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Obesity and Mammography: A Systematic Review and Meta-Analysis

Identifieur interne : 001D43 ( Pmc/Corpus ); précédent : 001D42; suivant : 001D44

Obesity and Mammography: A Systematic Review and Meta-Analysis

Auteurs : Nisa M. Maruthur ; Shari Bolen ; Frederick L. Brancati ; Jeanne M. Clark

Source :

Journal of General Internal Medicine [ 0884-8734 ] ; 2009.

RBID : PMC:2669867

Abstract

BACKGROUND

Obese women experience higher postmenopausal breast cancer risk, morbidity, and mortality and may be less likely to undergo mammography.

OBJECTIVES

To quantify the relationship between body weight and mammography in white and black women.

DATA SOURCES AND REVIEW METHODS

We identified original articles evaluating the relationship between weight and mammography in the United States through electronic and manual searching using terms for breast cancer screening, breast cancer, and body weight. We excluded studies in special populations (e.g., HIV-positive patients) or not written in English. Citations and abstracts were reviewed independently. We abstracted data sequentially and quality information independently.

RESULTS

Of 5,047 citations, we included 17 studies in our systematic review. Sixteen studies used self-reported body mass index (BMI) and excluded women <40 years of age. Using random-effects models for the six nationally representative studies using standard BMI categories, the combined odds ratios (95% CI) for mammography in the past 2 years were 1.01 (0.95 to 1.08), 0.93 (0.83 to 1.05), 0.90 (0.78 to 1.04), and 0.79 (0.68 to 0.92) for overweight (25–29.9 kg/m²), class I (30–34.9 kg/m²), class II (35–39.9 kg/m²), and class III (≥40 kg/m²) obese women, respectively, compared to normal-weight women. Results were consistent when all available studies were included. The inverse association was found in white, but not black, women in the three studies with results stratified by race.

CONCLUSIONS

Morbidly obese women are significantly less likely to report recent mammography. This relationship appears stronger in white women. Lower screening rates may partly explain the higher breast cancer mortality in morbidly obese women.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669867

