The impact of obesity on follow-up after an abnormal screening mammogram.

Abstract

Effective breast cancer screening and early detection are crucial for obese women, who experience a higher incidence of the disease and present at later stages. We examined the association between body mass index (BMI) and timeliness of follow-up after 241,222 abnormal screening mammograms carried out on 201,470 women in the Breast Cancer Surveillance Consortium. Each mammogram had one of three recommendations for follow-up: short-interval follow-up, immediate additional diagnostic imaging, and biopsy/surgical consultation. We used logistic regression to estimate the adjusted effect of BMI on any recorded follow-up within 270 days of the recommendation; linear regression was used to model the mean follow-up time among those with recorded follow-up. As compared with normal-weight women, higher BMI was associated with slightly increased odds of follow-up among women who received a recommendation for short-interval follow-up (ORs: 1.03-1.10; P = 0.04) or immediate additional imaging (ORs: 1.03-1.09; P = 0.01). No association was found for biopsy/surgical consultation recommendations (P = 0.90). Among those with recorded follow-up, higher BMI was associated with longer mean time to follow-up for both short-interval (3-10 days; P < 0.001) and additional imaging recommendations (2-3 days; P < 0.001) but not biopsy/surgical consultation (P = 0.06). Regardless of statistical significance, actual differences in days to follow-up across BMI groups were small and unlikely to be clinically significant. Once obese women access screening mammography, their follow-up after abnormal results is similar to that of normal-weight women. Efforts to improve early detection of breast cancer in obese women should focus elsewhere, such as improving participation in screening mammography.