Obesity, body image and past screening experiences : impacts on breast screening participation

Background: Obesity is an urgent global health issue which increases risk of chronic disease, such as breast cancer. Evidence suggests individuals with a higher body mass index (BMI) are less likely to engage in preventative health screens, such as breast screening programs, due to self-stigmatisation and a prior poor experiences, despite obesity being the number one risk factor for breast cancer. Method: An online survey, investigating breast screening participation, body shame and past screening experiences was distributed to women across Australia via targeted social media marketing. Descriptive statistics, chi-square tests of independence and generalised linear regression were used to analyse the data. Results: Among the convenience sample of women who completed the survey (n=892), negative past screening experiences were correlated with reduced levels of rescreening (p = 0.0001). Higher BMI was also associated with reduced rescreening (p = 0.007) compared to those with a lower BMI. Increased body shame scores were also linked to negative previous screening experiences (p <0.0001). These data also suggest body image disturbances may be correlated with BMI. Low body shame was associated with higher healthcare seeking scores (p <0.0001). Conclusion: Body image, obesity and past screening experiences influence how women access breast screening programs. Having a higher BMI appears to contribute to negative screening experiences via increased body image shame, both of which may reduce screening, and in particular rescreening among obese women. Consideration of these issues is warranted if screening participation is to be optimised in this group of higher risk women, as well as education for mammographic staff on sensitive handling of obese women.