Obesity Impacts Patient Initiative Toward Colon Cancer Screening

Obese, white women may be less likely than their normal-weight peers and African-Americans of any weight or gender to obtain colon cancer screening tests, according to a new study by Johns Hopkins researchers.

“No group is perfect when it comes to screening, and overall rates of colonoscopy are low, but if you’re obese, female and white, our data show you’re probably even less likely to be screened,” says study leader Nisa M. Maruthur, MD, MHS, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine.

Reluctance to screening is especially consequential for these women because obesity relates to higher risk for colon cancer and an increased risk of death from the disease, Maruthur explains.

“Being concerned about your weight usually is good, but here it appears to be keeping people from a test we know saves lives,” she says. “Obese white women may avoid screening because they feel stigmatized and embarrassed to disrobe for the tests.”

Maruthur and colleagues considered data from 23 published studies citing body mass index (BMI) and colon cancer screening rates. Overall, no link between higher BMI and lower rates of colon cancer screening was established. However, an association was detected in a subgroup of white women with a BMI in the range between 30 and 34.9. When compared with normal-weight counterparts, these women were 13% less likely to be screened. Women who were the most obese, with a BMI of 40 or more, were 27% less likely to be screened.

In an effort to better understand patient barriers to colon cancer screening, preventive care researchers have determined that preparatory laxatives, anesthesia, fear of discomfort, and embarrassment are known to discourage many patients.

Negative body image among obese white people seems to be fostered particularly in white women, where the pressure to be thin appears to be more intense, Maruthur says. This factor may also explain these study results. 

If necessary, outreach and education programs can be shaped to overcome the negative relationship between obesity and screening in white women, Maruthur says.

Source: Johns Hopkins Medicine.