Massachusetts General Hospital, Boston, MA
Randy C. Miles , Anand Narayan , Sarah Mercaldo , Rulla M. Tamimi , Constance Dobbins Lehman
Background: Prior studies suggest that obese women demonstrate reduced breast cancer screening rates. These studies however were limited in their ability to adjust for potential confounding factors and obesity rates have increased considerably since these studies were performed. Our objective was to assess the current association between increasing BMI and mammography screening adherence. Methods: Self-reported breast cancer screening data was included for 116,343 women ages 50-74 years from the 2016 Behavioral Risk Factor Surveillance System, a nationally representative telephone survey. Proportions reporting mammography within the last two years were calculated by BMI categories (normal: 18.5-24.9 kg/m2, overweight: 25-29.9 kg/m2, obese Class I: 30-34.9 kg/m2, obese Class II: 35-39.9 kg/m2, and obese Class III: > 40 kg/m2) and by race (White, Black, Hispanic, and Asian), accounting for complex survey design elements. The effect of BMI on mammography adherence was examined using a multivariate logistic regression model, adjusting for age, income, insurance, marital status, and education, and stratified by race. Statistical significance was assessed using Wald tests. Results: Of survey respondents, 33.5% had a normal BMI, 32.6% were overweight, 19.3% were obese Class I, 8.4% were obese Class II, and 6.2% were obese Class III. After adjusting for age, income, insurance, marital status and education, BMI was positively associated with higher screening adherence among overweight (OR 1.15, p < 0.01) and obese Class II (OR 1.17, p = 0.02) White women, compared to White women with normal BMI. No statistically significant associations were found between screening adherence and BMI categories among Blacks (p = 0.22), Hispanics (p = 0.19) or Asians (p = 0.11). Using a Wald test, we found no evidence of effect modification of BMI category by race (p = 0.37). Conclusions: After controlling for potential confounding factors such as income and insurance status, we found no association between increased BMI and reduced screening adherence. Sociodemographic factors may represent primary drivers of mammography screening within this population.
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