Obesity's Impact on Screening for Cervical Cancer

Andrew M. Kaunitz, MD


February 14, 2018

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville. Today I'd like to discuss obesity's impact on cervical cancer screening.

In the United States and many other countries, the prevalence of obesity continues to increase. Researchers at Kaiser Permanente of Northern California conducted a study[1] to assess how body mass index (BMI) impacts the outcomes of cervical cancer screening. In 2003, Kaiser initiated cytology and HPV co-testing every 3 years for women aged 30 and older.

Among women screened over a 12-year period, the likelihood of being diagnosed with cervical cancer or precancer was assessed, using the following definitions:

  • Cervical precancer was defined as cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ.

  • Cervical cancer was defined as invasive squamous cell carcinoma, adenocarcinoma, and microinvasive cancer.

Among almost 950,000 women studied, approximately one third were obese. The likelihood of being diagnosed with precancer was highest among normal- and underweight women, and lowest among obese women. In contrast, the risk for cancer was higher with increasing BMI.

This apparent paradoxical decrease in preinvasive cervical neoplasia among obese women suggests that cervical cancer screening is less effective in this population. The authors estimated that if screening for preinvasive disease was as effective in obese women as in normal-weight women, then 1 in 5 invasive cancers in their population could be prevented.

In obese women, adequate visualization and sampling of the cervix is more challenging for clinicians. My clinical impression also is that vaginal examination can be particularly uncomfortable for obese women. Using appropriately sized vaginal specula and maintaining close supportive communication with patients during vaginal examination may improve results of cervical cancer screening in our increasingly obese patient population.

Thank you for the honor of your time. I'm Andrew Kaunitz.


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