IS OBESITY A BARRIER TO PHYSICIAN SCREENING FOR CERVICAL-CANCER

OBJECTIVE: To determine if obese and morbidly obese women are as likel y to receive Papanicolaou (Pap) smears as nonobese women. PATIENTS AND METHODS: A secondary analysis was conducted of data collected during a prospective, controlled trial of computer-generated reminders to imp rove preventive care. The site was a large, academic general medicine practice providing primary care to an urban population at a university -affiliated municipal teaching hospital. Data were analyzed from 15 fa culty and 77 resident physicians who delivered care to 1,321 women who were eligible for Pap smears. Patient data were obtained from a compu terized medical record system. RESULTS: Outcomes were physician report s of Pap smear performance and reasons for nonperformance of Pap smear s in eligible women. Pap smear performance was 21% for nonobese women, 20% for obese women, and 20% for morbidly obese women (P = NS). After adjusting for age and race, odds ratios for omission of Pap smear wer e 1.20 for both obese (95% confidence interval [CI] 0.86 to 1.67; P = NS) and morbidly obese women (95% CI, 0.58 to 2.47; P = NS). A signifi cant dose-response relationship was found between increasing patient w eight and physician responses that the Pap smear was delayed due to pa tient's acute illness, vaginitis, or menstruation (odds ratios [OR] 1. 73 for obese, OR 4.59 for morbidly obese women; P <0.005). CONCLUSIONS : In our general medicine practice, obesity does not appear to be asso ciated with less Pap smear performance. Physicians are more likely to report delaying obese patients' Pap smears due to acute illness, vagin itis, or menstruation.