Body mass index and mammography screening in Caucasian and African-American women

Abstract

1605

It has been hypothesized that obese and underweight women may be less likely to seek cancer screening because of health status, self-perception and body image related to non-desirable weight. This study examined the relationship between body mass index (BMI) and mammography screening for breast cancer, using the data from the year 2000 National Health Interview Survey. The study participants in the survey were randomly selected to yield nationally representative estimates of health and health behavior. In-person interviews were conducted to collect data. The analysis of this study included 7,967 Caucasian and 1,527 African-American female participants aged 40-80. We used screening mammography conducted in the past two years as the outcome of the study. BMI, the factor of interest for the study, was defined as weight in kilograms divided by height in meters squared, and categorized according to the World Health Organization criteria (0 - 18.4, underweight; 18.5 - 24.9, normal weight; 25 - 29.9, overweight; 30-34.9, mild obesity; 35 - 39.9, moderate obesity; and 40 or higher, extreme obesity). We compared BMI between women with and without a mammogram in the past two years using logistic regression with adjustment for potential confounders including demographic factors, psychological variables, medical histories, general health care access and utilizations, personal habits, physical functional status, family history of breast cancer, menstrual and reproductive factors. Our results showed that compared with women with normal BMI, underweight and extremely obese women were more likely to have no screening mammograms in the past two years (odds ratio (OR) = 1.60, 95% confidence interval (CI), 1.07 - 2.40 for underweight women; OR = 1.41, 95% CI, 1.01 - 1.96 for extremely obese women) while overweight and mild/moderate obesity were not related to the underuse of mammography. When data were analyzed by race, the odds ratio estimates were 1.72 for underweight Caucasian women (95% CI, 1.14 - 2.62) and 1.46 for extremely obese Caucasian women (95% CI, 1.00 - 2.14). The corresponding estimates were 0.91 (95% CI, 0.18 - 4.60) and 1.05 (95% CI, 0.50 - 2.20) for underweight and extremely obese African-American women, respectively. Our results suggest that underweight and extreme obesity may increase the risk of underusing screening mammography. The association between underweight/extreme obesity and underuse of mammography might exist only in Caucasian women.