# Adherence to breast and cervical cancer screening guidelines according to obesity status: a French cross-sectional multicenter survey

## TL;DR

This study finds that women with obesity are less likely to follow recommended breast and cervical cancer screening guidelines compared to normal-weight women in France.

## Contribution

The study reveals that obesity is independently associated with lower adherence to cancer screening guidelines, regardless of socioeconomic factors.

## Key findings

- Women with class I and II obesity had two-to-four times higher odds of not being up-to-date with breast and cervical cancer screenings.
- Class II obesity was associated with more frequent follow-up by general practitioners rather than gynecologists.
- Screening disparities were not explained by socioeconomic status.

## Abstract

To assess breast and cervical cancer screening rates among women according to body mass index (BMI).

This cross-sectional study used anonymous self-administered questionnaires given to women from three French university hospitals with normal weight (BMI 18.5–25 kg/m2), class I obesity (BMI 30–35 kg/m2), or class II obesity (BMI ≥ 35 kg/m2) in 2020–2021. Up-to-date screening was defined according to national guidelines: biennial clinical breast exams and mammograms for women aged 50–74, and triennial cervical samples for women aged 25–65, excluding those with prior cancer or related surgery. Screening rates and gynecological follow-up were compared across BMI groups.

Among 439 women (20% class I, 22% class II obesity), 178 and 370 were eligible for breast and cervical cancer screening, respectively. Women with class I and II obesity were less likely to be up-to-date for clinical breast exams (Odds Ratio [95% confidence interval] 2.35[1.06,5.20] and 2.68[1.12,6.42], respectively), mammography (4.43[1.49,13.18] and 4.08[1.22,13.62]), and cervical samples (2.23[1.09,4.54] and 2.85[1.42,5.72]). Class II obesity was associated with more frequent follow-up by general practitioners (p < 0.05).

Women with obesity are less likely to receive recommended gynecological cancer screenings than normal-weight peers. These disparities call for more inclusive healthcare strategies.

Trial registration: NCT04357652.

•Both breast and cervical cancer screening were assessed across body mass index groups.•Obesity (class I and II) was linked to breast and cervical cancer underscreening.•Odds of non-up-to-date screening was two-to-four times higher in women with obesity.•In class-II obesity, general practitioner more often led gynecological follow-up.•Screening disparities were not explained by socioeconomic status.

Both breast and cervical cancer screening were assessed across body mass index groups.

Obesity (class I and II) was linked to breast and cervical cancer underscreening.

Odds of non-up-to-date screening was two-to-four times higher in women with obesity.

In class-II obesity, general practitioner more often led gynecological follow-up.

Screening disparities were not explained by socioeconomic status.