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Obesity a big barrier for getting a mammogram
January 31st, 2011
02:06 PM ET

Obesity a big barrier for getting a mammogram

Women are less likely to be screened for breast cancer if they are obese, according to a new study in the Journal of Women's Health. Despite having insurance and receiving reminders to get screened, "...a significant portion of the population is not getting screened," according to the study.

The reasons women gave for skipping mammograms are clear-cut, but the solutions are not. Among obese patients, the main reason cited for skipping mammograms was that the test is too painful, yet many women who are not obese also cite pain as a reason for avoiding the test.

Addressing the issue of obese women skipping mammograms has a special sense of urgency, according to the study: "Given the obesity epidemic, the higher incidence and mortality from breast cancer among the obese, and the need for patients to participate in regular screening to achieve desired reductions in mortality, obesity is an exceedingly common and important barrier to mammography."

According to the National Cancer Institute, after menopause, obese women have 1.5 times the risk of developing breast cancer. Obese women are also at increased risk of dying from breast cancer compared with lean women.

The study, conducted among 340 women aged 50 to 69 insured by Kaiser Permanente, is revealing because skipping cancer screening is typically associated with not having insurance. In this study, however, all of the women were insured.

"Access to mammograms through health insurance and reminding patients that mammograms are due does not completely alleviate patient barriers," according to the study. "Disparities cannot be addressed solely by providing access to clinician advice about the procedure."

One in eight women will develop breast cancer in their lifetime, according to the American Cancer Society, and around 40,000 women die from breast cancer each year. According to experts, the best existing tool for preventing breast cancer is screening. The U.S. Preventive Services Task Force advises women to begin screening for breast cancer at age 50, and to get screened every two years.

Other organizations, including the ACS, suggest a more rigorous screening schedule: Yearly mammograms beginning at age 40.

Other groups less likely to get a mammogram include younger women - under age 60 - and women whose annual household income was less than $40,000. Younger patients were more likely to say they were too busy to get a mammogram, and they were more concerned about the accuracy of the test. Those worries stem from "concerns about the accuracy of mammograms that could cause either missed cancers or unnecessary surgery," according to the study.

Study authors suggest practical solutions to the mammography problem - such as worksite and mobile screening facilities - and broad ones such as improved technologies for breast cancer screening, but note that studying why obesity is such a barrier for breast cancer screening should be a priority.


soundoff (175 Responses)
  1. Sarah

    Mike, I am seriously concerned about your lack of compassion for patients. Perhaps the rigors of emergency room work have left you jaded, but I find that an insufficient excuse for your level of contempt. Other commenters just sound callous and ignorant. That you would write in this fashion as a medical professional doesn't augur well for your hospital. And, no, a medical degree is not a license for arrogance.

    February 1, 2011 at 02:01 | Report abuse | Reply
  2. Simon

    As a side note, I love how fat people coined the word "skinny" as though there is something wrong with being thin. Wake up people, being skinny is within your normal weight, being fat is not. There are fat people and then there are normal people, not skinny.

    February 1, 2011 at 02:03 | Report abuse | Reply
  3. wows

    You know? Whether obese people are obese because of laziness or some random medical condition, what is the point of being rude about it? I mean, really it is no ones business. Some people just don't have the self control others have. Really it doesn't matter. I find it hard to believe that anyone speaking this callously of another human being has made it beyond their high school years. How about just worry about yourself and not someone elses weight? Anyways, I grew up being told "if you don't have anything nice to say, then don't say anything at all". Goodness people just be nice to each other.

    February 1, 2011 at 02:04 | Report abuse | Reply
  4. Angela Ohanian

    Its not just mammograms that obese women skip. Speaking for myself of course, I am overweight and I had not gone to a gynocologist for many years, and when I finally found a woman doctor I figured I would feel more comfortable but it was the most humiliating and exasperating experience. She was a size 0, looked at me like I was the fat lady in the circus, and when she tried to examine my breasts it was uncomfortable and she said, "I cannot examine you, you keep moving, I will write that you were uncooperative." She was tickling me! And if that wasn't nasty enough, the examining table was so narrow, I was having difficulty getting on and off because of problems with my leg, she didn't even offer to help me, she just let me struggle my way on and off, I was out of breath. Oh yes, I know I needed to lose weight, but she made me feel like dirt. I haven't gone for an exam since and that was 2 years ago. As for the mammogram, everyone said that St. Barnabas was wonderful, well it was horrible. I had to wait for almost three hours, and when I did go in the woman was nasty, I had never had a mammogram before, she was very rough and it was painful because I have big boobs. A couple of days later I got a notice that they saw something in my left breast and I needed to go back. I was not nervous about the exam anymore, just worrying if it was anything serious. When I went back, the second technician was a little nicer but it was still a bit painful for me they squeezed my boobs like they were grapfruits going to give juice. Then they told me to go to another room where a technician would examine the x-ray. The techinican left me alone in the room and I was nervous as hell, she had to show the results to a doctor, and when she came back she said it was "most likely" a water cyst. Nothing serious. The doctor never even came in to see me! So, why do women get breast cancer? Because of idiots like this. I would never go back there again, and I will NEVER go for another mammogram and if I drop dead, the message I got is too bad – I am a fat piece of garbage and I don't deserve to live!

