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TOPLINE: 

A study of over 2 million US adults revealed that severe obesity was associated with significantly reduced rates of guideline-recommended cancer screenings. Adults with a BMI of at least 50.0 were less likely to undergo colonoscopy, sigmoidoscopy, or prostate-specific antigen (PSA) testing but more likely to complete fecal occult blood testing than adults with a BMI of 18.5-29.9.

METHODOLOGY:

• Obesity is a known risk factor for cancer and is linked to worse outcomes. However, despite rising obesity rates, the impact of obesity severity on adherence to routine screenings has not been investigated, limiting targeted interventions.
• Researchers analyzed data of 2,057,525 participants (mean age, 55.5 years; 54.9% women; mean BMI, 28.2) from the Behavioral Risk Factor Surveillance System across five cycles (2012, 2014, 2016, 2018, and 2020).
• Participants were categorized into five BMI groups: 18.5-29.9 (reference), 30.0-34.9, 35.0-39.9, 40.0-49.9, and at least 50.0.
• Cancer screenings were defined according to US Preventive Services Task Force guidelines and included colonoscopy, sigmoidoscopy, fecal occult blood test, Papanicolaou test, mammography, and PSA testing.
• Researchers estimated risk ratios (RRs) using survey-weighted Poisson regression models adjusted for age, sex, and self-reported race and ethnicity.

TAKEAWAY

• Sigmoidoscopy or colonoscopy rates were reduced by 8% (RR, 0.92) in adults with a BMI of at least 50.0 but increased in adults with a BMI of 30.0-34.9 (RR, 1.02) or 35.0-39.9 (RR, 1.03), compared with the rates in adults with a BMI of 18.5-29.9 (reference).
• Mammography rates declined with increasing BMI, from 76.8% among adults with a BMI of 30.0-34.9 to 70.7% in those with a BMI at least 50.0; however, this difference was not significant after adjustment. Conversely, the rates of fecal occult blood testing steadily increased with rising BMI, peaking at a BMI of at least 50.0 (RR, 1.13).
• Papanicolaou testing rates were marginally higher at a BMI of 30.0-34.9 (RR, 1.00) but significantly lower at a BMI at least 50.0 (RR, 0.98).
• PSA testing revealed mixed trends, with increased rates at a BMI of 30.0-34.9 (RR, 1.02) but decreased rates at a BMI of 40.0-49.9 (RR, 0.94).

IN PRACTICE:

"These findings highlight the need for targeted, equity-focused strategies to improve cancer screening access among individuals with obesity," the authors concluded. 

SOURCE:

The study, led by Florina Corpodean, MD, Metamor Institute, Pennington Biomedical Research Center in Baton Rouge, Louisiana, was published online in JAMA Network Open.

LIMITATIONS:

The study limitations included self-reported, cross-sectional data and instances in which small effect sizes did not reflect clinical significance. 

DISCLOSURES:

The authors did not disclose any funding information. Some authors reported receiving grants or honoraria and having other ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.