Breast and Cervical Cancer Screening. Specific Effects of Depression and Obesity

Evette J. Ludman, Laura E. Ichikawa, Gregory E. Simon, Paul Rohde, David Arterburn, Belinda H. Operskalski, Jennifer A. Linde, Robert W. Jeffery

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background: Obesity and depression may each be associated with lower rates of cervical and breast cancer screening. Studies have examined obesity or depression alone, but not together, despite the established link between them. Purpose: This article aims to disentangle the effects of depression and obesity on receipt of breast and cervical cancer screening. Methods: A stratified sampling design was used to recruit women aged 40-65 years with information on BMI from an integrated health plan in Washington State in 2003-2005. A telephone survey included the Patient Health Questionnaire-9 for depression, weight, and height. Automated data assessed Paps for 3097 women over a 3-year period and screening mammograms over a 2-year period for 2163 women aged ≥51 years. Logistic regression models (conducted in 2008) examined the association between obesity and depression and receipt of screening tests. Results: In univariate logistic regression models, women were less likely to receive a Pap if they were obese (OR=0.53, 95% CI=0.41, 0.69) or depressed (OR=0.60, 95% CI=0.42, 0.87). Further, women were less likely to receive a screening mammogram if they were depressed (OR=0.45, 95% CI=0.30, 0.67). In multivariable models, only obesity remained significantly associated with a lower likelihood of Pap screening (OR=0.67, 95% CI=0.0.49, 0.93), and only depression remained significantly associated with lower rates of screening mammography (OR=0.49, 95% CI=0.31, 0.76). Obesity and depression did not interact significantly in either model. Conclusions: Obesity and depression appear to have specific effects on receipt of different cancer-screening tests.

Original languageEnglish (US)
Pages (from-to)303-310
Number of pages8
JournalAmerican journal of preventive medicine
Issue number3
StatePublished - Mar 2010

Bibliographical note

Funding Information:
This project was supported by NIH Research Grant MH68127 funded by the National Institute of Mental Health and the Office of Behavioral Social Sciences Research . An earlier version of this article was presented in a poster at the annual meeting of the Society of Behavioral Medicine, San Diego CA, March 2008. The funder had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. The authors thank Rebecca Hughes for her help with editing the manuscript.


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