    February 1, 2011 at 02:10 | Report abuse | Reply
    • Trees Please

      A lot of doctors don't have a kind "bed-side manner," and so you should try another female physician, possibly at a different clinic, until you find one you like. Most of us are not lucky enough to find a nice doctor the first time we go. Whenever I become unhappy with a doctor/dentist/ etc. myself, I try a new one. It's worth the search. Please do not stop getting your preventative health exams. The doctors was completely out-of-line for saying you were being uncooperative, but there are better doctors out there. I'm sorry she didn't help you get on or off the exam table, but there may have been a good reason, like liability if you fell or received an injury while she was touching you. As for the doctor not coming in to discuss your results with you, I agree, he should have.

      February 1, 2011 at 05:15 | Report abuse |
    • JenLaw

      Yes, please go see another good woman OB/GYN. I have seen several over the years and my mammogram people are fantastic. They always ask me how far I'm comfortable with pressure wise. I asked them to stop, they would. I have dense breasts so I always go through about 1/2 hours worth for them to find nothing, but it is better than chemo and radiation, by far.

      February 1, 2011 at 15:05 | Report abuse |
  5. js

    @derp, no need to get so defensive. There are such things as 'normal weight' and 'normal lifestyles'. You don't have to be EITHER obese or anorexic, although nearly 1 in 3 are technically obese today in America.

    Which begs the question, if obesity can be blamed on genetics (you know, some people are just 'born this way') then why does this country (a country built on immigrants) have among the highest obesity rates in the world? Surely the genetic composition of our population didn't change THAT MUCH in two-to-three hundred years.. There's really no excuse to be obese. Its true some people have faster/slower metabolisms than others and they will be naturally thinner/thicker than others. However being OBESE is a whole other issue. Humans weren't designed to be this big, obviously indicated by all these health problems that come with it.

    February 1, 2011 at 02:30 | Report abuse | Reply
  6. kat

    Wasn't sure that I wanted to make comment. I have lost 60 pounds over last year but still obese.
    I am a nurse so I hear what docs say. I would never come to er for treatment as I know how they feel.
    I make fun of myself to beat others to punch. Reasons for weight are varied but basically guess I don't love myself. I would do anything to help colleages, friends, & patients.
    Going to gym uncomfortable, never would I accept any touch such as massage & do not date.
    When I fly I get 2 seats & am amazed how other passenger just takes over empty seat 4 bags, coat, computer. Las time I flew a young asian girl was in aisle seat while I had middle and window & when I asked to be let in she said no to trade with someone. I said I had both seats so she would be comfortable but perhaps she might want to trade as I might not like flying with an asian.
    I don't get female exams as I don't wish to have someone look at my fat ass or do mammagrams as if something was found I would not subject anyone to have to treat me.

    February 1, 2011 at 02:31 | Report abuse | Reply
    • Trees Please

      Please realize you deserve love, care, and medical treatment just as much as anyone else. If I were a massage therapist, I would be happy to give a massage to anyone who needed healing. You have to look for a therapist or doctor you feel comfortable with. Dating is difficult, but there are men who can see past weight. Try to make small changes toward your goals, like asking around until you find a compassionate doctor or massage therapist. Please don't just give up on what you deserve. And if you purchase two seats on the airplane and someone puts their junk on the seat, be assertive and explain you purchased both seats and need the space. I'm sure they just thought it was an empty seat.

      February 1, 2011 at 05:21 | Report abuse |
  7. Jaystar

    I think laziness is the Main reason and pain is just another typical excuse. I am sure these women have an excuse for everything included why they are fat. When I read this story, I think of the people of wal-mart waddling through life taking no personal responsibility for their lifestyle and choices. Just as every person is responsible for eating healthy and getting some exercise, it takes discipline. The same discipline required to go to the doctor or the dentist for bi-anual check-ups.

