According to information in the article, obese postmenopausal women have an increased risk of breast cancer compared with postmenopausal women of normal weight, and are often diagnosed with later stages of breast cancer. It has been hypothesized that women with larger breasts may be less able to feel breast lumps, making it more likely that once diagnosed, their breast cancers will be in later stages, the article states. However, the influence of obesity on mammography screenings has not been well studied.
Joann G. Elmore, M.D., M.P.H., of the University of Washington School of Medicine, Seattle, and colleagues investigated the relationship between obesity and mammographic accuracy.
The researchers analyzed 100,622 screening mammographies performed on members of a non-profit health plan. Body mass index (BMI, weight in kilograms divided by the square of height in meters) was assessed and mammography screening accuracy was determined. Participants were categorized based on their BMIs: underweight or normal weight, BMI of less than 25; overweight, BMI of 25 to 29; obesity class I, BMI of 30 to 34; and obesity classes II to III, BMI of 35 or higher.
The researchers found that "Compared with underweight or normal weight women, overweight and obese women were more likely to be recalled for additional tests after adjusting ... for age and breast density." Overweight women were 17 percent more likely to be recalled, women in the obese category I group were 27 percent more likely to be recalled, and women in the obese category II and III groups were 31 percent more likely to be recalled.
"A woman's weight may influence the accuracy of screening mammography in several important ways," write the authors. "Obese women had more than a 20 percent increased risk of having a false-positive mammogram result compared with underweight and normal weight women. We did not find statistically significant improvements in sensitivity in obese women to counter this increase in false-positive rates. Understanding the quality of mammography among obese women is important, especially since the American population is becoming more obese and obesity is a modifiable risk factor," the researchers write.
(Arch Intern Med. 2004;164: 1140-1148. Available post-embargo at archinternmed.com)
Editor's Note: This project was supported by a Public Health Service Grant (Dr. Elmore) from the Agency for Healthcare Research and Quality and the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, and a National Cancer Institute Surveillance grant (Dr. Taplin).
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