Barriers to routine gynecological cancer screening for White and African-American obese women

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The specific factors that contribute to obese women not obtaining timely cancer screening have not been identified. To investigate the factors that contribute to lower rates of gynecological cancer screening as related to women's body size. A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m2, including 60 women with BMI>55 kg/m2, was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (N=129) were surveyed concerning their education, practices, and attitudes about providing care and gynecological cancer-screening tests for obese women. Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care. The percent of women reporting these statements increased significantly as the women's BMI increased. Women with BMI>55 kg/m2 had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were ‘moderately’ or ‘very concerned’ about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them. Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce the weight barriers to these tests and improve the quality of the health care experience. Providers should receive specific training related to care of large women.","datePublished":"2005-10-04T00:00:00Z","dateModified":"2005-10-04T00:00:00Z","pageStart":"147","pageEnd":"155","sameAs":"https://doi.org/10.1038/sj.ijo.0803105","keywords":["women","barrier","gynecological cancer","mammogram","African-American","Medicine/Public Health","general","Public Health","Epidemiology","Internal Medicine","Metabolic Diseases","Health Promotion and Disease Prevention"],"image":["https://media.springernature.com/lw1200/springer-static/image/art%3A10.1038%2Fsj.ijo.0803105/MediaObjects/41366_2006_Article_BF0803105_Fig1_HTML.gif","https://media.springernature.com/lw1200/springer-static/image/art%3A10.1038%2Fsj.ijo.0803105/MediaObjects/41366_2006_Article_BF0803105_Fig2_HTML.jpg"],"isPartOf":{"name":"International Journal of Obesity","issn":["1476-5497","0307-0565"],"volumeNumber":"30","@type":["Periodical","PublicationVolume"]},"publisher":{"name":"Nature Publishing Group UK","logo":{"url":"https://www.springernature.com/app-sn/public/images/logo-springernature.png","@type":"ImageObject"},"@type":"Organization"},"author":[{"name":"N K Amy","affiliation":[{"name":"University of California","address":{"name":"Department of Nutritional Sciences and Toxicology, University of California, Berkeley, USA","@type":"PostalAddress"},"@type":"Organization"}],"email":"nkamy@nature.berkeley.edu","@type":"Person"},{"name":"A Aalborg","affiliation":[{"name":"Kaiser Permanente Northern California","address":{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, USA","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"P Lyons","affiliation":[{"name":"Connections Women's Health Consulting","address":{"name":"Connections Women's Health Consulting, Oakland, USA","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"},{"name":"L Keranen","affiliation":[{"name":"Connections Women's Health Consulting","address":{"name":"Connections Women's Health Consulting, Oakland, USA","@type":"PostalAddress"},"@type":"Organization"}],"@type":"Person"}],"isAccessibleForFree":false,"hasPart":{"isAccessibleForFree":false,"cssSelector":".main-content","@type":"WebPageElement"},"@type":"ScholarlyArticle"},"@context":"https://schema.org","@type":"WebPage"}</script> <link rel="canonical" href="https://www.nature.com/articles/0803105"> <meta name="journal_id" content="41366"/> <meta name="dc.title" content="Barriers to routine gynecological cancer screening for White and African-American obese women"/> <meta name="dc.source" content="International Journal of Obesity 2006 30:1"/> <meta name="dc.format" content="text/html"/> <meta name="dc.publisher" content="Nature Publishing Group"/> <meta name="dc.date" content="2005-10-04"/> <meta name="dc.type" content="OriginalPaper"/> <meta name="dc.language" content="En"/> <meta name="dc.copyright" content="2006 Springer Nature Limited"/> <meta name="dc.rights" content="2006 Springer Nature Limited"/> <meta name="dc.rightsAgent" content="journalpermissions@springernature.com"/> <meta name="dc.description" content="Obese women are reported to be at higher risk from gynecological cancers than nonobese women, yet these women are less likely to get cancer-screening tests. The specific factors that contribute to obese women not obtaining timely cancer screening have not been identified. To investigate the factors that contribute to lower rates of gynecological cancer screening as related to women's body size. A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m2, including 60 women with BMI&gt;55 kg/m2, was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (N=129) were surveyed concerning their education, practices, and attitudes about providing care and gynecological cancer-screening tests for obese women. Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care. The percent of women reporting these statements increased significantly as the women's BMI increased. Women with BMI&gt;55 kg/m2 had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were ‘moderately’ or ‘very concerned’ about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them. Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce the weight barriers to these tests and improve the quality of the health care experience. 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1 0 0 10)"/> </svg> </li><li class="c-breadcrumbs__item" id="breadcrumb3" itemprop="itemListElement" itemscope itemtype="https://schema.org/ListItem"> <span itemprop="name">article</span><meta itemprop="position" content="4"></li> </ol> </div> </nav> </div> <div class="u-container u-mt-32 u-mb-32 u-clearfix" id="content" data-component="article-container" data-container-type="article"> <main class="c-article-main-column u-float-left js-main-column" data-track-component="article body"> <article lang="en"> <div class="c-article-header"> <header> <ul class="c-article-identifiers" data-test="article-identifier"> <li class="c-article-identifiers__item" data-test="article-category">Original Article</li> <li class="c-article-identifiers__item">Published: <time datetime="2005-10-04">04 October 2005</time></li> </ul> <h1 class="c-article-title" data-test="article-title" data-article-title="">Barriers to routine gynecological cancer screening for White and African-American obese women</h1> <ul class="c-article-author-list c-article-author-list--short" data-test="authors-list" data-component-authors-activator="authors-list"><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-N_K-Amy-Aff1" data-author-popup="auth-N_K-Amy-Aff1" data-author-search="Amy, N K" data-corresp-id="c1">N K Amy<svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-mail-medium"></use></svg></a><sup class="u-js-hide"><a href="#Aff1">1</a></sup>, </li><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-A-Aalborg-Aff2" data-author-popup="auth-A-Aalborg-Aff2" data-author-search="Aalborg, A">A Aalborg</a><sup class="u-js-hide"><a href="#Aff2">2</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-P-Lyons-Aff3" data-author-popup="auth-P-Lyons-Aff3" data-author-search="Lyons, P">P Lyons</a><sup class="u-js-hide"><a href="#Aff3">3</a></sup> & </li><li class="c-article-author-list__show-more" aria-label="Show all 4 authors for this article" title="Show all 4 authors for this article">…</li><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-L-Keranen-Aff3" data-author-popup="auth-L-Keranen-Aff3" data-author-search="Keranen, L">L Keranen</a><sup class="u-js-hide"><a href="#Aff3">3</a></sup> </li></ul><button aria-expanded="false" class="c-article-author-list__button"><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-down-medium"></use></svg><span>Show authors</span></button> <p class="c-article-info-details" data-container-section="info"> <a data-test="journal-link" href="/ijo" data-track="click" data-track-action="journal homepage" data-track-category="article body" data-track-label="link"><i data-test="journal-title">International Journal of Obesity</i></a> <b data-test="journal-volume"><span class="u-visually-hidden">volume</span> 30</b>, <span class="u-visually-hidden">pages </span>147–155 (<span data-test="article-publication-year">2006</span>)<a href="#citeas" class="c-article-info-details__cite-as u-hide-print" data-track="click" data-track-action="cite this article" data-track-label="link">Cite this article</a> </p> <div class="c-article-metrics-bar__wrapper u-clear-both"> <ul class="c-article-metrics-bar u-list-reset"> <li class=" c-article-metrics-bar__item" data-test="access-count"> <p class="c-article-metrics-bar__count">7118 <span class="c-article-metrics-bar__label">Accesses</span></p> </li> <li class="c-article-metrics-bar__item" data-test="citation-count"> <p class="c-article-metrics-bar__count">273 <span class="c-article-metrics-bar__label">Citations</span></p> </li> <li class="c-article-metrics-bar__item" data-test="altmetric-score"> <p class="c-article-metrics-bar__count">235 <span class="c-article-metrics-bar__label">Altmetric</span></p> </li> <li class="c-article-metrics-bar__item"> <p class="c-article-metrics-bar__details"><a href="/articles/0803105/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Metrics <span class="u-visually-hidden">details</span></a></p> </li> </ul> </div> </header> </div> <div class="c-article-body"> <section aria-labelledby="Abs1" data-title="Abstract" lang="en"><div class="c-article-section" id="Abs1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Abs1">Abstract</h2><div class="c-article-section__content" id="Abs1-content"><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Background:</h3><p>Obese women are reported to be at higher risk from gynecological cancers than nonobese women, yet these women are less likely to get cancer-screening tests. The specific factors that contribute to obese women not obtaining timely cancer screening have not been identified.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Objective:</h3><p>To investigate the factors that contribute to lower rates of gynecological cancer screening as related to women's body size.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Design:</h3><p>A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m<sup>2</sup>, including 60 women with BMI>55 kg/m<sup>2</sup>, was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (<i>N</i>=129) were surveyed concerning their education, practices, and attitudes about providing care and gynecological cancer-screening tests for obese women.