Body Mass Index and Colon Cancer Screening: A Systematic Review and Meta-Analysis

Abstract

Background Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing. Methods We conducted a systematic review to determine if 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 BMI categories: Normal, 18.5–24.9 kg/m2 (reference); overweight, 25–29.9 kg/m2; class I obesity, 30–34.9 kg/m2; class II obesity, 35–39.9 kg/m2; and class III obesity, ≥ 40 kg/ m2. Results 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 to those with a normal BMI with combined odds ratios (95% CI) of 0.87 (0.82 to 0.93), 0.80 (0.65 to 0.99), and 0.73 (0.54 to 0.94) for class I, II, and III obesity, respectively. Results were similar among white men with class II obesity. Conclusions Overall, BMI was not associated with colon cancer screening. Obese white men and women may be less likely to undergo colon cancer screening compared to those with a normal BMI. Impact Further investigation of this disparity may reduce the risk of obesity-related colon cancer death.

Otyłość a ryzyko rozwoju cukrzycy typu 2 i niektórych nowotworów złośliwych

“…Moreover, in the population of white obese women, the frequency of screening was lower than in the population of white women of normal body weight (OR = 0.87, 95% CI: 0.82; 0.93 for grade I obesity, BMI: 30-34.9 kg/m 2 , OR = 0.80, 95% CI: 0.65; 0.99 for grade II obesity, BMI: 35-39.9 kg/m 2 , OR = 0.73, 95% CI: 0.58; 0.94 for grade III obesity, BMI > 40 kg/m 2 ). In the population of white men, similar results were obtained only for grade II obesity [61].…”

Obesity and colorectal cancer

“…Nevertheless, white women and men with obesity had lower rates of CRC screening than their normal BMI counterparts. For women, the trend was significantly associated with obesity classes 62. Additional findings were reported in a prospective study that assessed reporting of CRC screening and the probability of agreeing with statements denoting attitudes/perceptions about CRC and screening 63.…”

“…A study comparing screening of normal weight patients to that of the latter displayed a reduced rate of CRC screening, whether by opportunistic colonoscopy or faecal occult blood testing 61. A recently published meta-analysis highlighted possible racial disparities, suggesting that BMI was not associated with CRC screening 62. Nevertheless, white women and men with obesity had lower rates of CRC screening than their normal BMI counterparts.…”

Body mass index and cancer screening: Findings from the English Longitudinal Study of Ageing

“…An advantage of our study was that it included objective measurements of height and weight, because dependence on self-reported BMI has been cited as a limitation of the research in this area. 6,7 The results of this study highlight the potential impact of weight on participation in CRC but not breast cancer screening, in England. To our knowledge, this is the first investigation of screening uptake by weight status in the English population, and it is therefore important that the findings are replicated.…”