    February 1, 2011 at 02:37 | Report abuse | Reply
    • Trees Please

      What is your excuse for making fun of other people's appearance, judging others, and thinking you are superior?
      I will take a nice caring person over a meanie who is smug about his so-called "discipline" any day.

      February 1, 2011 at 05:23 | Report abuse |
  8. ann

    I wish people were not so judgemental. I certainly have weight issues and have been dealing with them off and on my whole life. I haven't had a mammogram for several years, not because I don't care about my health, but because my insurance premiums became so high I could no longer afford health insurance. Prior to having to let go of the health insurance because it was beyond my ability to afford it, I had pretty regular screenings. I have just learned that I can be screened locally through a special program in my area and I plan to have a mammogram this month. I tend to question the validity of this finding that more heavy woman do not get screened. I have known a whole lot of women who are not obese who also do not get screend. One observation I will make is that for people with weight issues in general, any type of invasive check ups are psychologically uncomfortable and I honestly think that is because in far too many cases the obese are made to feel so guilty for their weight when there are a great number of reasons for each person's situation from biological to pyschological factors.

    February 1, 2011 at 03:32 | Report abuse | Reply
  9. Amy

    Mammograms do hurt. There have been times when that last turn of the dial has brought tears to my eyes and I am convinced the machine is damaging sensitive breast tissue–how could it not? It's worth the pain to stay healthy, but why oh why can't someone device a less medieval device? Also, practically every woman I know, myself included, has been told she has dense breast tissue and must also have an ultrasound to follow-up the mammo. Why not just go straight to the painless ultrasound then? And if both tests are necessary, why can't they both be scheduled the same day, rather than make me come back and go through that anxiety all over again? I'm fortunate to go to a radiology group that specializes in mammos and the staff could not be nicer–I can't even imagine wanting to go through this experience with people who are as insensitive as some described here.

    February 1, 2011 at 05:17 | Report abuse | Reply
  10. Elizabeth

    I don't think they are looking in the right direction for a reason larger women don't get as many mammograms. Most large women I know gave up on monthly breast exams years ago because it's just too hard to tell the differences within larger breasts. When they aren't doing the monthly checks, I think it becomes less forward in the mind and they either forget or don't want to know out of fear of the results because they haven't been checking on their own. (head in the sand as it were) and then there is just plain fear of cancer. When you're large you see so many doctors and all they seem to have for you is bad news about weight loss and what's going on with women these days ( latest rheumatologist says they are looking at something that has changed our basic chemistry.. like chemicals in food and in plastics).... you don't want to see that one more who tells you now there is something wrong with your breasts.
    I wonder if there is a direct correlation between women who don't go for pap smears/gyno checks and if the same women don't go for mammos? That would have been a good link to discover.

    February 1, 2011 at 05:32 | Report abuse | Reply
  11. focker

    maybee they need a mammothgram instead.

    February 1, 2011 at 05:33 | Report abuse | Reply
  12. LOW LYF

    I LIKE BOOBS

    February 1, 2011 at 05:47 | Report abuse | Reply
  13. NYDude

    Why are there no pictures? This thread needs pictures to get the message across.

    February 1, 2011 at 05:50 | Report abuse | Reply
  14. BadPatient

    Doesn't matter, it missed mine and we put it right in there (not operator error). i weighed about 124 pounds. ultrasound caught it. This company wants to sell you something. they put it in the guidelines so people will spend money...it wasn't as good as they said it was. be careful of things people get put into guidelines like that...they are trying to sell you something.

    February 1, 2011 at 06:35 | Report abuse | Reply
  15. Willow

    They need to find a way other than mammograms to test for breast cancer. I read somewhere about a blood test in the works, has this been implemented yet?

    February 1, 2011 at 07:16 | Report abuse | Reply
  16. Jimbob

    This is Natural selection at work.

    It is an individual's responsibility to take care of themself.
    If you don't, then prepare to live with the consequences.
    Lifestyle choices like smoking, junk food, and sendentary inactivity account for half of the health care costs of this country, possibly more.
    Personally I'd rather live long, and live well.

    but thats my choice, you're all free to make your own.

    February 1, 2011 at 07:18 | Report abuse | Reply
  17. Carmen

    so both lean and obese women cite the reason they are skipping the test is because of the pain. Hmmm Hmmm. Maybe we should look at getting a new test. Just a thought

    February 1, 2011 at 07:18 | Report abuse | Reply
  18. I'mDa King

    Well... If these fat girls go through chemo as a result of not getting their obama's squashed then they'll lose weight from the treatment. At least they'll get something out of it!