DOI: 10.1007/s11606-009-0939-3
PubMed: 19277790
PubMed Central: 2669867

Links to Exploration step

PMC:2669867

Le document en format XML

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<author><name sortKey="Maruthur, Nisa M" sort="Maruthur, Nisa M" uniqKey="Maruthur N" first="Nisa M." last="Maruthur">Nisa M. Maruthur</name>
<affiliation><nlm:aff id="Aff1">Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA</nlm:aff>
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<affiliation><nlm:aff id="Aff2">Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, MD USA</nlm:aff>
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<author><name sortKey="Bolen, Shari" sort="Bolen, Shari" uniqKey="Bolen S" first="Shari" last="Bolen">Shari Bolen</name>
<affiliation><nlm:aff id="Aff1">Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA</nlm:aff>
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<author><name sortKey="Brancati, Frederick L" sort="Brancati, Frederick L" uniqKey="Brancati F" first="Frederick L." last="Brancati">Frederick L. Brancati</name>
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<affiliation><nlm:aff id="Aff3">Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA</nlm:aff>
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<author><name sortKey="Clark, Jeanne M" sort="Clark, Jeanne M" uniqKey="Clark J" first="Jeanne M." last="Clark">Jeanne M. Clark</name>
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<affiliation><nlm:aff id="Aff3">Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA</nlm:aff>
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<author><name sortKey="Brancati, Frederick L" sort="Brancati, Frederick L" uniqKey="Brancati F" first="Frederick L." last="Brancati">Frederick L. Brancati</name>
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<affiliation><nlm:aff id="Aff3">Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA</nlm:aff>
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<author><name sortKey="Clark, Jeanne M" sort="Clark, Jeanne M" uniqKey="Clark J" first="Jeanne M." last="Clark">Jeanne M. Clark</name>
<affiliation><nlm:aff id="Aff1">Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="Aff2">Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, MD USA</nlm:aff>
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<front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND</title>
<p>Obese women experience higher postmenopausal breast cancer risk, morbidity, and mortality and may be less likely to undergo mammography.</p>
</sec>
<sec><title>OBJECTIVES</title>
<p>To quantify the relationship between body weight and mammography in white and black women.</p>
</sec>
<sec><title>DATA SOURCES AND REVIEW METHODS</title>
<p>We identified original articles evaluating the relationship between weight and mammography in the United States through electronic and manual searching using terms for breast cancer screening, breast cancer, and body weight. We excluded studies in special populations (e.g., HIV-positive patients) or not written in English. Citations and abstracts were reviewed independently. We abstracted data sequentially and quality information independently.</p>
</sec>
<sec><title>RESULTS</title>
<p>Of 5,047 citations, we included 17 studies in our systematic review. Sixteen studies used self-reported body mass index (BMI) and excluded women <40 years of age. Using random-effects models for the six nationally representative studies using standard BMI categories, the combined odds ratios (95% CI) for mammography in the past 2 years were 1.01 (0.95 to 1.08), 0.93 (0.83 to 1.05), 0.90 (0.78 to 1.04), and 0.79 (0.68 to 0.92) for overweight (25–29.9 kg/m<sup>2</sup>
), class I (30–34.9 kg/m<sup>2</sup>
), class II (35–39.9 kg/m<sup>2</sup>
), and class III (≥40 kg/m<sup>2</sup>
) obese women, respectively, compared to normal-weight women. Results were consistent when all available studies were included. The inverse association was found in white, but not black, women in the three studies with results stratified by race.</p>
</sec>
<sec><title>CONCLUSIONS</title>
<p>Morbidly obese women are significantly less likely to report recent mammography. This relationship appears stronger in white women. Lower screening rates may partly explain the higher breast cancer mortality in morbidly obese women.</p>
</sec>
</div>
</front>
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  <front><journal-meta><journal-id journal-id-type="nlm-ta">J Gen Intern Med</journal-id>
<journal-title>Journal of General Internal Medicine</journal-title>
<issn pub-type="ppub">0884-8734</issn>
<issn pub-type="epub">1525-1497</issn>
<publisher><publisher-name>Springer-Verlag</publisher-name>
<publisher-loc>New York</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">19277790</article-id>
<article-id pub-id-type="pmc">2669867</article-id>
<article-id pub-id-type="publisher-id">939</article-id>
<article-id pub-id-type="doi">10.1007/s11606-009-0939-3</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Clinical Review</subject>
</subj-group>
</article-categories>
<title-group><article-title>Obesity and Mammography: A Systematic Review and Meta-Analysis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name name-style="western"><surname>Maruthur</surname>
<given-names>Nisa M.</given-names>
</name>
<degrees>MD, MHS</degrees>
<address><phone>+1-410-502-8896</phone>
<fax>+1-410-955-0476</fax>
<email>maruthur@jhmi.edu</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name name-style="western"><surname>Bolen</surname>
<given-names>Shari</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name name-style="western"><surname>Brancati</surname>
<given-names>Frederick L.</given-names>
</name>
<degrees>MD, MHS</degrees>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name name-style="western"><surname>Clark</surname>
<given-names>Jeanne M.</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<aff id="Aff1"><label>1</label>
Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD USA</aff>
<aff id="Aff2"><label>2</label>
Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, MD USA</aff>
<aff id="Aff3"><label>3</label>
Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA</aff>
</contrib-group>
<pub-date pub-type="epub"><day>11</day>
<month>3</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="ppub"><month>5</month>
<year>2009</year>
</pub-date>
<volume>24</volume>
<issue>5</issue>
<fpage>665</fpage>
<lpage>677</lpage>
<history><date date-type="received"><day>9</day>
<month>11</month>
<year>2007</year>
</date>
<date date-type="rev-recd"><day>28</day>
<month>8</month>
<year>2008</year>
</date>
<date date-type="accepted"><day>16</day>
<month>1</month>
<year>2009</year>
</date>
</history>
<permissions><copyright-statement>© Society of General Internal Medicine 2009</copyright-statement>
</permissions>
<abstract xml:lang="EN"><sec><title>BACKGROUND</title>
<p>Obese women experience higher postmenopausal breast cancer risk, morbidity, and mortality and may be less likely to undergo mammography.</p>
</sec>
<sec><title>OBJECTIVES</title>
<p>To quantify the relationship between body weight and mammography in white and black women.</p>
</sec>
<sec><title>DATA SOURCES AND REVIEW METHODS</title>
<p>We identified original articles evaluating the relationship between weight and mammography in the United States through electronic and manual searching using terms for breast cancer screening, breast cancer, and body weight. We excluded studies in special populations (e.g., HIV-positive patients) or not written in English. Citations and abstracts were reviewed independently. We abstracted data sequentially and quality information independently.</p>
</sec>
<sec><title>RESULTS</title>
<p>Of 5,047 citations, we included 17 studies in our systematic review. Sixteen studies used self-reported body mass index (BMI) and excluded women <40 years of age. Using random-effects models for the six nationally representative studies using standard BMI categories, the combined odds ratios (95% CI) for mammography in the past 2 years were 1.01 (0.95 to 1.08), 0.93 (0.83 to 1.05), 0.90 (0.78 to 1.04), and 0.79 (0.68 to 0.92) for overweight (25–29.9 kg/m<sup>2</sup>
), class I (30–34.9 kg/m<sup>2</sup>
), class II (35–39.9 kg/m<sup>2</sup>
), and class III (≥40 kg/m<sup>2</sup>
) obese women, respectively, compared to normal-weight women. Results were consistent when all available studies were included. The inverse association was found in white, but not black, women in the three studies with results stratified by race.</p>
</sec>
<sec><title>CONCLUSIONS</title>
<p>Morbidly obese women are significantly less likely to report recent mammography. This relationship appears stronger in white women. Lower screening rates may partly explain the higher breast cancer mortality in morbidly obese women.</p>
</sec>
</abstract>
<kwd-group><title>KEY WORDS</title>
<kwd>obesity</kwd>
<kwd>mammography</kwd>
<kwd>screening</kwd>
<kwd>systematic review</kwd>
</kwd-group>
<custom-meta-wrap><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© Society of General Internal Medicine 2009</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body><sec id="Sec1" sec-type="introduction"><title>INTRODUCTION</title>
<p>Breast cancer remains the second leading cause of cancer death among women in the United States<xref ref-type="bibr" rid="CR1">1</xref>
. Screening mammography reduces breast cancer mortality<xref ref-type="bibr" rid="CR2">2</xref>
–<xref ref-type="bibr" rid="CR6">6</xref>
, and current guidelines recommend mammography every 1–2 years for women over 40 years of age<xref ref-type="bibr" rid="CR7">7</xref>
,<xref ref-type="bibr" rid="CR8">8</xref>
.</p>
<p>Obesity has increased over the past 2 decades among women in the US<xref ref-type="bibr" rid="CR9">9</xref>
 and has disparate effects on pre- and postmenopausal breast cancer. Excess body weight may actually decrease the risk of premenopausal breast cancer<xref ref-type="bibr" rid="CR10">10</xref>
,<xref ref-type="bibr" rid="CR11">11</xref>
, but the relationship between obesity and premenopausal breast cancer mortality is ambiguous<xref ref-type="bibr" rid="CR11">11</xref>
,<xref ref-type="bibr" rid="CR12">12</xref>
. However, obesity is an important risk factor for both the development of<xref ref-type="bibr" rid="CR10">10</xref>
,<xref ref-type="bibr" rid="CR11">11</xref>
,<xref ref-type="bibr" rid="CR13">13</xref>
–<xref ref-type="bibr" rid="CR15">15</xref>
 and mortality from<xref ref-type="bibr" rid="CR16">16</xref>
–<xref ref-type="bibr" rid="CR19">19</xref>
 postmenopausal breast cancer. Obesity may also worsen breast cancer morbidity, including risk of breast cancer recurrence<xref ref-type="bibr" rid="CR20">20</xref>
, contralateral breast cancer<xref ref-type="bibr" rid="CR21">21</xref>
, wound complications after breast surgery<xref ref-type="bibr" rid="CR22">22</xref>
, and lymphedema<xref ref-type="bibr" rid="CR23">23</xref>
,<xref ref-type="bibr" rid="CR24">24</xref>
.</p>
<p>The mechanism by which obesity leads to poorer prognosis of breast cancer is not well understood and may be related to tumor characteristics, hormonal mechanisms, suboptimal diet and physical activity, or delay in diagnosis<xref ref-type="bibr" rid="CR16">16</xref>
. Studies of the relationship between obesity and stage at breast cancer diagnosis are conflicting<xref ref-type="bibr" rid="CR25">25</xref>
,<xref ref-type="bibr" rid="CR26">26</xref>
.</p>
<p>Several observational studies suggest that obese women may be less likely to report recent mammography<xref ref-type="bibr" rid="CR27">27</xref>
–<xref ref-type="bibr" rid="CR39">39</xref>
, but the relationship between obesity and screening mammography remains unclear<xref ref-type="bibr" rid="CR40">40</xref>
–<xref ref-type="bibr" rid="CR43">43</xref>
. Some studies suggest the problem may be confined to white women<xref ref-type="bibr" rid="CR31">31</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR36">36</xref>
.</p>
