Obese Women Less Prone to Complete Mammograms, More Likely to Experience Pain with the Procedure

A study found that obstacles to breast cancer screening remain even among insured American women.

Obese women may avoid mammograms because of pain and women under 60 may avoid the test because they are too busy, according to a study by Kaiser Permanente Center for Health Research (Portland, OR, USA) published online February 1, 2011, in the Journal of Women's Health. Funded by the US National Cancer Institute (Bethesda, MD, USA), the study was one of the largest to examine why insured women fail to complete mammograms.

Although regular mammograms can reduce breast cancer deaths by more than 30% and the US Preventive Services Task Force recommends screenings every one-to-two years beginning at age 50, nearly one-third of eligible women do not get regular screenings.

"These are important findings because, even though we know that mammograms can save lives, many women put them off,” said study lead author and physician Dr. Adrianne Feldstein, a senior investigator with the Kaiser Permanente Center for Health Research. "Our study found that, even when women have access to health care, there are still barriers to getting this important screening test. We need to do more to understand these barriers and help women overcome them.”

The study looked at 4,708 women aged 50-69 at Kaiser Permanente in Oregon and Washington who had gone longer than 20 months since their last mammogram and were reminded through postcards and phone calls that they would soon be due for the test. Researchers identified these women by looking at their medical records, which contained the date of their last mammogram. Researchers also examined physical and demographic information--including height and weight, age, race, length of time on the health plan and family income--to find out how these factors affected mammogram completion rates.

Characteristics associated with lower mammogram completion rates included being younger than 60, having a household income of less than US$40,000, being obese, and having had health insurance coverage for less than five years. A subset of 677 women was mailed a survey asking why they had not completed their mammograms. About half--34--of these women completed the survey. The reasons they cited most often for not completing a mammogram included the test causing too much pain, being too busy, and feeling embarrassed to have the test.

Nearly one-quarter of the women surveyed (24.7%) reported too much pain as a reason why they had not completed a mammogram. Obese women were nearly twice as likely as non-obese women to report pain as a deterrent (31% vs. 19%). "We don't know why obese women report more pain with mammograms,” said Dr. Feldstein. "One previous study suggests that obesity might be associated with a lower pain threshold. Nearly half of the women in our study were obese and obese women are more likely to get breast cancer so we need to find better ways to ensure that these women are screened.”

The researchers pointed out that their study has implications for helping health care systems reduce barriers to mammogram completion. Since obese women reported receiving the same amount of advice to be screened as non-obese women, and did not report feeling more embarrassed to get mammograms, it is unlikely that they would respond to more clinician-oriented interventions. The authors suggest that patient-controlled compression or the use of alternate screening technologies could be especially helpful to obese women.

Women under 60 were more likely than those 60 and over to report being too busy to get a mammogram (19% of younger women stated that they were too busy, vs. only 6% of older women). The investigators reported that younger women might be more likely to complete mammograms if health-care systems provided more opportunities for worksite screening and after-hours mammography appointments.

Related Links:
Kaiser Permanente Center for Health Research