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Results:</h3><p>Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care. The percent of women reporting these statements increased significantly as the women's BMI increased. Women with BMI>55 kg/m<sup>2</sup> had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were ‘moderately’ or ‘very concerned’ about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Conclusion:</h3><p>Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce the weight barriers to these tests and improve the quality of the health care experience. 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We thank our many study participants for offering insights into their medical experiences, the California Black Women's Project, Michelle Soeffer, MS, for project management and data entry, and Mark Hudes, PhD, for statistical support.</p></div></div></section><section aria-labelledby="author-information" data-title="Author information"><div class="c-article-section" id="author-information-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="author-information">Author information</h2><div class="c-article-section__content" id="author-information-content"><h3 class="c-article__sub-heading" id="affiliations">Authors and Affiliations</h3><ol class="c-article-author-affiliation__list"><li id="Aff1"><p class="c-article-author-affiliation__address">Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA</p><p class="c-article-author-affiliation__authors-list">N K Amy</p></li><li id="Aff2"><p 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id="corresponding-author">Corresponding author</h3><p id="corresponding-author-list">Correspondence to <a id="corresp-c1" href="mailto:nkamy@nature.berkeley.edu">N K Amy</a>.</p></div></div></section><section data-title="Rights and permissions"><div class="c-article-section" id="rightslink-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="rightslink">Rights and permissions</h2><div class="c-article-section__content" id="rightslink-content"><p class="c-article-rights"><a data-track="click" data-track-action="view rights and permissions" data-track-label="link" 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<i>et al.</i> Barriers to routine gynecological cancer screening for White and African-American obese women. <i>Int J Obes</i> <b>30</b>, 147–155 (2006). https://doi.org/10.1038/sj.ijo.0803105</p><p class="c-bibliographic-information__download-citation u-hide-print"><a data-test="citation-link" data-track="click" data-track-action="download article citation" data-track-label="link" data-track-external="" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1038/sj.ijo.0803105?format=refman&flavour=citation">Download citation<svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-download-medium"></use></svg></a></p><ul class="c-bibliographic-information__list" data-test="publication-history"><li class="c-bibliographic-information__list-item"><p>Received<span class="u-hide">: </span><span class="c-bibliographic-information__value"><time 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title="Digital Object Identifier">DOI</abbr><span class="u-hide">: </span><span class="c-bibliographic-information__value">https://doi.org/10.1038/sj.ijo.0803105</span></p></li></ul><div data-component="share-box"><div class="c-article-share-box u-display-none" hidden=""><h3 class="c-article__sub-heading">Share this article</h3><p class="c-article-share-box__description">Anyone you share the following link with will be able to read this content:</p><button class="js-get-share-url c-article-share-box__button" type="button" id="get-share-url" data-track="click" data-track-label="button" data-track-external="" data-track-action="get shareable link">Get shareable link</button><div class="js-no-share-url-container u-display-none" hidden=""><p class="js-c-article-share-box__no-sharelink-info c-article-share-box__no-sharelink-info">Sorry, a shareable link is not currently available for this article.</p></div><div class="js-share-url-container u-display-none" hidden=""><p class="js-share-url 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data-track="click" data-track-action="view keyword" data-track-label="link">barrier</a></span></li><li class="c-article-subject-list__subject"><span><a href="/search?query=gynecological%20cancer&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">gynecological cancer</a></span></li><li class="c-article-subject-list__subject"><span><a href="/search?query=mammogram&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">mammogram</a></span></li><li class="c-article-subject-list__subject"><span><a href="/search?query=African-American&facet-discipline="Medicine%20%26%20Public%20Health"" data-track="click" data-track-action="view keyword" data-track-label="link">African-American</a></span></li></ul><div data-component="article-info-list"></div></div></div></div></div></section> </div> <section> <div class="c-article-section js-article-section" 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Barriers to routine gynecological cancer screening for White and African-American obese women | International Journal of Obesity