A recent study of more than 2 million adults in the United States found that severe obesity is linked to lower rates of guideline-recommended cancer screenings, including prostate-specific antigen (PSA) testing, colonoscopy, and sigmoidoscopy. Interestingly, individuals with the highest body mass index (BMI) were more likely to complete fecal occult blood tests, suggesting that screening patterns vary by type of test.
Why This Matters
Obesity is a known risk factor for several types of cancer and is associated with poorer outcomes. As obesity rates continue to rise across the country, understanding how weight affects participation in preventive screenings is critical. Lower screening rates in individuals with severe obesity may delay diagnosis and treatment, contributing to health disparities.
Study Methodology
The study analyzed data from 2,057,525 participants collected across five cycles of the Behavioral Risk Factor Surveillance System (2012, 2014, 2016, 2018, and 2020). The average age of participants was 55.5 years, 54.9% were women, and the mean BMI was 28.2.
Participants were divided into five BMI categories:
- 18.5–29.9 (reference group)
- 30.0–34.9
- 35.0–39.9
- 40.0–49.9
- ≥50.0
Cancer screenings were defined according to the US Preventive Services Task Force guidelines and included colonoscopy, sigmoidoscopy, fecal occult blood testing, Papanicolaou testing, mammography, and PSA testing. Researchers calculated risk ratios using survey-weighted Poisson regression models, adjusting for age, sex, and self-reported race and ethnicity.
Key Findings
The study revealed notable differences in screening rates by BMI:
- Colonoscopy and sigmoidoscopy: Adults with a BMI ≥50 had 8% lower screening rates compared with normal-weight adults (RR, 0.92). In contrast, adults with a BMI of 30–34.9 and 35–39.9 showed slightly higher screening rates (RR, 1.02 and 1.03, respectively).
- Mammography: Screening rates decreased with higher BMI, from 76.8% in adults with BMI 30–34.9 to 70.7% in adults with BMI ≥50. Adjusted models, however, showed these differences were not statistically significant.
- Fecal occult blood testing: Rates increased with BMI, peaking in adults with BMI ≥50 (RR, 1.13), suggesting this test may be more accessible for individuals with severe obesity.
- Papanicolaou tests: Slightly higher among adults with BMI 30–34.9 (RR, 1.00) but lower among those with BMI ≥50 (RR, 0.98).
- PSA testing: Showed mixed trends. Rates increased slightly in adults with BMI 30–34.9 (RR, 1.02) but decreased in adults with BMI 40–49.9 (RR, 0.94).
Clinical Implications
“These findings highlight the need for targeted, equity-focused strategies to improve cancer screening access among individuals with obesity,” the study authors concluded. Lower PSA testing and colonoscopy rates in severely obese adults may increase the risk of late-stage cancer diagnoses, underlining the importance of proactive outreach and tailored interventions.
Limitations
The study relied on self-reported data, which may introduce inaccuracies. It was cross-sectional, meaning it provides a snapshot rather than longitudinal trends. Some effect sizes were small and may not translate into clinically meaningful differences.
Conclusion
Severe obesity is associated with lower rates of several critical cancer screenings, including PSA testing. Health systems and clinicians should consider targeted outreach and supportive strategies to ensure adults with high BMI receive timely preventive care. Awareness and accessibility are key to reducing cancer disparities linked to obesity.
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