<p>Therefore, we conducted a systematic review and meta-analysis to determine whether overweight or obese women are less likely to have recent mammography than their normal-weight counterparts. We also studied the effect of race on the relationship between weight and recent mammography.</p>
</sec>
<sec id="Sec2" sec-type="methods"><title>METHODS</title>
<sec id="Sec3"><title>Search Strategy</title>
<p>Our overall search strategy addressed a broader question regarding the association between obesity and screening for breast, cervical, and colon cancer. For this study, we searched the PubMed, CINAHL, and Cochrane Library electronic databases from inception to July 2008 to identify original articles evaluating the relationship between body weight and recent mammography in the US using search terms for breast cancer screening, breast cancer, and body weight (Appendix Table <xref rid="Tab5" ref-type="table">5</xref>
). We manually searched the references of included articles and the tables of contents of 11 key medical journals from August 2006 through November 2006 and then updated our manual search from April 2008 to July 2008. General medical, cancer, women’s health, and prevention journals were selected based on the origin of the included articles and the topic itself to avoid missing articles due to any delays in electronic indexing. Searchers were physician investigators and included a senior obesity researcher (J.M.C.), an investigator with systematic review experience (S.B.), and a post-doctoral epidemiology trainee with relevant clinical experience (N.M.M). Two reviewers conducted title and abstract reviews independently. If a title was selected by either investigator, it was advanced to abstract review. Title and abstract reviews were designed to be sensitive; if there was any question of an article exploring weight as a predictor of screening upon title or abstract review, we advanced the article to the next level of review. Of 273 abstracts, there were 62 conflicts (23%) in abstract review, which we resolved by consensus through discussion. Disagreements usually pertained to misreading on the part of one of the investigators, and disagreements in judgment were rare.</p>
</sec>
<sec id="Sec4"><title>Study Selection</title>
<p>We included published original articles if they reported the prevalence of mammography by body weight in adults ≥18 years of age and were written in English. We defined original articles as articles in which the authors analyzed raw data and thus excluded reviews, commentaries, editorials, and consensus statements. We excluded studies conducted outside of the US since other countries may have different screening guidelines and resources, and the relationship between weight and mammography might differ based on cultural norms. We also excluded studies of screening in special populations since there may be different screening expectations for some populations (e.g., participants presenting to a cancer screening clinic, HIV-positive patients, those with a history of breast cancer, and those involved in a study of interventions to improve screening). Two investigators reviewed articles independently. Of 101 articles, there were 3 disagreements (3%), which were resolved through discussion.</p>
</sec>
<sec id="Sec5"><title>Data Abstraction and Quality Assessment</title>
<p>Two reviewers sequentially abstracted the data on population characteristics, the exposure, and the outcome using standardized data abstraction forms. Two studies included body mass index (BMI) in models when exploring determinants of screening, but did not explicitly report mammography prevalence by BMI; the authors kindly provided these results<xref ref-type="bibr" rid="CR34">34</xref>
,<xref ref-type="bibr" rid="CR39">39</xref>
.</p>
<p>Two reviewers evaluated study quality independently using a quality form (Appendix <xref ref-type="app" rid="App1">A</xref>
) based on the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement, Checklist of Essential Items version 3 (September 2005)<xref ref-type="bibr" rid="CR44">44</xref>
, which was published recently<xref ref-type="bibr" rid="CR45">45</xref>
. We assumed that the importance of any confounding variable varied according to study design. Therefore, we did not expect each study to handle confounding in the same fashion and assessed quality as being adequate, fair, or inadequate on an individual basis. We resolved disagreements in data abstraction and quality evaluation through discussion.</p>
</sec>
<sec id="Sec6"><title>Data Synthesis and Analysis</title>
<p>First, we created tables to describe all studies qualitatively. We reported results of adjusted analyses when available. In order to obtain generalizable combined estimates for the association between weight and mammography, we conducted unstratified meta-analyses and meta-analyses stratified by white and black race for studies that: (1) had nationally representative data and (2) reported BMI in five standard categories according to the World Health Organization<xref ref-type="bibr" rid="CR46">46</xref>
 and the National Institutes of Health<xref ref-type="bibr" rid="CR47">47</xref>
: (normal: 18.5–24.9 kg/m<sup>2</sup>
, overweight: 25–29.9 kg/m<sup>2</sup>
, class I obesity: 30–34.9 kg/m<sup>2</sup>
, class II obesity: 35–39.9 kg/m<sup>2</sup>
, and class III obesity: ≥ 40 kg/m<sup>2</sup>
). We contacted the authors of articles that did not report results for mammography by BMI in five standard categories; two authors provided the quantitative results requested<xref ref-type="bibr" rid="CR28">28</xref>
,<xref ref-type="bibr" rid="CR40">40</xref>
. Two authors were unable to provide quantitative results stratified by race<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR33">33</xref>
.</p>
<p>Using the DerSimonian and Laird method<xref ref-type="bibr" rid="CR48">48</xref>
, we used random-effects models to calculate combined odds ratios and 95% confidence intervals for mammography by BMI category using normal BMI as the reference category. For the study that reported adjusted proportions<xref ref-type="bibr" rid="CR33">33</xref>
, we calculated odds ratios. We converted the relative risk to an odds ratio<xref ref-type="bibr" rid="CR49">49</xref>
 for another study<xref ref-type="bibr" rid="CR32">32</xref>
. One study provided results stratified by race only<xref ref-type="bibr" rid="CR31">31</xref>
, and we included the results from the white and black cohorts separately in our main and race-specific analyses.</p>
<p>We tested for heterogeneity using the <italic>I</italic>
<sup>2</sup>
 statistic<xref ref-type="bibr" rid="CR50">50</xref>
 with an I<sup>2</sup>
 value of >50% signifying “substantial heterogeneity”<xref ref-type="bibr" rid="CR51">51</xref>
. We chose a random-effects model as a more conservative approach to account for potential between-study variability.</p>
<p>We tested for publication bias using the tests of Begg and Mazumdar<xref ref-type="bibr" rid="CR52">52</xref>
 and Egger and colleagues<xref ref-type="bibr" rid="CR53">53</xref>
. All analyses were completed using STATA (StataCorp. 2005. Stata Statistical Software: Release 9. College Station, TX: StataCorp LP).</p>
<p>We conducted several sensitivity analyses. We examined the effect of the removal of any one study on the combined estimate for the unstratified analyses. Also, two<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
 of the seven studies<xref ref-type="bibr" rid="CR30">30</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
 that were based on nationally representative data and reported BMI in five categories used the same 2000 National Health Interview Survey (NHIS) data but performed slightly different analyses. We included the study with more conservative results in the main meta-analysis<xref ref-type="bibr" rid="CR35">35</xref>
. We included the other, less conservative estimate from the other study<xref ref-type="bibr" rid="CR37">37</xref>
 in a separate analysis. In another analysis, we included all studies that provided BMI in five standard categories regardless of whether they were nationally representative.</p>
</sec>
</sec>
<sec id="Sec7" sec-type="results"><title>RESULTS</title>
<sec id="Sec8"><title>Literature Search Results</title>
<p>Of 5,047 titles identified in the overall search, 17 articles met our inclusion criteria and addressed mammography (Fig. <xref rid="Fig1" ref-type="fig">1</xref>
). Seven<xref ref-type="bibr" rid="CR30">30</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
 of the 17 studies were sufficiently homogeneous (i.e., used nationally representative survey data and provided information for mammography by five standard categories of BMI) to include in the unstratified meta-analyses. Two of these studies were based on the same 2000 NHIS data<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
; thus, six studies were included in our main meta-analyses. Five nationally-representative studies<xref ref-type="bibr" rid="CR30">30</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
 reported race-stratified analyses, and two of these<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR33">33</xref>
 did not report the necessary quantitative results to allow their inclusion in the meta-analyses; thus, we included three studies in our race-stratified meta-analysis. Six studies were not nationally representative and were conducted in primarily non-white populations<xref ref-type="bibr" rid="CR34">34</xref>
,<xref ref-type="bibr" rid="CR39">39</xref>
,<xref ref-type="bibr" rid="CR40">40</xref>
,<xref ref-type="bibr" rid="CR42">42</xref>
,<xref ref-type="bibr" rid="CR43">43</xref>
 or reported race-stratified results<xref ref-type="bibr" rid="CR36">36</xref>.
<fig id="Fig1"><label>Figure 1</label>
<caption><p>Study flow diagram. *Search terms for breast cancer, cervical cancer, colon cancer, body weight, breast cancer screening, cervical cancer screening, and colon cancer screening were used to conduct the search of electronic databases. Specific terms are provided in Appendix Table <xref rid="Tab5" ref-type="table">5</xref>
. <sup>†</sup>
Manual searching involved searching of references of included and key articles and searching of tables of contents of the following journals: Cancer, Journal of General Internal Medicine, Annals of Internal Medicine, Obesity, Ethnicity and Disease, Cancer Detection and Prevention, Journal of Health Care for the Poor and Underserved, Preventing Chronic Disease, Journal of Women’s Health, American Journal of Public Health, Preventive Medicine, and American Journal of Epidemiology. <sup>‡</sup>
Reasons for exclusion add up to more than abstracts or articles excluded since reviewers could have more than one reason for exclusion. <sup>§</sup>
Studies included in the main meta-analysis reported nationally-representative results in five standard body mass index categories (normal 18–24.9 kg/m<sup>2</sup>
, overweight 25–29.9 kg/m<sup>2</sup>
, class I obesity 30–34.9 kg/m<sup>2</sup>
, class II obesity 35–39.9 kg/m<sup>2</sup>
, class III obesity ≥ 40 kg/m<sup>2</sup>
). A seventh study<xref ref-type="bibr" rid="CR37">37</xref>
 met these criteria, but was based on the same data as another study<xref ref-type="bibr" rid="CR35">35</xref>
 and therefore was only included in a sensitivity analysis. <sup>║</sup>
Studies included in the race-specific meta-analysis reported nationally representative results in five standard body mass index categories (normal 18–24.9 kg/m<sup>2</sup>
, overweight 25–29.9 kg/m<sup>2</sup>
, class I obesity 30–34.9 kg/m<sup>2</sup>
, class II obesity 35–39.9 kg/m<sup>2</sup>
, class III obesity ≥40 kg/m<sup>2</sup>
).</p>
</caption>
<graphic position="anchor" xlink:href="11606_2009_939_Fig1_HTML" id="MO1"></graphic>
</fig>
</p>
</sec>
<sec id="Sec9"><title>Study Characteristics</title>
<p>The 17 included studies, which comprised approximately 276,034 participants, are described in Tables <xref rid="Tab1" ref-type="table">1</xref>
 and <xref rid="Tab2" ref-type="table">2</xref>
. Sixteen studies were cross-sectional<xref ref-type="bibr" rid="CR27">27</xref>
