Maruthur Nisa M, Bolen Shari D, Brancati Frederick L, Clark Jeanne M
Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Obesity (Silver Spring). 2009 Feb;17(2):375-81. doi: 10.1038/oby.2008.480. Epub 2008 Nov 6.
Obese women are at an increased risk of death from cervical cancer, but the explanation for this is unknown. Through our systematic review, we sought to determine whether obesity is associated with cervical cancer screening and whether this association differs by race. We identified original articles evaluating the relationship between body weight and Papanicolaou (Pap) testing in the United States through electronic (PubMed, CINAHL, and the Cochrane Library) and manual searching. We excluded studies in special populations or those not written in English. Two reviewers sequentially extracted study data and independently extracted quality using standardized forms. A total of 4,132 citations yielded 11 relevant studies. Ten studies suggested an inverse association between obesity and cervical cancer screening. Compared to women with a normal BMI, the combined odds ratios (95% CI) for Pap testing were 0.91 (0.80-1.03), 0.81 (0.70-0.93), 0.75 (0.64-0.88), and 0.62 (0.55-0.69) for the overweight and class I, class II, and class III obesity categories, respectively. Three out of four studies that presented the results by race found this held true for white women, but no study found this for black women. In conclusion, obese women are less likely to report being screened for cervical cancer than their lean counterparts, and this does not hold true for black women. Less screening may partly explain the higher cervical cancer mortality seen in obese white women.
肥胖女性患宫颈癌死亡的风险增加，但其原因尚不清楚。通过我们的系统评价，我们试图确定肥胖是否与宫颈癌筛查相关，以及这种关联是否因种族而异。我们通过电子检索（PubMed、CINAHL和考克兰图书馆）和手工检索，确定了评估美国体重与巴氏试验之间关系的原始文章。我们排除了特殊人群的研究或非英文撰写的研究。两名评审员依次提取研究数据，并使用标准化表格独立提取质量信息。总共4132条引文产生了11项相关研究。十项研究表明肥胖与宫颈癌筛查之间存在负相关。与体重指数正常的女性相比，超重以及I类、II类和III类肥胖女性进行巴氏试验的合并比值比（95%CI）分别为0.91（0.80-1.03）、0.81（0.70-0.93）、0.75（0.64-0.88）和0.62（0.55-0.69）。四项按种族呈现结果的研究中有三项发现白人女性情况如此，但没有研究发现黑人女性存在这种情况。总之，肥胖女性报告接受宫颈癌筛查的可能性低于瘦女性，而黑人女性并非如此。筛查较少可能部分解释了肥胖白人女性中较高的宫颈癌死亡率。
