions, making heavier men higher users of health care and perhaps more encouraged to be tested by their health care provider.”
According to a review of breast cancer screening studies, researchers found no association between women’s weight and use of mammography screening. One of the three reviewed studies that stratified the association between obesity screenings according to race demonstrated that obesity was linked to a lower use of mammography in white women and a higher use in black women, whilst the other two studies revealed a positive link between obesity and mammography use in black women, with one study showing no effect.
The study also revealed that similarly women of higher weight tended to receive less screening for colorectal cancer (CRC), and even though the data contained no reference to differences in screening levels amongst different races, the study did demonstrate inconsistencies in the link between obesity and CRC screening in men. A direct comparison was difficult in the studies on CRC screening as these included a variety of testing options, however, overall the findings revealed that endoscopy and not fecal occult blood tests (FOBT) were more likely to be influenced by a person’s weight status, particularly in women. The researchers speculate that this could be linked to endoscopy being a more invasive procedure and therefore more difficult in obese patients as compared with other screening tests.
The findings demonstrated that certain cancer screenings could either be limited or accessible depending on cultural differences amongst males and females, black or white individuals and socioeconomic factors like insurance status and access to health care, which can be confounded with race/ethnicity and gender.
Fagan and Wender conclude, stating:
“We hope to have built a more detailed picture of the relationship between obesity and cancer screening to inform efforts to identify and reduce disparities in cancer screening. Screening behaviors can vary by ethnicity/race and gender, but more research is needed to create a comprehensive understanding of obesity and cancer screening in race-gender subgroups such as white men, white women, black men and black women, accounting for the effects of the doctor-patient relationship, access to care and type of screening test.”
Written by Petra Rattue