–<xref ref-type="bibr" rid="CR38">38</xref>
,<xref ref-type="bibr" rid="CR40">40</xref>
–<xref ref-type="bibr" rid="CR43">43</xref>
, and one was longitudinal<xref ref-type="bibr" rid="CR39">39</xref>
. All studies used BMI as the measure of excess body weight. Thirteen studies defined the outcome as mammography in the last 2 years<xref ref-type="bibr" rid="CR28">28</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
–<xref ref-type="bibr" rid="CR38">38</xref>
,<xref ref-type="bibr" rid="CR40">40</xref>
,<xref ref-type="bibr" rid="CR42">42</xref>
,<xref ref-type="bibr" rid="CR43">43</xref>
, two as mammography in the last year<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR34">34</xref>
, one as mammography in the last 3 years<xref ref-type="bibr" rid="CR41">41</xref>
, and one as mammography every 2 years over a 6-year period<xref ref-type="bibr" rid="CR39">39</xref>
. Ten<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR29">29</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
,<xref ref-type="bibr" rid="CR41">41</xref>
 of the 17 studies (59%) were based on nationally representative surveys, the NHIS, Behavioral Risk Factor Surveillance System (BRFSS), or Health and Retirement Survey. Most subjects were white. Reported absolute screened proportions ranged from 53.2% to 85.6%<xref ref-type="bibr" rid="CR29">29</xref>
,<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR32">32</xref>
–<xref ref-type="bibr" rid="CR34">34</xref>
,<xref ref-type="bibr" rid="CR36">36</xref>
–<xref ref-type="bibr" rid="CR41">41</xref>
,<xref ref-type="bibr" rid="CR43">43</xref>.
<table-wrap id="Tab1"><label>Table 1</label>
<caption><p>Description of Studies Included in Qualitative and Quantitative Analyses*</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th>Author, year</th>
<th>Study population</th>
<th>Mean age, y (range)</th>
<th>Race/ethnicity (%)</th>
<th>Exclusion criteria</th>
</tr>
</thead>
<tbody><tr><td>Amonkar et al. 2002<xref ref-type="bibr" rid="CR27">27</xref>
</td>
<td>9,908 respondents to the 1997 BRFSS</td>
<td>NR (40–80+)</td>
<td>White 83.8%; black 15%; Asian/Pacific Islander 0.4%; American Indian 0.4%; other 0.4%</td>
<td><40 years of age</td>
</tr>
<tr><td>Amy et al. 2006<xref ref-type="bibr" rid="CR28">28</xref>
</td>
<td>338 respondents to survey available in clothing stores, a convention, magazine, and research database</td>
<td>45(21–80)<sup>†</sup>
</td>
<td>White 68%<sup>‡</sup>
</td>
<td><40 years of age, BMI <25 kg/m<sup>2</sup>
</td>
</tr>
<tr><td>Berz et al. 2008<sup>§</sup>
<xref ref-type="bibr" rid="CR38">38</xref>
</td>
<td>105,899 respondents to the 2004 BRFSS</td>
<td>59.3(40–99)<sup>†</sup>
</td>
<td>White 75.2%; black 7.3%; Hispanic 9.7%; others 7.8%<sup>‡</sup>
</td>
<td><40 years of age, missing BMI, mammography response, or any confounding variable</td>
</tr>
<tr><td>Cohen et al. 2007 (36)</td>
<td>25,060 participants in the Southern Community Cohort Study</td>
<td>NR (42–70+)<sup>†</sup>
</td>
<td>White 25.2%; black 74.8%</td>
<td><42 or >79 years of age, BMI <18.5 kg/m<sup>2</sup>
, not black or white, diagnosis of breast cancer, treatment for cancer in last year, missing BMI or mammography use, not English-speaking</td>
</tr>
<tr><td>Coughlin et al. 2004<xref ref-type="bibr" rid="CR29">29</xref>
</td>
<td>49,564 respondents to the 1999 BRFSS</td>
<td>NR</td>
<td>NR</td>
<td><40 years of age</td>
</tr>
<tr><td>Ferrante et al. 2006<xref ref-type="bibr" rid="CR40">40</xref>
</td>
<td>1,809 patients in 3 urban New Jersey academic family medicine practices from 2000–2003</td>
<td>53.4(40–74)<sup>†</sup>
</td>
<td>Hispanic 50%; black 36%<sup>‡</sup>
</td>
<td><40 or ≥75 years of age, breast or cervical cancer, pregnant, missing weight, no visit in 12 months before index visit, new patient</td>
</tr>
<tr><td>Ferrante et al. 2007<xref ref-type="bibr" rid="CR37">37</xref>
</td>
<td>8,289 respondents to the 2000 NHIS</td>
<td>NR(40–74)<sup>†</sup>
</td>
<td>White 31.3%; black 26%; Hispanic 28.7%; other 14%<sup>‡</sup>
</td>
<td><40 or ≥75 years of age, BMI <18.5 kg/m<sup>2</sup>
</td>
</tr>
<tr><td>Fontaine et al. 1998<xref ref-type="bibr" rid="CR41">41</xref>
</td>
<td>3,105 respondents to the 1992 NHIS</td>
<td>46.2(18–97)<sup>†</sup>
</td>
<td>White 79.9%<sup>‡</sup>
</td>
<td>NR</td>
</tr>
<tr><td>Fontaine et al. 2001<sup>§</sup>
<xref ref-type="bibr" rid="CR30">30</xref>
</td>
<td>38,682 respondents to the 1998 BRFSS</td>
<td>47.7<sup>†</sup>
 (NR)</td>
<td>White 84.4%; non-white 15.6%</td>
<td><40 years of age</td>
</tr>
<tr><td>Gorin et al. 2001<xref ref-type="bibr" rid="CR42">42</xref>
</td>
<td>408 respondents to Harlem Survey from 46 blocks in Central Harlem in 1991</td>
<td>NR</td>
<td>NR<sup>║</sup>
</td>
<td><40 or >65 years of age, not English-speaking, unable to answer questions</td>
</tr>
<tr><td>Ostbye et al. 2005<sup>§</sup>
<xref ref-type="bibr" rid="CR31">31</xref>
</td>
<td>8,449 participants in the Health and Retirement Study (1996, 2000 waves)</td>
<td>NR(50–64)<sup>¶</sup>
</td>
<td>White 82%; black 18%<sup>¶</sup>
</td>
<td>Lack of response to 1996 and/or 2000 waves of HRS</td>
</tr>
<tr><td>Rosenberg et al. 2005<xref ref-type="bibr" rid="CR39">39</xref>
</td>
<td>14,706 participants in the Black Women’s Health Study 1995–2001</td>
<td>NR(40–69)<sup>†</sup>
</td>
<td>Black 100%</td>
<td><40 years of age, not African American, lack of valid address, lack of completion of survey</td>
</tr>
<tr><td>Satia et al. 2007<xref ref-type="bibr" rid="CR43">43</xref>
</td>
<td>405 enrollees in cancer risk behavior surveillance study in North Carolina in 2003</td>
<td>NR(41–70)</td>
<td>Black 100%</td>
<td><40 years of age, not African American, not on Department of Motor Vehicles roster in one six counties in North Carolina</td>
</tr>
<tr><td>Wee et al. 2000<sup>§</sup>
<xref ref-type="bibr" rid="CR33">33</xref>
</td>
<td>3,077 respondents to the 1994 NHIS</td>
<td>62</td>
<td>White 81%; black 10%</td>
<td><50 or >75 years of age</td>
</tr>
<tr><td>Wee et al. 2004<sup>§</sup>
<xref ref-type="bibr" rid="CR32">32</xref>
</td>
<td>5,277 respondents to 1998 NHIS Sample Adult and Prevention questionnaires</td>
<td>61(50–75)</td>
<td>White 80%; black 10%; Hispanic/Asian/other 10%</td>
<td><50 or >70 years of age</td>
</tr>
<tr><td>Winkleby et al. 2003<xref ref-type="bibr" rid="CR34">34</xref>
</td>
<td>169 women responding to a community random-digit-dial survey in Monterey California</td>
<td>NR(18–64)<sup>†</sup>
</td>
<td>Latino 100%</td>
<td><40 years of age, not Latino, not living in Monterey County, California</td>
</tr>
<tr><td>Zhu et al. 2006<sup>§</sup>
<xref ref-type="bibr" rid="CR35">35</xref>
</td>
<td>9,188 respondents to the 2000 NHIS</td>
<td>NR(40–80)<sup>†</sup>
</td>
<td>White 83.7%; black 16.3%</td>
<td><40 or >80 years of age, not white or black, history of breast cancer, mammography for reason other than screening</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p>*Characteristics of participants included in the main analysis unless otherwise noted</p>
<p><sup>†</sup>
Mean age and range from overall study</p>
<p><sup>‡</sup>
Race from overall study</p>
<p><sup>§</sup>
Studies included in the main, unstratified meta-analysis</p>
<p><sup>║</sup>
Authors stated, “…majority of women in the survey were non-Hispanic blacks.”</p>
<p><sup>¶</sup>
From 1996 wave of Health and Retirement Study</p>
<p>BRFSS, Behavioral Risk Factor Surveillance System; NR, not reported; BMI, body mass index; NHIS, National Health Interview Survey; HRS, Health and Retirement Study</p>
</table-wrap-foot>
</table-wrap>
<table-wrap id="Tab2"><label>Table 2</label>
<caption><p>Results of Studies Included in Qualitative and Quantitative Analyses</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th>Author, year</th>
<th>BMI (kg/m<sup>2</sup>
)*</th>
<th>Outcome assessment</th>
<th>Outcome measure</th>
<th>Outcome estimate (95% CI)<sup>†</sup>
</th>
<th>Adjustments</th>
</tr>
</thead>
<tbody><tr><td>Amonkar et al. 2002<xref ref-type="bibr" rid="CR27">27</xref>
</td>
<td>Self-report, standard 2 categories</td>
<td>Self-report of mammogram in last year</td>
<td>OR</td>
<td>0.81 (0.69 to 0.95)</td>
<td>Age, race, education, marital status, residential status, smoking, health status, health-care utilization</td>
</tr>
<tr><td>Amy et al. 2006<xref ref-type="bibr" rid="CR28">28</xref>
</td>
<td>Self-report, standard 5 categories<sup>‡</sup>
</td>
<td>Self-report of mammogram in last 2 years</td>
<td>Proportion</td>
<td>Overweight 94%, class I 82%, class II 80%, class III 78% <italic>P</italic>
 = 0.24<sup>§</sup>
</td>
<td>None</td>
</tr>
<tr><td>Berz et al. 2008<sup>║</sup>
<xref ref-type="bibr" rid="CR38">38</xref>
</td>
<td>Self report, standard 5 categories</td>
<td>Self-report of screening mammogram in last 2 years</td>
<td>OR</td>
<td>Normal 1.00, overweight 1.08 (1.01 to 1.15), class I 1.08 (0.99 to 1.18), class II 1.10 (0.98 to 1.25), class III 0.97 (0.84 to 1.13)</td>
<td>Age, race, education, income, smoking, general health perception</td>
</tr>
<tr><td rowspan="2">Cohen et al. 2007<xref ref-type="bibr" rid="CR36">36</xref>
</td>
<td rowspan="2">Self-report, standard 5 categories</td>
<td rowspan="2">Self-report of mammogram in last 2 years</td>
<td rowspan="2">OR</td>
<td><italic>Whites:</italic>
 normal 1.00, overweight 0.89 (0.76 to 1.05), class I 0.99 (0.83 to 1.18), class II 0.96 (0.78 to 1.18), class III 0.70 (0.56 to 0.87)</td>
<td rowspan="2">Age, education, income, smoking status, number of live births, co-morbid conditions, family history of breast cancer, time since last physician visit, type of insurance</td>
</tr>
<tr><td><italic>Blacks:</italic>
 normal 1.00, overweight 1.12 (1.00 to 1.25), class I 1.25 (1.12 to 1.40), class II 1.22 (1.07 to 1.38), class III 1.06 (0.93 to 1.21)</td>
</tr>
<tr><td>Coughlin et al. 2004<xref ref-type="bibr" rid="CR29">29</xref>
</td>
<td>Self-report, BMI categories: >18.5-<25, 25–30, >30</td>
<td>Self-report of mammogram in last 2 years</td>
<td>Adjusted proportion</td>
<td>>18.5-<25: 76.0% (75.1 to 76.8), 25–29: 76.6% (75.7 to 77.5), >30: 74.6% (73.5 to 75.8) <italic>P</italic>
 <0.001<sup>¶</sup>
</td>
<td>Age, race, education, marital status, income, employment, smoking, physical activity, alcohol, use of preventive services, number of children, number of persons in household, health status, diabetes, physician visit in last year, insurance</td>
</tr>
<tr><td>Ferrante et al. 2006<xref ref-type="bibr" rid="CR40">40</xref>
</td>
<td>Chart review, standard 5 categories<sup>‡</sup>
</td>
<td>Mammogram in last 2 years recorded in chart</td>
<td>OR</td>
<td>Normal 1.00, overweight 1.61 (1.03 to 2.54), class I 1.32 (0.84 to 2.07), class II 1.92 (1.12 to 3.28), class III 1.53 (0.88 to 2.65)</td>
<td>Age, race, marital status, smoking, co-morbid conditions, physician visits, insurance</td>
</tr>
<tr><td>Ferrante et al. 2007<xref ref-type="bibr" rid="CR37">37</xref>
</td>
<td>Self-report, standard 5 categories</td>
<td>Self-report of mammogram in last 2 years</td>
<td>OR</td>
<td>Normal 1.00, overweight 0.95 (0.81 to 1.10), class I 1.01 (0.83 to 1.23), class II 0.79 (0.60 to 1.05), class III 0.50 (0.37 to 0.68)</td>
<td>Age, race/ethnicity, education, marital status, smoking, vitamin use, number of visits, contact with primary care doctor, family history of breast cancer, insurance</td>
</tr>
<tr><td>Fontaine et al. 1998<xref ref-type="bibr" rid="CR41">41</xref>
</td>
<td>Self-report, BMI groups: 25 (reference), 35, and 40</td>
<td>Self-report of no mammogram in last 3 years<sup>#</sup>
</td>
<td>OR</td>
<td>25: 1.0, 35: 0.81 (0.59 to 1.12), 45: 0.73 (0.45 to 1.19)</td>
<td>Age, race, education, income, smoking status, insurance status</td>
</tr>
<tr><td>Fontaine et al. 2001<sup>║</sup>
<xref ref-type="bibr" rid="CR30">30</xref>
</td>
<td>Self-report, standard 5 categories</td>
<td>Self-report of no mammogram in last 2 years<sup>#</sup>
</td>
<td>OR</td>
<td>Normal 1.00, overweight 1.00 (0.94 to 1.07), class I 1.12 (1.02 to 1.23), class II 1.13 (0.98 to 1.30), class III 1.32 (1.09 to 1.59)</td>
