Environment and Breast Cancer: Science Review

Evidence From Humans
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Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? [see comment]
Wee, C. C., McCarthy, E. P., Davis, R. B., Phillips, R. S. Annals of Internal Medicine. 2000. 132:9, 697-704.
Topic area
Body size
Study design
Population based survey
Funding agency
Other: Medical Foundation INC., and National Resea
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number in Cohort
Cohort: 3077 women who reported the date of their last mammography in a survey
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: women who participated in the "Year 2000 Supplement" National Health Interview Survey regarding mammograms; age 50-74 years at the time of survey Ex: women with missing information
Comment about participation selection
Strengths: population based survey; developed unadjusted and fully adjusted models for analysis; high participation rate (88%); analyzed by race; analyzed the rate of mammograms in a population of obese women that is more frequently diagnosed with advanced stage of breast cancer Limitations: Did not include ORs or CI in analysis; self-reported information on mammograms and anthropometric data that could lead to error or recall bias; could not adequately control for comorbid illnesses, which are highly correlated with BMI; could not control for medical provider-related factors; unable to account for certain cancer risk factors
Exposure Investigated
How exposure was measured
Questionnaire, self-administered
Exposure assessment comment
Anthropometric data self-reported
Breast cancer outcome investigated
Other: Mammogram examination
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
African Americans Non-hispanic White Americans
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Adequately controlled, Confounders: age, ethnicity, marital status, education, region of the country, insurance type, number of visits to a physician, specialty of usual health provider, health status, and number of days hospitalized
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Results Comments
Overweight (BMI 25 to <30 vs. 18.5 to <25) and obese women (BMI 30 to <35 vs. 18.5 to <25) are 2.8% and 5.3% less likely to undergo screening for breast cancer with mammography, respectively.
Author address
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. cweekuo@caregroup.harvard.edu