Correlation of BMI With Potential Barriers to Mammographic Screening: Body Image, Pain, and Perceived Risk of Breast Cancer–A Cross-Sectional Study

Introduction: Higher BMI is associated with reduced breast screening participation but it is unclear if BMI is a proxy for other potential barriers to screening. This study describes the correlations between BMI and body image, perceptions of risk, and pain in a large sample of breast screening participants to help identify targets for improving screening participation within people with obesity. Methods: A survey collected information on body image, perceived risk of breast cancer, and pain experienced during mammography from 10,751 participants attending BreastScreen Western Australia between June and December, 2023. Latent variable analysis was used to generate single unobserved index variables for perceived risk, body surveillance, and body shame. Spearman's rho correlations were estimated between BMI, four body shame variables, six body surveillance variables, overall perceived risk index, and a pain score. Results: BMI was significantly positively correlated with responses indicating increased body shame and increased body surveillance, except for one question where participants with increased BMI indicated that they think it is more important that their clothes are comfortable than look good. BMI was also positively correlated with overall perceived risk index (r_s = 0.08, p < 0.0001), and negatively correlated with the pain score (r_s = −0.04, p < 0.0001). Conclusion: The findings demonstrate that BMI is more highly correlated with body shame than body surveillance, perceived risk, or breast pain. Targeting body shame barriers to screening may improve participation within people with obesity, thereby improving breast cancer outcomes in this high-risk group.