<td>Age, race, smoking, insurance</td>
</tr>
<tr><td>Gorin et al. 2001<xref ref-type="bibr" rid="CR42">42</xref>
</td>
<td>Self-report, BMI categories: ≤27.3 and >27.3</td>
<td>Self-report of mammogram in last 2 years</td>
<td>OR</td>
<td>Not overweight: 1.00, overweight: 3.60 (0.57 to 22.64)</td>
<td>Age, marital status, employment, fruit/vegetable intake, insurance</td>
</tr>
<tr><td rowspan="2">Ostbye et al. 2005<sup>║</sup>
<xref ref-type="bibr" rid="CR31">31</xref>
</td>
<td rowspan="2">Self-report, standard 5 categories</td>
<td rowspan="2">Self-report of mammogram in last 2 years</td>
<td rowspan="2">OR</td>
<td><italic>Whites:</italic>
 normal 1.00, overweight 0.90 (0.78 to 1.05), class I 0.73 (0.60 to 0.88), class II 0.69 (0.51 to 0.93), class III 0.59 (0.40 to 0.88)</td>
<td rowspan="2">Age, education, marital status, income, smoking, physical activity, health status, co-morbid conditions, physician visits, hospitalization, insurance</td>
</tr>
<tr><td><italic>Blacks:</italic>
 normal 1.00, overweight 1.13 (0.79 to 1.62), class I 0.97 (0.65 to 1.45), class II 1.03 (0.61 to 1.76), class III 1.07 (0.60 to 1.92)</td>
</tr>
<tr><td>Rosenberg et al. 2005<xref ref-type="bibr" rid="CR39">39</xref>
</td>
<td>Self-report, standard 5 categories<sup>‡</sup>
</td>
<td>Self-report of mammogram every 2 years from 1995–2001</td>
<td>OR</td>
<td>Normal 1.00, overweight 1.09 (0.98 to 1.22), class I 1.08 (0.95 to 1.23), class II 1.13 (0.95 to 1.34), class III 0.96 (0.79 to 1.16)</td>
<td>Age, education, region, income, neighborhood SES score, childcare responsibilities, smoking, multivitamins, Pap smear, cystic breast disease, breast self exam, hormone use, family history of breast cancer, insurance</td>
</tr>
<tr><td>Satia et al. 2007<xref ref-type="bibr" rid="CR43">43</xref>
</td>
<td>Self-report, BMI categories: normal 18.5–24.9, overweight 25–29.9, obese >30</td>
<td>Self-report of mammogram in last 2 years</td>
<td>OR</td>
<td>Normal 1.00, overweight 1.5 (0.6 to 3.6), obese 0.5 (0.2 to 1.3) <italic>P</italic>
 = 0.39<sup>**</sup>
</td>
<td>Age, education, BMI</td>
</tr>
<tr><td>Wee et al. 2000<sup>║</sup>
<xref ref-type="bibr" rid="CR33">33</xref>
</td>
<td>Self-report, standard 5 categories</td>
<td>Self-report of mammogram in last 2 years</td>
<td>Adjusted difference in proportion</td>
<td>Normal 0, overweight -2.8 (-6.7 to 0.9), class I -5.3 (-11.1 to 0.5), class II -4.5 (-12.5 to 3.4), class III -8.8 (-22.9 to 5.3)</td>
<td>Age, race, education, marital status, region of country, health status, health-care use, hospitalization, days in bed, insurance type, physician specialty</td>
</tr>
<tr><td>Wee et al. 2004<sup>║</sup>
<xref ref-type="bibr" rid="CR32">32</xref>
</td>
<td>Self report, standard 5 categories</td>
<td>Self-report of mammogram in last 2 years</td>
<td>RR</td>
<td>Normal 1.00, overweight 1.01 (0.95 to 1.06), class I 0.99 (0.91 to 1.05), class II 0.89 (0.77 to 1.01), class III 0.88 (0.71 to 1.01)</td>
<td>Age, race, education, marital status, region of country, health-care access, health status, co-morbid conditions, mobility, hospitalization</td>
</tr>
<tr><td>Winkleby et al. 2003<xref ref-type="bibr" rid="CR34">34</xref>
</td>
<td>Self-report, standard 5 categories<sup>‡</sup>
</td>
<td>Self-report of mammogram in last year</td>
<td>OR</td>
<td>Normal 1.00, overweight 1.03 (0.41 to 2.62), class I 0.85 (0.25 to 2.89), class II 2.94 (0.42 to 20.61), class III 0.59 (0.06 to 5.79)</td>
<td>Age, education, marital status, years in US</td>
</tr>
<tr><td>Zhu et al. 2006<sup>║</sup>
<xref ref-type="bibr" rid="CR35">35</xref>
</td>
<td>Self-report, standard 5 categories</td>
<td>Self-report of no screening mammogram in last 2 years**</td>
<td>OR</td>
<td>Normal 1.00, overweight 0.9 (0.8 to 1.1), class I 0.9 (0.8 to 1.1), class II 1.0 (0.8 to 1.3), class III 1.3 (1.0 to 1.8)</td>
<td>Age, race, education, marital status, income, employment, smoking, alcohol, skin cancer exam, health status, co-morbid conditions, days in bed, need for special equipment, functional limitations, home health-care, recent surgery, status of walking, moving, lifting, and carrying, medical care visits, insurance</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p>*Standard two categories of BMI: non-obese <30 kg/m<sup>2</sup>
 and obese ≥30 kg/m<sup>2</sup>
; standard five categories of BMI: normal 18–24.9 kg/m<sup>2</sup>
, overweight 25–29.9 kg/m<sup>2</sup>
, class I obesity 30–34.9 kg/m<sup>2</sup>
, class II obesity 35–39.9 kg/m<sup>2</sup>
, class III obesity ≥ 40 kg/m<sup>2</sup>
</p>
<p><sup>†</sup>
Adjusted results reported with the exception of Amy et al.<xref ref-type="bibr" rid="CR28">28</xref>
</p>
<p><sup>‡</sup>
Obtained data in standard five categories upon request from author</p>
<p><sup>§</sup>
Result of chi-square test</p>
<p><sup>║</sup>
Studies included in main, unstratified meta-analysis</p>
<p><sup>¶</sup>
Unclear which statistical test used by authors to obtain reported <italic>P</italic>
 value</p>
<p><sup>#</sup>
Study used lack of mammogram as an outcome</p>
<p><sup>**</sup>
<italic>P</italic>
 value for trend</p>
<p>BMI, body mass index; CI, confidence interval; OR, odds ratio; SES, socioeconomic status; RR, relative risk</p>
</table-wrap-foot>
</table-wrap>
</p>
<p>Sixteen of the 17 studies<xref ref-type="bibr" rid="CR27">27</xref>
–<xref ref-type="bibr" rid="CR39">39</xref>
,<xref ref-type="bibr" rid="CR41">41</xref>
–<xref ref-type="bibr" rid="CR43">43</xref>
 (94%) relied on self-reported BMI and mammography. Fourteen studies accounted for confounding adequately<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR29">29</xref>
–<xref ref-type="bibr" rid="CR41">41</xref>
, and one study did not adjust for any confounding factors<xref ref-type="bibr" rid="CR28">28</xref>
. Reported survey response rates ranged from 55% to 88%. Eight studies did not report missing data<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR31">31</xref>
,<xref ref-type="bibr" rid="CR32">32</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
,<xref ref-type="bibr" rid="CR39">39</xref>
,<xref ref-type="bibr" rid="CR41">41</xref>
,<xref ref-type="bibr" rid="CR43">43</xref>
, seven had <10% missing data<xref ref-type="bibr" rid="CR28">28</xref>
–<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR32">32</xref>
,<xref ref-type="bibr" rid="CR34">34</xref>
,<xref ref-type="bibr" rid="CR36">36</xref>
,<xref ref-type="bibr" rid="CR42">42</xref>
, and two reported >20% missing data<xref ref-type="bibr" rid="CR38">38</xref>
,<xref ref-type="bibr" rid="CR40">40</xref>
. All studies provided an adequate exposure description, and all but one<xref ref-type="bibr" rid="CR27">27</xref>
 provided an adequate outcome description. Ten studies used nationally representative surveys<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR29">29</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
,<xref ref-type="bibr" rid="CR41">41</xref>
, and 14 did not report the validity of the surveys used<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR29">29</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
–<xref ref-type="bibr" rid="CR39">39</xref>
,<xref ref-type="bibr" rid="CR41">41</xref>
–<xref ref-type="bibr" rid="CR43">43</xref>
. See Table <xref rid="Tab3" ref-type="table">3</xref>.
<table-wrap id="Tab3"><label>Table 3</label>
<caption><p>Quality Review of Included Studies*</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th>Author</th>
<th>Missing data</th>
<th>Exposure description</th>
<th>Outcome description</th>
<th>Confounding</th>
<th>Validity</th>
<th>Response rate</th>
</tr>
</thead>
<tbody><tr><td>Amonkar et al. 2002<xref ref-type="bibr" rid="CR27">27</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Fair</td>
<td>Adequate</td>
<td>NR<sup>†</sup>
</td>
<td>NR</td>
</tr>
<tr><td>Amy et al. 2006<xref ref-type="bibr" rid="CR28">28</xref>
</td>
<td><10%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Inadequate</td>
<td>Fair</td>
<td>NR</td>
</tr>
<tr><td>Berz et al. 2008<xref ref-type="bibr" rid="CR38">38</xref>
</td>
<td>>20%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>†</sup>
</td>
<td>NR</td>
</tr>
<tr><td>Cohen et al. 2007<xref ref-type="bibr" rid="CR36">36</xref>
</td>
<td><10%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR</td>
<td>NR</td>
</tr>
<tr><td>Coughlin et al. 2004<xref ref-type="bibr" rid="CR29">29</xref>
</td>
<td>None</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>†</sup>
</td>
<td>55.2%</td>
</tr>
<tr><td>Ferrante et al. 2006<xref ref-type="bibr" rid="CR40">40</xref>
</td>
<td>>20%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>N/a</td>
<td>N/a</td>
</tr>
<tr><td>Ferrante et al. 2007<xref ref-type="bibr" rid="CR37">37</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>‡</sup>
</td>
<td>72%</td>
</tr>
<tr><td>Fontaine et al. 1998<xref ref-type="bibr" rid="CR41">41</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>‡</sup>
</td>
<td>87%</td>
</tr>
<tr><td>Fontaine et al. 2001<xref ref-type="bibr" rid="CR30">30</xref>
</td>
<td><10%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>†</sup>
</td>
<td>NR</td>
</tr>
<tr><td>Gorin et al. 2001<xref ref-type="bibr" rid="CR42">42</xref>
</td>
<td>None</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Fair</td>
<td>Referred to other reference for details of Harlem Survey used</td>
<td>72%</td>
</tr>
<tr><td>Ostbye et al. 2005<xref ref-type="bibr" rid="CR31">31</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>§</sup>
</td>
<td>84.7%</td>
</tr>
<tr><td>Rosenberg et al. 2005<xref ref-type="bibr" rid="CR39">39</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR</td>
<td>61.7%</td>
</tr>
<tr><td>Satia et al. 2007<xref ref-type="bibr" rid="CR43">43</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Fair</td>
<td>NR</td>
<td>17.5%</td>
</tr>
<tr><td>Wee et al. 2000<xref ref-type="bibr" rid="CR33">33</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>‡</sup>
</td>
<td>94% for NHIS overall; 88% for supplement<sup>║</sup>
</td>
</tr>
<tr><td>Wee et al. 2004<xref ref-type="bibr" rid="CR32">32</xref>
</td>
<td><10%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>‡</sup>
</td>
<td>90% for NHIS overall; 73% for Family Core and supplement<sup>¶</sup>
</td>
</tr>
<tr><td>Winkleby et al. 2003<xref ref-type="bibr" rid="CR34">34</xref>
</td>
<td><10%</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Fair</td>
<td>87%</td>
</tr>
<tr><td>Zhu et al. 2006<xref ref-type="bibr" rid="CR35">35</xref>
</td>
<td>NR</td>
<td>Adequate</td>
<td>Adequate</td>
<td>Adequate</td>
<td>NR<sup>‡</sup>
</td>
<td>72%</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p>*Quality rating based on scale: inadequate, fair, adequate</p>
<p><sup>†</sup>
Study based on the Behavioral Risk Factor Surveillance System</p>
<p><sup>‡</sup>
Study based on the National Health Interview Survey</p>
<p><sup>§</sup>
Study based on the Health and Retirement Study</p>
<p><sup>║</sup>
Participants given an additional questionnaire regarding preventive health-care service use</p>
<p><sup>¶</sup>
Participants given additional questionnaires inquiring about height, weight, medical conditions, sociodemographics, health status, health-care utilization, health habits, tobacco use, physical activity, functional status, and cancer screening</p>
<p>NR, not reported; NHIS, National Health Interview Survey</p>
</table-wrap-foot>
</table-wrap>
</p>
</sec>
<sec id="Sec10"><title>Quantitative Assessment of Mammography by BMI</title>
<p>Fourteen<xref ref-type="bibr" rid="CR27">27</xref>
–<xref ref-type="bibr" rid="CR39">39</xref>
,<xref ref-type="bibr" rid="CR43">43</xref>
 of 17 studies reported an inverse association between recent mammography and increasing BMI that was statistically significant in five<xref ref-type="bibr" rid="CR27">27</xref>
,<xref ref-type="bibr" rid="CR29">29</xref>
,<xref ref-type="bibr" rid="CR31">31</xref>
,<xref ref-type="bibr" rid="CR36">36</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
