Women are less likely to be screened for breast cancer if they are obese, according to a new study in the Journal of Women's Health.
Despite having insurance and receiving reminders to get screened, "...a significant portion of the population is not getting screened," according to the study.
The reasons women gave for skipping mammograms are clear-cut, but the solutions are not. Among obese patients, the main reason cited for skipping mammograms was that the test is too painful, yet many women who are not obese also cite pain as a reason for avoiding the test.
Addressing the issue of obese women skipping mammograms has a special sense of urgency, according to the study: "Given the obesity epidemic, the higher incidence and mortality from breast cancer among the obese, and the need for patients to participate in regular screening to achieve desired reductions in mortality, obesity is an exceedingly common and important barrier to mammography."
According to the National Cancer Institute, after menopause, obese women have 1.5 times the risk of developing breast cancer. Obese women are also at increased risk of dying from breast cancer compared with lean women.
The study, conducted among 340 women aged 50 to 69 insured by Kaiser Permanente, is revealing because skipping cancer screening is typically associated with not having insurance. In this study, however, all of the women were insured.
"Access to mammograms through health insurance and reminding patients that mammograms are due does not completely alleviate patient barriers," according to the study. "Disparities cannot be addressed solely by providing access to clinician advice about the procedure."
One in eight women will develop breast cancer in their lifetime, according to the American Cancer Society, and around 40,000 women die from breast cancer each year. According to experts, the best existing tool for preventing breast cancer is screening. The U.S. Preventive Services Task Force advises women to begin screening for breast cancer at age 50, and to get screened every two years.
Other organizations, including the ACS, suggest a more rigorous screening schedule: Yearly mammograms beginning at age 40.
Other groups less likely to get a mammogram include younger women - under age 60 - and women whose annual household income was less than $40,000. Younger patients were more likely to say they were too busy to get a mammogram, and they were more concerned about the accuracy of the test. Those worries stem from "concerns about the accuracy of mammograms that could cause either missed cancers or unnecessary surgery," according to the study.
Study authors suggest practical solutions to the mammography problem - such as worksite and mobile screening facilities - and broad ones such as improved technologies for breast cancer screening, but note that studying why obesity is such a barrier for breast cancer screening should be a priority.