Use of mammography, Pap test and prostate examination by body mass index during the developmental period of cancer screening in Estonia

Abstract

Objectives: Analysis of the use of mammography, Pap test and prostate examination (palpation and/or prostate-specific antigen test) by body mass index (BMI) in Estonia.

Study design: Cross-sectional.

Methods: In total, 7286 individuals aged 16-64 years, randomly selected from the National Population Register, filled out questionnaires in postal surveys in 2000, 2004 and 2008. The target age group was 45-64 years for mammography, 25-64 years for Pap test and 50-64 years for prostate examination. The probability of using these preventive medical services within the past 2 years by BMI was analysed using logistic regression models. Potential confounding variables included socio-economic factors, health behaviour, number of outpatient visits, current self-rated health, study year and age.

Results: Compared with women of normal weight, the probability of mammography use was higher for overweight women [adjusted odds ratio (OR) 1.32, 95% confidence interval (CI) 1.01-1.73], and the probability of a Pap test was significantly lower for severely obese women (adjusted OR 0.51, 95% CI 0.35-0.76). Prostate examination was independent of BMI. In 2008, mammography was predominantly performed within the screening framework for all BMI groups (highest rate in the mild obesity group, 76.2%), while Pap tests were predominantly performed following referral by a doctor (especially in the severe obesity group, 66.7%). The attendance rate for prostate examination was higher for men who rated their current health status as rather poor/poor.

Conclusions: In a country where population-based breast cancer screening works fairly well, cervical cancer screening is in its developmental stage and there is no screening for prostate cancer, the deciding role in referring people for preventive examinations for cervical and prostate cancer is still held by doctors. As such, they should pay particular attention to obese women, as this group has a worse prognosis for cervical cancer, and perform more prostate examinations for preventive purposes.