. Seven studies<xref ref-type="bibr" rid="CR30">30</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR37">37</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
 used nationally representative surveys with BMI in five standard categories. Using the six studies based on unique data, class III obesity was inversely associated with the likelihood of having recently undergone mammography compared to women with a normal BMI. The seventh study by Ferrante et al.<xref ref-type="bibr" rid="CR37">37</xref>
 was excluded from the main analysis because it was based on the same data as the study by Zhu et al.<xref ref-type="bibr" rid="CR35">35</xref>
 Combined odds ratios for mammography (95% confidence interval) by BMI category were 1.01 (0.95 to 1.08), 0.93 (0.83 to 1.05), 0.90 (0.78 to 1.04), and 0.79 (0.68 to 0.92) for overweight, class I, class II, and class III obese women, respectively, compared to women with a normal BMI (Fig. <xref rid="Fig2" ref-type="fig">2</xref>
). We found statistical evidence of heterogeneity for the class I and II obesity categories; I<sup>2</sup> statistics were 41%, 74%, 59%, and 42% for the overweight, and class I, II, and III obesity categories, respectively. The exclusion of any one study did not change the results of the meta-analyses substantially (data not shown). No statistically significant publication bias was found, although evaluation was limited by the relatively small number of studies.
<fig id="Fig2"><label>Figure 2</label>
<caption><p>Meta-analyses of nationally representative studies with BMI in five categories. Note: Included studies:<xref ref-type="bibr" rid="CR30"> 30</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
; BMI categories: overweight 25–29.9 kg/m<sup>2</sup>
, class I obesity 30–34.9 kg/m<sup>2</sup>
, class II obesity 35–39.9 kg/m<sup>2</sup>
, class III obesity ≥40 kg/m<sup>2</sup>
. *Data from analysis of white women. <sup>**</sup>
Data from analysis of black women. BMI, body mass index; OR, odds ratio; CI, confidence interval.</p>
</caption>
<graphic position="anchor" xlink:href="11606_2009_939_Fig2_HTML" id="MO2"></graphic>
</fig>
</p>
</sec>
<sec id="Sec11"><title>Sensitivity Analyses</title>
<p>We obtained similar results when we excluded the article by Zhu et al.<xref ref-type="bibr" rid="CR35">35</xref>
 and instead included the article by Ferrante et al.<xref ref-type="bibr" rid="CR37">37</xref>
, which used the same data. Results were also similar when we included all nine studies with BMI in five categories including three that were not based on nationally representative surveys (data not shown)<xref ref-type="bibr" rid="CR30">30</xref>
–<xref ref-type="bibr" rid="CR36">36</xref>
,<xref ref-type="bibr" rid="CR38">38</xref>
,<xref ref-type="bibr" rid="CR40">40</xref>
.</p>
</sec>
<sec id="Sec12"><title>Effect of Race</title>
<p>Five nationally representative studies<xref ref-type="bibr" rid="CR30">30</xref>
–<xref ref-type="bibr" rid="CR33">33</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
 evaluated the effect of race on the relationship between BMI and recent mammography. Compared to women with a normal BMI, meta-analyses of the three race-stratified studies using five categories of BMI<xref ref-type="bibr" rid="CR31">31</xref>
,<xref ref-type="bibr" rid="CR32">32</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
 revealed an inverse association between class II and III obesity and recent mammography for white women, but a positive association between overweight and recent mammography among black women (Table <xref rid="Tab4" ref-type="table">4</xref>). We found statistical evidence of heterogeneity for class I obesity in the analyses for white women and for class I and II obesity in the analyses for black women. There was no statistical evidence of publication bias.
<table-wrap id="Tab4"><label>Table 4</label>
<caption><p>Combined Odds Ratios for Mammography by BMI for Race-Stratified Analyses<sup>*†</sup>
</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th>BMI category</th>
<th>Combined odds ratios (95% CI)</th>
<th>I<sup>2</sup>
 (%)<sup>‡</sup>
</th>
</tr>
</thead>
<tbody><tr><td colspan="3">White women</td>
</tr>
<tr><td>Normal</td>
<td>1.00 (reference)</td>
<td></td>
</tr>
<tr><td>Overweight</td>
<td>0.98 (0.85 to 1.13)</td>
<td>49</td>
</tr>
<tr><td>Class I obesity</td>
<td>0.84 (0.69 to 1.02)</td>
<td>60</td>
</tr>
<tr><td>Class II obesity</td>
<td>0.73 (0.56 to 0.95)</td>
<td>47</td>
</tr>
<tr><td>Class III obesity</td>
<td>0.67 (0.53 to 0.84)</td>
<td>0</td>
</tr>
<tr><td colspan="3">Black women</td>
</tr>
<tr><td>Normal</td>
<td>1.00 (reference)</td>
<td></td>
</tr>
<tr><td>Overweight</td>
<td>1.28 (1.03 to 1.60)</td>
<td>0</td>
</tr>
<tr><td>Class I obesity</td>
<td>1.38 (0.90 to 2.12)</td>
<td>54</td>
</tr>
<tr><td>Class II obesity</td>
<td>1.46 (0.76 to 2.80)</td>
<td>66</td>
</tr>
<tr><td>Class III obesity</td>
<td>0.91 (0.62 to 1.33)</td>
<td>0</td>
</tr>
</tbody>
</table>
<table-wrap-foot><p>*Studies included:<xref ref-type="bibr" rid="CR31">31</xref>
,<xref ref-type="bibr" rid="CR32">32</xref>
,<xref ref-type="bibr" rid="CR35">35</xref>
. Additional studies<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR33">33</xref>
 evaluated the interaction between race and BMI, but did not provide the quantitative results necessary for inclusion in our meta-analyses. Fontaine et al. in 2001<xref ref-type="bibr" rid="CR30">30</xref>
 provided a <italic>P</italic>
 value (<italic>P</italic>
 = 0.908) for the interaction between race and mammography, and Wee et al.<xref ref-type="bibr" rid="CR33">33</xref>
 reported adjusted rate differences, suggesting a possible decline in screening with BMI among white women, but not among black women. We contacted the authors, but were unable to obtain further results</p>
<p><sup>†</sup>
Adjusted odds ratios used in analysis</p>
<p><sup>‡</sup>
I<sup>2</sup>
 Statistic is a measure of heterogeneity with an I<sup>2</sup>
 >50% signifying “substantial heterogeneity”<xref ref-type="bibr" rid="CR51">51</xref>
</p>
<p>BMI, body mass index</p>
</table-wrap-foot>
</table-wrap>
</p>
<p>Four studies conducted in primarily non-white populations did not find a statistically significant association between BMI and recent mammography<xref ref-type="bibr" rid="CR34">34</xref>
,<xref ref-type="bibr" rid="CR39">39</xref>
,<xref ref-type="bibr" rid="CR42">42</xref>
,<xref ref-type="bibr" rid="CR43">43</xref>
. One study based on a chart review of patients (86% non-white) of urban family practices reported an increased odds of recent mammography among overweight and class II obese patients compared to patients with a normal BMI<xref ref-type="bibr" rid="CR40">40</xref>
. A study of baseline data from the Southern Community Cohort Study found that compared to women with a normal BMI, white women with class III obesity were less likely to report recent mammography, but overweight and class I and II obese black women were more likely to report recent mammography<xref ref-type="bibr" rid="CR36">36</xref>
.</p>
</sec>
</sec>
<sec id="Sec13" sec-type="discussion"><title>DISCUSSION</title>
<p>This systematic review demonstrates an inverse relationship between class I, II, and III obesity and recent mammography that was statistically significant for class III obesity. Compared to their lean counterparts, women with class III obesity were 20% less likely to report recent mammography. In white women, we found a statistically significant negative association between class II and III obesity and being up-to-date with mammography. We did not find this association between BMI and mammography among black women.</p>
<p>Two of the three studies that did not report an inverse association between recent mammography and increasing BMI were not nationally representative. One was a chart review from family practices in New Jersey with primarily non-white patients<xref ref-type="bibr" rid="CR40">40</xref>
, and the other was a Harlem survey among mostly non-Hispanic blacks<xref ref-type="bibr" rid="CR42">42</xref>
. The findings of these two studies are consistent with the results of our meta-analyses in which we observed no significant inverse relationship between obesity and mammography in non-whites. The third negative study<xref ref-type="bibr" rid="CR41">41</xref>
 included women <40 years of age. These results may be confounded by age since younger women are more likely to have a lower BMI<xref ref-type="bibr" rid="CR54">54</xref>
 and to report a lower prevalence of mammography since it is not routinely recommended for them.</p>
<p>Obese women may experience several possible barriers to mammography. Prior data show that obese women may delay medical care<xref ref-type="bibr" rid="CR55">55</xref>
 because of poor self-esteem and body image, embarrassment<xref ref-type="bibr" rid="CR29">29</xref>
,<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR55">55</xref>
,<xref ref-type="bibr" rid="CR56">56</xref>
, a perceived lack of respect from health-care providers, or to avoid unwanted weight loss advice<xref ref-type="bibr" rid="CR28">28</xref>
. Obesity may be a marker for sub-optimal health behavior in general, of which lack of mammography is simply one facet<xref ref-type="bibr" rid="CR30">30</xref>
,<xref ref-type="bibr" rid="CR33">33</xref>
. Also, beliefs regarding cancer screening may vary by BMI<xref ref-type="bibr" rid="CR33">33</xref>
. There could be physical limitations to obtaining mammography for obese women, but obesity is associated with a higher content of fat in the breast tissue that actually increases the sensitivity of mammography for detecting breast cancer<xref ref-type="bibr" rid="CR57">57</xref>
,<xref ref-type="bibr" rid="CR58">58</xref>
. Finally, obesity is associated with lower socioeconomic status<xref ref-type="bibr" rid="CR59">59</xref>
, which may decrease access to preventive care.</p>
<p>There are also many physician-related factors that may decrease screening mammography among obese women. Obesity-related co-morbid conditions may hinder referral for purely preventive services<xref ref-type="bibr" rid="CR41">41</xref>
,<xref ref-type="bibr" rid="CR60">60</xref>
,<xref ref-type="bibr" rid="CR61">61</xref>
. In addition, providers have reported difficulty and inadequate resources and education in providing care for obese women<xref ref-type="bibr" rid="CR28">28</xref>
. Finally, physicians may have biases against obese women, resulting in less screening<xref ref-type="bibr" rid="CR62">62</xref>
–<xref ref-type="bibr" rid="CR64">64</xref>
.</p>
<p>Obesity did not appear to affect the report of recent mammography in black women. This may be due to racial differences in obesity-related body image<xref ref-type="bibr" rid="CR65">65</xref>
–<xref ref-type="bibr" rid="CR67">67</xref>
. In particular, it has been reported that overweight or obese white, but not black, women were more likely to feel worthless, which may impact willingness to undergo mammography<xref ref-type="bibr" rid="CR32">32</xref>
. Black women may have a similar risk of developing breast cancer<xref ref-type="bibr" rid="CR68">68</xref>
,<xref ref-type="bibr" rid="CR69">69</xref>
, but higher breast cancer mortality<xref ref-type="bibr" rid="CR21">21</xref>
,<xref ref-type="bibr" rid="CR68">68</xref>
–<xref ref-type="bibr" rid="CR71">71</xref>
. They tend to present with a higher stage of breast cancer<xref ref-type="bibr" rid="CR69">69</xref>
,<xref ref-type="bibr" rid="CR71">71</xref>
, which has been linked to (1) less follow-up for abnormal exams<xref ref-type="bibr" rid="CR72">72</xref>
, (2) higher rates of obesity<xref ref-type="bibr" rid="CR72">72</xref>
–<xref ref-type="bibr" rid="CR75">75</xref>
, (3) socioeconomic factors<xref ref-type="bibr" rid="CR76">76</xref>
, (4) cultural beliefs (e.g., belief in herbal treatments)<xref ref-type="bibr" rid="CR76">76</xref>
, and possibly, lower likelihood of screening<xref ref-type="bibr" rid="CR77">77</xref>
–<xref ref-type="bibr" rid="CR79">79</xref>
, although this is controversial<xref ref-type="bibr" rid="CR68">68</xref>
,<xref ref-type="bibr" rid="CR80">80</xref>