    February 1, 2011 at 07:33 | Report abuse | Reply
  19. Karen

    I'm obese and the reason I don't like getting the test done is that they have a hard time getting my breasts into the machine because of my belly. But I have it done and I know the reason for the discomfort is my fault because of my weight – I accept it.

    February 1, 2011 at 07:43 | Report abuse | Reply
  20. freetime1

    And the good news is it will be the fat women that die. I mean if I had to pick which group to die that's the one I would say I could get along without.

    February 1, 2011 at 07:54 | Report abuse | Reply
  21. jrn

    or maybe it's because society believes 20 pounds overweight is obese. Real women aren't sticks.

    February 1, 2011 at 08:04 | Report abuse | Reply
  22. hudson03

    Not surprising, I am a doctor and I find that across the board, obese patients are much less compliant with all forms of treatment, including recommendations, medical compliance and follow-up. It would be an intersesting study, to compare decision making paradigms of obese and non-obese

    February 1, 2011 at 08:09 | Report abuse | Reply
    • Kapten

      It was really nice to go troguhh the post focusing on human brain. Thanks for sharing the views on human brain and its functions. The human brain is the most complex and relevant organ of our body. Brain is responsible for every actions and thoughts of an human or an animal. The composition and functions of the brain is really complicate. The wonders and exceptional task it performs is something that makes us to unravel the mystery of human brain and its functions even today. But still we have not finished our research on human brain completely.

      July 1, 2012 at 14:15 | Report abuse |
  23. Mary

    With the evil that some of you people think regarding so-called "obese" people, I'm sure you yourself are absolutely perfect.

    The health Nazis have redefined obesity, hence the higher obesity rates.

    February 1, 2011 at 08:20 | Report abuse | Reply
  24. Lauren

    I have almost no breasts, I'm gonna admit to like less than an A cup....And when they try to get what I've got into that vise, it kills. I've had one and left the office saying "Never again." I know I'll get another, but they have got to come up with a better way. How many men would get their business checked, if it involved putting their business in a vise and cranking it shut??? I have thought about getting implants but I cannot imagine what the mammogram machine would do to those...

    February 1, 2011 at 08:33 | Report abuse | Reply
  25. bk

    I've had pain with mammograms from the machine pressing hard down on my breasts. I'm not overly large breasted, a C cup, and around average weight. I made the mistake once of getting a mammogram a few days before my period, and the pain lasted for days! I'll never do that again, that's for sure.

    For my last mammogram, no lump was found, and I did a radiological scan. I was told that my breasts were too dense, and I should have a biopsy done. For what lump, if none was felt? It seemed to me to be unnecessary surgery, with no family history of breast cancer. I didn't get the biopsy done, and I am still well around 6 years later. (Still no lumps.)

    February 1, 2011 at 08:35 | Report abuse | Reply
  26. DoubleD

    I'm guessing that the size of the breasts of obese women are probably not the cause. I am small-boned and thin-normal size, but like many in my family have size double D breasts. I have been getting annual mammograms for 14 years and it is no where near as painful as childbirth (I've given birth twice...without being allowed any meds.) I would say it is 1/1000 the pain of childbirth. So, I doubt my radiologists are just better than anyone else's. Every person is unique, but I have a good friend who is obese and as very smart as she is, she has a problem with physical discomfort, almost to the point of an irrational fear. This inability to deal with physical discomfort has also caused her to avoid getting a colonoscopy even though she is well over the age where she should be getting checked and we have a good friend who had colon cancer, and we assured her that she will be asleep and not feel a thing. It also causes her to avoid exercise because she has a long list of what hurts after going for a walk. She has never had children. She eats enough calories for a teenage boy and would find a small pang of hunger overwhelming. So, maybe there is more of a prevalence of extreme avoidance of physical discomfort among some people, which causes some of them to avoid exercise, avoid adjusting their diet as they age, avoid colonoscopies, avoid mammograms, etc. and maybe a lot of those people are obese. My friend's obsession with physical comfort causes her to ignore ideas of future health problems. She admits she lives day to day and her priority is to be happy (physically and emotionally comfortable) each day.

    February 1, 2011 at 08:43 | Report abuse | Reply
  27. Dr. Sam Chu

    You're a flaming idiot, Rhiannon. Did your mother ever have any kids that lived?

