Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Cancer Epidemiol Biomarkers Prev. 2012 May;21(5):737-46. doi: 10.1158/1055-9965.EPI-11-0826. Epub 2012 Apr 4.
Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing.
We conducted a systematic review to determine whether obesity is associated with lower rates of colon cancer screening. We searched the PubMed, CINAHL, and Cochrane Library databases. Two investigators reviewed citations, abstracts, and articles independently. Two investigators abstracted study information sequentially and evaluated quality independently using standardized forms. We included all studies in our qualitative syntheses. We used random effects meta-analyses to combine those studies providing screening results by the following body mass index (BMI) categories: Normal, 18.5-24.9 kg/m(2) (reference); overweight, 25-29.9 kg/m(2); class I obesity, 30-34.9 kg/m(2); class II obesity, 35-39.9 kg/m(2); and class III obesity, ≥ 40 kg/m(2).
Of 5,543 citations, we included 23 articles. Almost all studies were cross-sectional and ascertained BMI and screening through self-report. BMI was not associated with colon cancer screening overall. The subgroup of obese white women reported lower rates of colon cancer screening compared with those with a normal BMI with combined ORs (95% CI) of 0.87 (0.82-0.93), 0.80 (0.65-0.99), and 0.73 (0.58-0.94) for class I, II, and III obesity, respectively. Results were similar among white men with class II obesity.
Overall, BMI was not associated with colon cancer screening. Obese white men and women may be less likely to undergo colon cancer screening compared with those with a normal BMI.
Further investigation of this disparity may reduce the risk of obesity-related colon cancer death.
肥胖与结肠癌死亡率增加以及乳房 X 线摄影和巴氏试验检查率降低有关。
我们进行了一项系统评价，以确定肥胖是否与较低的结肠癌筛查率有关。我们检索了 PubMed、CINAHL 和 Cochrane 图书馆数据库。两名调查员独立审查了引文、摘要和文章。两名调查员顺序提取研究信息，并使用标准化表格独立评估质量。我们将所有符合条件的研究纳入定性综合分析。我们使用随机效应荟萃分析来合并提供以下体重指数（BMI）分类筛查结果的研究：正常体重，18.5-24.9 kg/m2（参考）；超重，25-29.9 kg/m2；I 级肥胖，30-34.9 kg/m2；II 级肥胖，35-39.9 kg/m2；III 级肥胖，≥40 kg/m2。
在 5543 条引文中，我们纳入了 23 篇文章。几乎所有的研究都是横断面的，通过自我报告来确定 BMI 和筛查情况。总体而言，BMI 与结肠癌筛查无关。肥胖的白人女性亚组报告的结肠癌筛查率低于 BMI 正常的女性，合并 OR（95%CI）分别为 0.87（0.82-0.93）、0.80（0.65-0.99）和 0.73（0.58-0.94），用于 I 级、II 级和 III 级肥胖。在白人男性中，II 级肥胖也有类似的结果。
总体而言，BMI 与结肠癌筛查无关。肥胖的白人男性和女性进行结肠癌筛查的可能性可能低于 BMI 正常的人群。
进一步研究这种差异可能会降低肥胖相关结肠癌死亡的风险。