–<xref ref-type="bibr" rid="CR82">82</xref>
. Our findings, the first meta-analyses by race, suggest that rates of mammography in black women do not vary significantly by BMI.</p>
<p>We included only 6 of 17 studies in our meta-analyses based on the provision of unique nationally representative data and BMI in five standard categories. However, 14 of the 17 studies reported a negative association between BMI and report of mammography. Also, we obtained similar results when we included all nine studies that reported BMI in five standard categories.</p>
<p>Most of the included studies were cross-sectional and cannot establish causality, but it is unlikely that failure to undergo mammography would contribute to weight gain. Also, we relied on the use of observational studies, which are susceptible to residual and unmeasured confounding. In particular, socioeconomic factors and health behaviors may confound the relationship between obesity and breast cancer and are difficult to account for fully. Although we did not find publication bias, we had limited power with a small number of studies. However, our search also included articles in which body weight was not the primary exposure, and thus, the potential for publication bias should be low.</p>
<p>The included studies used self-report of BMI as the measure of body weight, which has several limitations: It may underestimate obesity, especially in women<xref ref-type="bibr" rid="CR83">83</xref>
, but may also overestimate obesity, especially in blacks<xref ref-type="bibr" rid="CR83">83</xref>
. Self-report of height and weight may differ by survey type (telephone versus in-person), age, and BMI<xref ref-type="bibr" rid="CR84">84</xref>
. Overall, the included studies may have placed more obese participants into less obese categories, which would bias our results toward the null or result in finding an inverse association in overweight or milder obesity. However, the overall qualitative association between body weight and mammography would be unchanged.</p>
<p>Most of the included studies also relied upon self-report of mammography. A recent meta-analysis found that self-report of mammography had a sensitivity of 93% and specificity of 62%<xref ref-type="bibr" rid="CR85">85</xref>
. While this study reported similar sensitivities for self-reported mammography in blacks and whites, the specificity of self-reported mammography was only 49% among blacks<xref ref-type="bibr" rid="CR85">85</xref>
. Thus, mammography results are likely inflated above their actual rates with the degree of inflation higher for blacks. There is no evidence that the accuracy of self-report of mammography varies by BMI, but if it does, our results would also be biased.</p>
<p>The included studies did not stratify on menopausal status, but only one study included women under the age of 40 years<xref ref-type="bibr" rid="CR41">41</xref>
. It seems unlikely that menopausal status would affect willingness to be screened in women over age 40. While the relationship between obesity and premenopausal breast cancer risk and mortality is unclear<xref ref-type="bibr" rid="CR10">10</xref>
–<xref ref-type="bibr" rid="CR12">12</xref>
, obesity increases postmenopausal breast cancer risk<xref ref-type="bibr" rid="CR10">10</xref>
,<xref ref-type="bibr" rid="CR11">11</xref>
,<xref ref-type="bibr" rid="CR13">13</xref>
–<xref ref-type="bibr" rid="CR15">15</xref>
 and mortality<xref ref-type="bibr" rid="CR16">16</xref>
–<xref ref-type="bibr" rid="CR19">19</xref>
.</p>
<p>Finally, our search strategy may have been susceptible to selection bias given that we included a small number of full articles from the total citations reviewed, we manually searched only 11 key journals, and we had limited success obtaining full results from contacted authors. However, the qualitative results matched our meta-analytic results, we included no new articles from the manual search of 11 journals, and we were very sensitive in promoting a title or abstract to full article review (i.e., if an article discussed risk factors associated with mammography, we promoted that to full article review). Additionally, we re-reviewed a random sample of 2.5% of the full articles excluded at title review and 5% of the full articles excluded at abstract review and did not find any additional articles that satisfied our inclusion criteria.</p>
<p>Our study also has several strengths. This is the first systematic review with meta-analyses exploring the relationship between obesity and mammography and the only one to examine the effect of race on this association. We comprehensively searched multiple electronic databases in addition to manual searching. Also, we contacted authors for data leading to additional results from four studies. Finally, the meta-analyses were based on nationally representative surveys and thus are generalizable to the US population.</p>
<p>The main implication of our study is that a lack of routine screening mammography may explain some of the increased breast cancer mortality in obese postmenopausal women. Clinicians should be aware of this disparity in evaluating their own practices. Future research should determine why obese women are less likely to report recent mammography, including the investigation of a lack of health care access due to perceived bias or lack of insurance as a possible cause and explore whether there are consistent differences by race.</p>
</sec>
</body>
<back><ack><p>We thank the following individuals for contributions to the study and/or providing access to their data: Eliseo Guallar, MD, DrPH (Johns Hopkins University, Baltimore, MD); Nancy K. Amy, PhD (University of California, Berkeley, CA); Jeanne Ferrante, MD (University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School and New Jersey Medical School, Newark, NJ); Marilyn Winkleby, PhD (Stanford School of Medicine, Stanford, CA); Lynn Rosenberg, ScD (Slone Epidemiology Center at Boston University, Boston, MA). No compensation was given to those acknowledged.</p>
<p><bold>Funding</bold>
 There was no project-specific support. Dr. Maruthur was supported by a training grant (5 T32 HL007024–31) from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH). Dr. Brancati was supported by a mid-career investigator award (5 K24 DK062222–05) from the National Institute of Diabetes and Digestive and Kidney Diseases, NIH.</p>
<p><bold>Conflicts of Interest</bold>
 Dr. Brancati declares the following conflicts: Healthways (disease management), Kidd and Company (venture capital), Klinger Advanced Aesthetics (cosmetics), and law firms (Burg Simpson Law Firm; Garrettson Law Firm; Richardson, Patrick, Westbrook & Brickman, LLC)—Zyprexa litigation. He donates all fees to Johns Hopkins University. Drs. Bolen and Clark had unrestricted grants from Pfizer, Glaxo-Smith-Kline, and Johnson & Johnson for analyses from several large Blue Cross Blue Shield Plans. Dr. Bolen received an honorarium from Laboratorios Faltrex in February 2007 to give a talk to health care providers in the Dominican Republic on the comparative effectiveness of oral diabetes medications. Dr. Maruthur has no conflicts to disclose.</p>
</ack>
<app-group><app id="App1"><sec id="Sec14"><title>Appendix</title>
<p><table-wrap id="Tab5"><label>Table 5</label>
<caption><p>Electronic Database Search Terms*</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th colspan="2">PubMed</th>
</tr>
</thead>
<tbody><tr><td><bold>Keywords</bold>
</td>
<td><bold>MeSH terms</bold>
</td>
</tr>
<tr><td>Breast cancer(s); breast neoplasm(s); breast tumor(s); neoplasm(s), breast; tumor(s), breast; cancer(s), breast; cancer(s) of breast; cancer(s) of the breast; mammary carcinoma(s) of breast; mammary carcinoma(s), human; carcinoma(s), mammary human; human mammary carcinoma(s); mammary neoplasm(s), human; human mammary neoplasm(s); neoplasm(s), human mammary; mammary neoplasm(s), human</td>
<td>Breast neoplasms</td>
</tr>
<tr><td>Breast cancer screening; mammogram; mammography; mammographies; screening mammography; screening for breast cancer</td>
<td>Mammography</td>
</tr>
<tr><td>Body weight(s); weight; obesity; adiposity; body mass index; Quetelet index; BMI; overweight; body measure(s); measure(s), body; index, body mass; index, Quetelet; Quetelet's index; Quetelets index; body weights and measures</td>
<td>Body weights and measures</td>
</tr>
<tr><td>Cancer screening</td>
<td></td>
</tr>
<tr><td colspan="2"><bold>CINAHL</bold>
</td>
</tr>
<tr><td><bold>Keywords</bold>
</td>
<td><bold>CINAHL headings</bold>
</td>
</tr>
<tr><td>Breast cancer, breast neoplasms</td>
<td>Breast neoplasms</td>
</tr>
<tr><td>Breast cancer screening, mammography, mammogram</td>
<td>Mammography</td>
</tr>
<tr><td>BMI, body mass index, obesity, Quetelet index</td>
<td>Body weights and measures</td>
</tr>
<tr><td>Cancer screening</td>
<td>Cancer screening</td>
</tr>
<tr><td colspan="2"><bold>Cochrane</bold>
</td>
</tr>
<tr><td><bold>Search all text</bold>
</td>
<td><bold>MeSH terms</bold>
</td>
</tr>
<tr><td>Breast cancer, breast neoplasms</td>
<td>Breast neoplasms</td>
</tr>
<tr><td>Breast cancer screening, mammography, mammogram</td>
<td>Mammography</td>
</tr>
<tr><td>BMI, body mass index, Quetelet index</td>
<td>Body weights and measures</td>
</tr>
<tr><td>Cancer screening</td>
<td></td>
</tr>
</tbody>
</table>
<table-wrap-foot><p>*Our overall search strategy addressed a broader question regarding the association between obesity and screening for breast, cervical, and colon cancer. This study focuses on the relationship between weight and mammography</p>
</table-wrap-foot>
</table-wrap>
</p>
</sec>
<sec id="Sec15"><title>Appendix A</title>
<p>Obesity and Cancer Screening</p>
<p>Quality Assessment Form</p>
<p>Reviewer: __________</p>
<p>Author/Year: ___________</p>
<p>Ref ID: _____</p>
<p>*Please check one answer for each question.</p>
<p>INTRODUCTION
<list list-type="order"><list-item><p>Were objectives and pre-specified hypotheses reported?
<list list-type="bullet"><list-item><p>_ adequate (objectives and pre-specified hypotheses were reported)</p>
</list-item>
<list-item><p>_ fair (objectives specified but hypotheses not clearly stated)</p>
</list-item>
<list-item><p>_ inadequate (minimal or no description)</p>
</list-item>
</list>
</p>
</list-item>
</list>
</p>
<p>METHODS
<list list-type="order"><list-item><p>Was the study setting described?
<list list-type="bullet"><list-item><p>_ adequate (setting, location, and dates of data collection stated)</p>
</list-item>
<list-item><p>_ fair (setting, location, and dates of data collection stated incompletely)</p>
</list-item>
<list-item><p>_ inadequate (minimal or no description)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Was the study population described?
<list list-type="bullet"><list-item><p>_ adequate (There was a complete description of methods of selection and exclusion criteria OR statement that all eligible patients enrolled.)</p>
</list-item>
<list-item><p>_ fair (There was an incomplete description of methods of selection and exclusion criteria. Would be difficult to replicate with the information provided)</p>
</list-item>
<list-item><p>_ inadequate (minimal or no description)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>How was the study population selected?
<list list-type="bullet"><list-item><p>_ random sampling</p>
</list-item>
<list-item><p>_ convenience sampling</p>
</list-item>
<list-item><p>_ consecutive selection</p>
</list-item>
<list-item><p>_ other purposive sampling</p>
</list-item>
<list-item><p>_ other (please specify.): ____________</p>
</list-item>
<list-item><p>_ not described</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Was there information on excluded or non-participating subjects?
<list list-type="bullet"><list-item><p>_ adequate (All reasons for exclusion or lack of participation noted OR no exclusions.)</p>
</list-item>
<list-item><p>_ fair (There was some discussion of this topic, but not sufficient to allow replication.)</p>
</list-item>
