Obesity as a barrier to participation in breast screening : insights from Australia

Background: Obesity increases risk of breast cancer and worse outcomes, yet screening participation can be lower in obese women. Obesity in Australia, and other settings, is steadily rising. Breast screening participation rates in Australia are suboptimal, meaning a number of obese higher risk women may not be accessing screening. This project explored barriers to breastscreening participation in obese women and stakeholders in Australia. Method: In-depth interviews (n=24), conducted with obese women and key stakeholders in 2017. Results: There was a disconnect between stakeholder and women's perceptions. Stakeholders perceived few issues in screening obese women beyond health and safety issues such as manoeuvering patients, though access for obese women was a concern, particularly in mobile breastscreen vans. From the women's perspective, low knowledge around a heightened need to screen existed, limited desire to prioritise personal health needs, reluctance to screen do to body image disturbances and prior poor mammographic experiences due to issues surrounding their weight. Women were also at a higher risk of adverse events during screening. Lack of communication about additional images/time needed for larger breasted women was also a discourager to screening, as negative experiences influenced future screening and screening of other women in their social circle. Overall, weight was perceived as being a taboo topic among our interviewees, indicating that a lack of discourse around this issue maybe putting obese women at increased risk of breast cancer morbidity and mortality due to their reluctance to re-attend following an unpleasant screening experience or refusal to attend at all. Conclusion: Consideration of breastscreening practice policy is warranted so weight is openly identified and addressed during the booking/screening process alongside education for mammographic staff around management of obese women. Targeted health promotion on increased breast cancer risk in obese women is required as is a need to address body image issues in this context.