Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort

Abstract

Objectives To investigate the relationship between patterns of gynaecological check-up and body mass index while accounting for various determinants of health care use. Methods Sequence analysis and clustering were used to highlight patterns of gynaecological check-up, which included the regularity of breast and cervical cancer screening and visits to the gynaecologist over four years, among 6182 women aged 54–65 included in the CONSTANCES cohort between 2013 and 2015 in France. Multinomial logistic regressions were used to study the association between these patterns and women’s body mass index. Results We identified four patterns of gynaecological check-up, from (A) no or inappropriate check-up (20%) to (D) almost one visit to the gynaecologist every year, overscreening for cervical cancer and frequent use of opportunistic breast cancer screening (12%). From patterns A to D, the proportion of obese women decreased and that of women with normal body mass index increased. Obese and overweight women underwent more breast than cervical cancer screening and were less often overscreened than normal weight women. These differences were only partly explained by the lower socioeconomic situation of overweight and obese women. Beyond the financial barrier, the screening modality and the type of exam may play a role. Among women who were screened for cervical cancer, obese and overweight women were less often screened by a gynaecologist. Conclusion Further efforts should be made to enhance the take-up of screening among obese women who are deterred by the healthcare system.

A systematic review of obesity as a barrier to accessing cancer screening services

“…Women living with severe obesity were most likely to have a cervical smear following a referral to screening by a doctor 27 . Women living with obesity were found to be less likely to routinely visit a gynecologist, and even when they did, they were less likely to be screened for cervical cancer than normal weight women 20 . Physician recommendation for screening was also found to be a key factor in colorectal cancer screening uptake among both women living with obesity and women with overweight or normal body mass index 23, 26 and among men living with obesity 26 .…”

“…27 Women living with obesity were found to be less likely to routinely visit a gynecologist, and even when they did, they were less likely to be screened for cervical cancer than normal weight women. 20 Physician recommendation for screening was also found to be a key factor in colorectal cancer screening uptake among both women living with obesity and women with overweight or normal body mass index 23,26 and among men living with obesity. 26 A smaller number of men and women with obesity reported a physician recommendation for colorectal cancer screening than those who were overweight or normal weight.…”

“…22 A mechanism of sequence analysis was utilized, clustering to illuminate specific patterns of attendance and experience of gynecological diagnostic check-ups, within which obesity was specifically highlighted as a key determinant. 20 This encompassed an evaluation of the regularity of atten- women who were neglecting to attend regular gynecological checkups and screening and those who were infrequent in their uptake of breast screening services. There was a clear differential between women living with obesity and overweight in terms of the cancer screening they accessed, with greater levels of uptake of breast screening as opposed to cervical cancer screening.…”

Health care use by adults with obesity: A French cohort study

“…Our results are consistent with those of Franck et al, who have reported that women with obesity have low rates of cervical cancer screening. Limited health literacy and social deprivation have been associated with suboptimal screening as well (25,26). Because individuals from class III have a higher prevalence of vulnerability and social deprivation indicators, the decrease in the use of gynecological care could have important consequences for this specific population.…”

“…Because absolute risk of developing a gynecological cancer has been shown to be higher in women with obesity, a weaker access to screening for women with severe obesity further increases their mortality risk (23,24) be a targeted goal of public health policy, and specific interventions could reduce inequities and prevent them from compromising their health (26,27).…”