Obese Women in Canada Less Likely to Get Pap Tests

Like the United States, Canada is experiencing an obesity epidemic, with nearly 60 percent of the population affected. A new study finds that heavier Canadian women are less likely to undergo cervical cancer screening than their normal-weight peers are, despite having a health system that offers universal access.

Researchers led by Dr. Rebecca Mitchell of the University of Alberta ruled out socioeconomic status, health habits, chronic medical conditions and health care access as sources of the disparity.

Obesity bias might be the culprit, suggested Rebecca Puhl, Ph.D., an expert on weight-related bias in U.S. health care. Puhl is the director of research and anti-stigma at the Rudd Center for Food Policy & Obesity at Yale University.

In recent U.S. studies, similar issues led women to put off screening for cervical and breast cancer. The women “specifically attributed avoidance of health care to experiences of weight bias: negative attitudes and disrespectful treatment by health care providers, embarrassment about being weighed and medical equipment that’s too small,” Puhl said.

In the new study, “obesity did not alter mammogram or colorectal cancer screening,” said co-author Dr. Scott Klarenbach, an associate professor at the University of Alberta. “However, we found that obese persons were less likely to have cervical cancer screening (Pap smears) than persons without obesity, and this gap widened as obesity increased.”

The most obese women — those with a BMI of 35 or higher — were nearly 40 percent less likely than others were to have had a Pap test.

The researchers used data from the Canadian Community Health Survey 2003. The findings appear in the August issue of the American Journal of Preventive Medicine.

Of the nearly 38,000 women participants, 82.6 percent reported having cervical cancer screening within the past three years.

Women in the lower obesity ranges had screening rates similar to normal-weight women; however, severely obese women were twice as likely to say that fear — including fear of pain, embarrassment or finding something wrong — led them to avoid having a Pap smear, Klarenbach said.

Puhl was pleased that the Canadian study analyzed rates of colorectal cancer screening in men: “We don’t know as much about health care decisions by men; we need to examine whether weight bias is also a factor for them.”

“The gap with Pap smears is concerning, but is potentially addressable through increased awareness and vigilance on the part of patients and health care providers,” Klarenbach said.

American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292 or eAJPM@ucsd.edu.

Mitchell R, et al. Cancer screening among the overweight and obese in Canada. Am J Prev Med 35(2), 2008.