Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Channing Institute, Brigham and Women's Hospital, Boston, Massachusetts.
Cancer. 2019 Dec 1;125(23):4158-4163. doi: 10.1002/cncr.32430. Epub 2019 Aug 8.
Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening.
Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9 kg/m ), overweight (25-29.9 kg/m ), obese class I (30-34.9 kg/m ), obese class II (35-39.9 kg/m ), and obese class III (>40 kg/m ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests.
Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P < .05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P = .53).
In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.
绝经后肥胖女性的乳腺癌风险升高，且与体重指数（BMI）正常的女性相比，乳腺癌发病率和死亡率更高。然而，据作者所知，先前的研究对于肥胖对乳房 X 光筛查依从性的影响尚未得出明确的结论。本研究使用全国横断面调查数据，旨在评估 BMI 增加与乳房 X 光筛查使用之间的当前关联。
本研究使用来自 2016 年行为风险因素监测系统的横断面调查数据，这是一项针对美国非机构化成年人的基于州的全国电话调查，以确定乳房 X 光筛查使用与不断增加的增量 BMI 类别之间的关联，包括正常（18.5-24.9 kg/m2）、超重（25-29.9 kg/m2）、肥胖 I 级（30-34.9 kg/m2）、肥胖 II 级（35-39.9 kg/m2）和肥胖 III 级（>40 kg/m2），并对潜在混杂因素进行了调整。使用多变量逻辑回归模型评估每个 BMI 类别对自我报告的乳房 X 光使用的影响，使用未经调整和调整后的优势比。通过 Wald 检验测试交互项来确定种族/民族的效应修饰作用。
在 116343 名调查对象中，33.5%（38984 名受访者）的 BMI 正常，32.6%（37969 名受访者）超重，19.3%（22416 名受访者）为肥胖 I 级，8.4%（9791 名受访者）为肥胖 II 级，6.2%（7183 名受访者）为肥胖 III 级。与 BMI 正常的女性相比，与肥胖女性（I 级-III 级）个体相比，在乳房 X 光使用方面，肥胖女性之间没有统计学意义上的显著差异（P<.05）。也没有证据表明种族存在效应修饰作用（P=.53）。
与之前的报告相反，本研究结果表明肥胖与筛查乳房 X 光检查的依从性之间没有关联。这些发现可能与所有种族/民族组的女性对肥胖的社会接受度不断提高以及随着时间的推移，与体重相关的设施障碍被消除有关。
