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Wednesday, June 18, 2008

The Pap Gap

Previous studies have shown that patients with obesity may not be receiving the same quality of health care as non-obese patients.

Reasons for this are likely to be complicated: yes, there is a provider bias - health professionals are likely to blame most complaints on the presence of obesity and perhaps not order the same tests that they may for the same complaints in a non-obese individual - on the other hand, patients with obesity may be more reluctant to go to their family physician because of embarrassment, frustrations about only being told again and again to simply lose weight, or fear of furniture or equipment that's too small.

How do these circumstances affect the rates of preventive screening?

This was addressed in a study by our own Rebecca Mitchell and colleagues from the University of Alberta, who examined the relationship between body weight and cancer screening in data from the 2003 Canadian Community Health Survey 2003. (The paper will appear in the August issue of the American Journal of Preventive Medicine).

Of the nearly 38,000 women participants, 82.6 percent reported having cervical cancer screening (Pap test) within the past three years. However, women with a BMI of 35 or higher, were nearly 40 percent less likely than others to have had a Pap test.

The findings were not explained by differences in socioeconomic status, health habits, chronic medical conditions or health care access. Reasons for less tests were more likely attributable to fear of pain, embarrassment or of finding something wrong.

Obesity did not alter mammogram or colorectal screening.

This study is only the latest in a number of studies that have looked at this issue before. Thus, Sarah S. Cohen and colleagues from the University of North Carolina in their review of 32 relevant published studies (10 breast cancer studies, 14 cervical cancer studies, and 8 colorectal cancer studies) found that in women obesity most likely is a barrier to screening for breast and cervical cancers whereas the evidence for colorectal cancer screening was inconclusive.

These finding certainly send a message to health care providers to be vigilant that their larger patients receive the same level of screening as their leaner patients - especially since obesity has been noted as a risk factor for both breast and cervical cancers.

Edmonton, Alberta

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