Contraception and Cervical and Breast Cancer Screening in Obese Versus Non-obese Women
Condition: Obesity
MeSH terms: Breast Neoplasms
Study type: Observational

Summary: 
      .Brief Summary:* Obesity is a major public health problem in France. Indeed, 17% of the
      French population is obese (BMI greater than or equal to 30 kg/m²) while almost half of the
      adult population is overweight (BMI greater than or equal to 25 kg/m²).

      There is an increased risk of gynecological cancer in obese women but screening is less often
      performed :

      In women, obesity is a risk factor for the occurrence of certain cancers such as uterine
      cancer, epithelial ovarian cancer and breast cancer, particularly post-menopausal. In
      addition, an increase in BMI from the first stage of obesity is associated with larger breast
      tumors with more frequent lymph node involvement, indicating more invasive cancers. Recent
      studies have shown an increase in breast cancer mortality for women with grade 2 and 3
      obesity compared to women of so-called normal weight. Mortality from invasive breast cancer
      is higher from the obesity stage onwards.

      The current recommendations of the High Authority for Health recommend breast cancer
      screening by mammography and clinical examination every two years in all women aged 50 to 74,
      excluding women at high risk and requiring specialist follow-up. Organized screening for
      cervical cancer has recently been modified. From 25 to 30 years of age the modalities remain
      the same and consist of two cytological examinations one year apart and then every 3 years if
      the latest results are normal. From the age of 30 and up to the age of 65, it is now
      recommended that an HPV test be performed as a first-line test, 3 years after the last normal
      cytological examination and then every 5 years if the last test was negative.

      Studies dating back quite some time had shown an under-screening of cancers in obese women,
      in terms of carrying out mammography and cervical smears compared to women of normal weight.
      More recent data on access to gynecological cancer screening for obese women are
      heterogeneous, but there still seems to be less access to these examinations, whether for
      mammography or cervical smears. For example, a large American cohort study observed poorer
      detection of pre-cancerous lesions by smear with increasing BMI. Obese women had the lowest
      cumulative risk of pre-cancerous lesions at five years (followed by overweight women), but
      the highest rate of cancer at five years, associated with higher mortality.

      A neglected contraception in obese women?

      Data in the literature show that rates of unintended and unplanned pregnancies are higher in
      obese women (mainly those with grade 3 obesity) than in normal-weight women. This is
      associated with a lower use of contraception which is certainly poly-factorial: contraception
      not necessary due to a decrease in fertility linked to obesity, increased risks linked to
      contraception in obese women... However, most current contraceptive methods have shown
      similar efficacy in obese and non-obese women.

      This context suggests that there is still a marked difference in the gynecological management
      of obese women. The role of the general practitioner seems essential in this follow-up by
      facilitating the use of screening tests and by improving the information of this population
      with regard to contraception in particular.

      The objective of this study is to compare the gynecological follow-up of obese and non-obese
      women in a sample of women in Occitania, in terms of screening for breast and cervical
      cancer, as well as in terms of access to a method of contraception in general practice.
    


Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All women between 25 and 74 years old, who have a consultation at the CHU of Montpellier in
        endocrinology and/or in metabolic surgery and/or in a general practice in Occitania for a
        period of 6 months.
      
Keywords: breast cancer; cervical cancer; contraception; screening