Obesity Is a Barrier to Mammography Compliance


From the Journal of Women's Health

Younger age, obesity, more recent health plan membership, and lower family income all reduce the likelihood that a woman will complete a mammogram, reported Dr. Adrianne C. Feldstein and her associates at Kaiser Permanente Northwest in Portland, Ore.

Younger age increased the likelihood that a woman would report being “too busy” to get a mammogram and that she would have more doubts about its usefulness or accuracy. Family income was a more significant variable than was race in mammogram completion, which is “consistent with findings from other studies,” they noted (J. Womens Health 2011 [doi:10.1089/jwh.2010.2195

In a study of 4,708 women aged 50–69 years, investigators first evaluated a patient's likelihood of completing a mammogram during a 10-month follow-up period after patients received multiple reminders over 3–4 months. Variables included age, visits to an ob.gyn. or primary care physician, race, family income, length of health plan membership, and body mass index.

In the study's second phase, a subgroup of 340 women completed a mail-in survey that identified barriers to and facilitators for mammograms by answering yes or no to provided statements such as “I'm embarrassed about having mammo-gram.” Their replies showed that although repeated reminders are effective, significant obstacles still remain.

Pain emerged as one of the major barriers for patients. The study cited 25% of the patients as reporting that a mammogram “causes too much pain,” and in obese patients the percentage rose to 31%. The relationship between pain and obesity remains unclear and could be the subject of further investigation, Dr. Feldstein said in an interview.

Meanwhile, she recommended that mammography providers explore ways to reduce pain for all patients.

“If you have the technician do the initial compression, and then the patient verbally controls the pressure from that point on, that seems to reduce the patient's pain and still preserve the quality of the x-ray image,” Dr. Feldstein said.

The study was funded by the National Cancer Institute. Dr. Feldstein and her associates said they had no relevant financial disclosures.

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