    Obese women avoid the doctor because some doctors are just as boneheaded as you are. There are many causes of obesity, but you don't bother to educate yourself. Had you bothered to look up the latest research you would see that scientists are finding more and more evidence to support the theory that obesity is at least partially caused by a defective gene that causes ghrelin overload. Never heard of ghrelin? Look it up, O Chosen One.

    February 1, 2011 at 08:45 | Report abuse | Reply
  28. Zekey's Mom

    There's an awful lot of mudslinging in a lot of these comments. That's a shame.

    Mammograms hurt, period. Fear prevents a lot of sensible people from doing sensible things. The healthcare community needs to address this issue. In all these years, why isn't there a more definitive and less painful method of detecting tumors, calcifications, and abnormal breast tissue? MRIs and ultrasounds are not always the answer.

    February 1, 2011 at 09:14 | Report abuse | Reply
  29. claire

    I was once fat. Got very fat from pregnancy and didn't lose it for 6 years due to other medical issues. When I had mammograms, the technician would pull and tug to get the tiisue under my arms into the machine. Did you now there is breast tissue in that area too. Under the arms, down where your bra goes around if you're fat or have very large breasts? So in addition to pulling breasts into the machine, they also pull and push and ram the tissue under your arm in there too. You are trying to balance at a weird angle and your skin is pulling tight and burning and then the clamping begins. I cried more than once from the pain and I'm a pretty tough cookie. I've since lost the weight because the other medical conditions are gone, but the mammograms still hurt, not as much as before, but still definitely hurts.
    Clueless skinny girls and men – sometimes you just don't know what it's like for fat women, so don't be so &^$% presumptive!

    February 1, 2011 at 09:21 | Report abuse | Reply
  30. Gonzodon

    What's the problem with this? Survival of the fittest. Good way to thin the herd.

    February 1, 2011 at 09:38 | Report abuse | Reply
  31. Ex-Seattleman

    Fat, drunk and stupid is no way to go through life.

    February 1, 2011 at 09:39 | Report abuse | Reply
  32. Alex knows

    This response is in regards to the Obese people who think that skipping and avoidng the doctors is justified by the fact that they dont want to be ridiculed. If you are fat and know your fat and are trying to control your weight thatrs good! BUT that doesnt mean the doctor isnt going to tell you to lose weight and shiet like that. Its the doctors job to advise you on how to be healthy. So stop being an idiot and making excuses for yourself you obese people

    February 1, 2011 at 10:36 | Report abuse | Reply
  33. Laura

    I'm 32 years old with family history of breast cancer (mother, father's mother and grandmother)and many other cancers in family history, so I had a baseline at age 30. Not painful at all. Had to repeat due to bad film. Not painful at all. Had to do more films due to questionable finding. Not painful at all. 6-month follow up due to the probable benign mass they found...not painful at all. I'm very obese (300lbs., size 46-C). I don't know what all the fuss is about, but I guess I'm just lucky. Oh, and no excuses for my obesity. Too many years of calories in > calories out. Simple as that.

    February 1, 2011 at 11:08 | Report abuse | Reply
  34. Michael1971

    I'm not sure I'm understanding this correctly. The article states that screening actually "prevents" breast cancer. Isn't it more accurate to say that it prevents deaths through early discovery.

    February 1, 2011 at 12:44 | Report abuse | Reply
  35. JAF

    I am a obese women. Since I have turned 40 I have had a momogram every year. Nobody called me to be in your study. To say obese women dont care about there health is not true. I most certainly am concerned about it so I take an active part in my health care. Stop blaming women who are obese for not caring about there health. We do care about our health!!

    February 1, 2011 at 14:29 | Report abuse | Reply
  36. Eileen l mccormick

    Ok? I am confused. This article is the result of a Publised Study, yet most of the people are attacking the writer, as if it is their own personal opinon. Wt(heck)? I'm a chunky woman in poor health with no insurance...who wishes she had insurance, so I could get well and am gratefull for this article. I was not offended by it in the least. I was shocked and appalled at the reactions other (chuncky mamas posted). That being said. I am looking for information on low cost/free mammos. I've got to get checked. Thanks

    February 1, 2011 at 15:15 | Report abuse | Reply
  37. Vera

    Please exercise a for at least 2.5 hours a week! This will save your life! The World Health Organization issued a press release regarding the necessity of exercise: http://www.who.int/mediacentre/multimedia/podcasts/2011/cancer_20110207/en/

    February 7, 2011 at 15:17 | Report abuse | Reply
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