Obesity and cervical cancer screening among women in Taiwan

Rationale: Studies have shown that obesity is correlated with cancer mortality, including breast and cervical cancer. Since 20.3% women in Taiwan were overweight in 1993-1996 and the prevalence of obesity increased from 13.2% in women from 1993-1996 to around 17% in 2005, it is important to understand whether obesity contributes to the underuse of cancer screening. Objectives: To investigate the relationship between obesity and regular Pap smear testing among women in Taiwan. Methodology: A national representative sample (n = 4,485 aged 30 years and older women) of the general adult population who participated in the Taiwan National Health Interview Survey (NHIS) in 2001. Body mass index (kg/m2), calculated from self-reported weight and height, was compared between women with and without a up-to-date cervical cancer screening in the past 3 years. Multiple logistical regression models were used. Results. Compared to women with normal weight, obese women had a significantly lower likelihood to receive pap smears (OR=0.77; 95% CI: 0.67, 0.89). After adjusting for age, education, smoking behavior and married status, obese women (OR=0.81; 95% CI: 0.70, 0.94) were still the least likely to undergo Pap smear tests. Over-weight women (OR=1.10; 95% CI: 0.94, 1.3) were more likely to undergo Pap smear tests but not significantly so. Likewise, under-weight women (OR=0.90; 95% CI: 0.68, 1.18) were also less likely to take routine pap smear tests than normal weight women but not significantly so. In terms of the influence of level of medical resource availability, women residing in the areas with the richest resources (OR=0.91; 95% CI: 0.90,0.91) were significantly less likely to receive a Pap test than those in the areas with the lowest level of resource availability. Conclusions. Obese women are less likely to comply with the international guideline for cervical cancer screening. The gap between non-obese and obese women persisted under the universal coverage of national health insurance.