The influence of overweight and obesity on participation in cervical cancer screening: A systematic review and meta-analysis

The prevalence of obesity is increasing worldwide. The incidence of cervical cancer has decreased after implementation of cervical cancer screening, however, obese women have higher risk of cervical cancer than women of normal weight. This might be caused by a lower participation rate in cervical cancer screening. The aim of this systematic review and meta-analysis was to examine the influence of overweight and obesity on adherence to cervical cancer screening recommendations. We conducted a thorough systematic literature search of electronic databases to identify studies examining screening participation among overweight and obese women compared to women of normal weight. Based on a random effect model, we calculated pooled odds ratios (OR) of screening participation with corresponding 95% confidence intervals (CI). I2 statistic was used to describe heterogeneity. A total of 32 papers were included. The pooled OR of screening participation was 0.94 (95%CI: 0.89-0.99) for overweight women and 0.79 (95%CI: 0.68-0.92) for obese women compared to women of normal weight. The heterogeneity was substantial (overweight: I2 = 89%; obese: I2 = 93%). The OR for screening adherence was 0.91 (95%CI: 0.80-1.05), 0.85 (95%CI: 0.70-1.03) and 0.67 (95%CI: 0.54-0.84) for women in obesity class I, II and III, respectively. The OR varied by geographical region and race. In conclusion, obese women are less likely to participate in cervical cancers screening compared to women of normal weight. In addition, the likelihood of adherence to screening recommendations decreases with increasing obesity class. This stresses the need for targeted intervention to increase screening adherence for overweight and obese women.