<list-item><p>_ inadequate (no description)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Was the exposure well-described?
<list list-type="bullet"><list-item><p>_ adequate (exposure explicitly defined, and method of measurement described)</p>
</list-item>
<list-item><p>_ fair (exposure described incompletely)</p>
</list-item>
<list-item><p>_ inadequate (no description)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Was the outcome well-described?
<list list-type="bullet"><list-item><p>_ adequate (outcome explicitly defined, and method of measurement described)</p>
</list-item>
<list-item><p>_ fair (outcome described incompletely)</p>
</list-item>
<list-item><p>_ inadequate (no description)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>If the study involved medical record review, was there standardized data abstraction?
<list list-type="bullet"><list-item><p>_ yes (please specify.) __________________________________</p>
</list-item>
<list-item><p>_ no</p>
</list-item>
<list-item><p>_ not described</p>
</list-item>
<list-item><p>_ other (please specify) _________________________________</p>
</list-item>
<list-item><p>_ not applicable</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>If the study involved medical record review, was there blinding of abstractors to the study question?
<list list-type="bullet"><list-item><p>_ yes</p>
</list-item>
<list-item><p>_ no</p>
</list-item>
<list-item><p>_ not described</p>
</list-item>
<list-item><p>_ not applicable</p>
</list-item>
<list-item><p>_ other (please specify) _________________________________</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>If the study involved medical record review, was there a description of handling of disagreements?
<list list-type="bullet"><list-item><p>_ not applicable</p>
</list-item>
<list-item><p>_ adequate (method for handling of disagreements described completely)</p>
</list-item>
<list-item><p>_ fair (method for handling of disagreements described incompletely)</p>
</list-item>
<list-item><p>_ poor (method for handing of disagreements not described)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>If data abstracted from medical records, was inter- and intra-rater reliability described?
<list list-type="bullet"><list-item><p>_ not applicable</p>
</list-item>
<list-item><p>_ inter-rater reliability
<list list-type="bullet"><list-item><p>_ yes
<list list-type="bullet"><list-item><p>_ kappa (please list) _______</p>
</list-item>
<list-item><p>_ other (please list) ________</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>_ no</p>
</list-item>
<list-item><p>_ other (please specify) ___________</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>_ intra-rater reliability
<list list-type="bullet"><list-item><p>_ yes
<list list-type="bullet"><list-item><p>_ kappa (please list) _______</p>
</list-item>
<list-item><p>_ other (please list) ________</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>_ no</p>
</list-item>
<list-item><p>_ other (please specify) ___________</p>
</list-item>
</list>
</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>If the study used a survey, was the survey response rate reported?
<list list-type="bullet"><list-item><p>_ not applicable</p>
</list-item>
<list-item><p>_ not reported</p>
</list-item>
<list-item><p>_ rate reported (please list) _____________________________</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Were key baseline characteristics ascertained?
<list list-type="order"><list-item><p>age</p>
</list-item>
<list-item><p>sex</p>
</list-item>
<list-item><p>comorbidity</p>
</list-item>
<list-item><p>socioeconomic factors</p>
</list-item>
<list-item><p>family history</p>
</list-item>
<list-item><p>race</p>
</list-item>
<list-item><p>smoking status
<list list-type="bullet"><list-item><p>_ adequate (0–2 applicable categories not described)</p>
</list-item>
<list-item><p>_ fair (2–3 applicable categories not described)</p>
</list-item>
<list-item><p>_ inadequate (>3 applicable categories not described)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>How did the study report the numbers of individuals at each stage of the study? (e.g., number of potentially eligible, examined for eligibility, confirmed eligible, included in the study, completed follow-up, and analyzed)
<list list-type="bullet"><list-item><p>_ adequate</p>
</list-item>
<list-item><p>_ fair (one of the above not described)</p>
</list-item>
<list-item><p>_ inadequate (>1 not described)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>For what percentage of participants were there missing data?
<list list-type="bullet"><list-item><p>_ none</p>
</list-item>
<list-item><p>_ <10%</p>
</list-item>
<list-item><p>_ 10–20%</p>
</list-item>
<list-item><p>_ >20%</p>
</list-item>
<list-item><p>_ not reported</p>
</list-item>
<list-item><p>_ n/a</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Was there a discussion of sample size rationalization?
<list list-type="bullet"><list-item><p>_ adequate (Practical and statistical considerations were described.)</p>
</list-item>
<list-item><p>_ fair (Rationale for sample size was discussed incompletely.)</p>
</list-item>
<list-item><p>_ inadequate (Rationale for sample size not discussed.)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Were statistical analyses clearly described?
<list list-type="bullet"><list-item><p>_ adequate (described for all analyses)</p>
</list-item>
<list-item><p>_ fair (described for some analyses)</p>
</list-item>
<list-item><p>_ inadequate (not described)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>For main analyses, were numbers of individuals experiencing the outcome reported?
<list list-type="bullet"><list-item><p>_ adequate (numbers provided or can be calculated for outcomes)</p>
</list-item>
<list-item><p>_ fair (proportions but not numbers provided for outcomes)</p>
</list-item>
<list-item><p>_ inadequate (no enumeration of outcome provided)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>For main analyses, are there estimates and a measure of variability (e.g., standard error, standard deviation, confidence intervals) reported?
<list list-type="bullet"><list-item><p>_ adequate (estimates and variability reported)</p>
</list-item>
<list-item><p>_ fair (estimates and p-value or test statistic reported)</p>
</list-item>
<list-item><p>_ inadequate (estimate only reported)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Were confounding factors treated adequately?
<list list-type="bullet"><list-item><p>_ adequate (Adjustments were made for most or all potential confounders.)</p>
</list-item>
<list-item><p>_ fair (Adjustments were made for most confounders.)</p>
</list-item>
<list-item><p>_ inadequate (There were minimal or no adjustments for confounding.)</p>
</list-item>
</list>
</p>
</list-item>
<list-item><p>Were methods for use of quantitative variables explained?
<list list-type="bullet"><list-item><p>_ adequate (description of covariates present)</p>
</list-item>
<list-item><p>_ inadequate (description of covariates not present)</p>
</list-item>
</list>
</p>
</list-item>
</list>
</p>
</list-item>
</list>
</p>
<p>CONFLICTS OF INTEREST
<list list-type="order"><list-item><p>Were sources of funding identified?
<list list-type="bullet"><list-item><p>_ adequate (source of funding or no funding specified)</p>
</list-item>
<list-item><p>_ poor (funding not described)</p>
</list-item>
</list>
</p>
</list-item>
</list>
</p>
<p>Other comments on study quality:</p>
<p>_________________________________________________________</p>
<p>_________________________________________________________</p>
<p>_________________________________________________________</p>
</sec>
</app>
</app-group>
<ref-list id="Bib1"><title>References</title>
<ref id="CR1"><label>1.</label>
<citation citation-type="other">U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2004 <italic>Incidence and Mortality Web-based Report.</italic>
 Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention <italic>and</italic>
 National Cancer Institute; 2007. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/uscs">http://www.cdc.gov/uscs</ext-link>
. Accessed February 6, 2009.</citation>
</ref>
<ref id="CR2"><label>2.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Miller</surname>
<given-names>AB</given-names>
</name>
<name><surname>Baines</surname>
<given-names>CJ</given-names>
</name>
<name><surname>To</surname>
<given-names>T</given-names>
</name>
<name><surname>Wall</surname>
<given-names>C</given-names>
</name>
</person-group>
<article-title>Canadian national breast screening study: 2. Breast cancer detection and death rates among women aged 50 to 59 years</article-title>
<source>Can Med Assoc J</source>
<year>1992</year>
<volume>147</volume>
<fpage>1477</fpage>
<lpage>1488</lpage>
</citation>
<citation citation-type="display-unstructured">Miller AB, Baines CJ, To T, Wall C. Canadian national breast screening study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. Can Med Assoc J. 1992;147:1477–88. <pub-id pub-id-type="pmid">1423088</pub-id>
</citation>
</ref>
<ref id="CR3"><label>3.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Miller</surname>
<given-names>AB</given-names>
</name>
<name><surname>Baines</surname>
<given-names>CJ</given-names>
</name>
<name><surname>To</surname>
<given-names>T</given-names>
</name>
<name><surname>Wall</surname>
<given-names>C</given-names>
</name>
</person-group>
<article-title>Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years</article-title>
<source>Can Med Assoc J</source>
<year>1992</year>
<volume>147</volume>
<fpage>1459</fpage>
<lpage>1498</lpage>
</citation>
<citation citation-type="display-unstructured">Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years. Can Med Assoc J. 1992;147:1459–98. <pub-id pub-id-type="pmid">1423087</pub-id>
</citation>
</ref>
<ref id="CR4"><label>4.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Alexander</surname>
<given-names>FE</given-names>
</name>
<name><surname>Anderson</surname>
<given-names>TJ</given-names>
</name>
<name><surname>Brown</surname>
<given-names>HK</given-names>
</name>
<etal></etal>
</person-group>
<article-title>14 years of follow-up from the Edinburgh Randomised Trial of Breast-Cancer Screening</article-title>
<source>Lancet</source>
<year>1999</year>
<volume>353</volume>
<issue>9168</issue>
<fpage>1903</fpage>
<lpage>1908</lpage>
<pub-id pub-id-type="doi">10.1016/S0140-6736(98)07413-3</pub-id>
</citation>
<citation citation-type="display-unstructured">Alexander FE, Anderson TJ, Brown HK, et al. 14 years of follow-up from the Edinburgh Randomised Trial of Breast-Cancer Screening. Lancet. 1999;353(9168):1903–8. <pub-id pub-id-type="pmid">10371567</pub-id>
</citation>
</ref>
<ref id="CR5"><label>5.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Tabar</surname>
<given-names>L</given-names>
</name>
<name><surname>Vitak</surname>
<given-names>B</given-names>
</name>
<name><surname>Chen</surname>
<given-names>HH</given-names>
</name>
<etal></etal>
</person-group>
<article-title>The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up</article-title>
<source>Radiol Clin North Am.</source>
<year>2000</year>
<volume>38</volume>
<issue>4</issue>
<fpage>625</fpage>
<lpage>651</lpage>
<pub-id pub-id-type="doi">10.1016/S0033-8389(05)70191-3</pub-id>
</citation>
<citation citation-type="display-unstructured">Tabar L, Vitak B, Chen HH, et al. The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. Radiol Clin North Am. 2000;38(4):625–51. <pub-id pub-id-type="pmid">10943268</pub-id>
</citation>
</ref>
<ref id="CR6"><label>6.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nystrom</surname>
<given-names>L</given-names>
</name>
<name><surname>Andersson</surname>
<given-names>I</given-names>
</name>
<name><surname>Bjurstam</surname>
<given-names>N</given-names>
</name>
<name><surname>Frisell</surname>
<given-names>J</given-names>
</name>
<name><surname>Nordenskjold</surname>
<given-names>B</given-names>
</name>
<name><surname>Rutqvist</surname>
<given-names>LE</given-names>
</name>
</person-group>
<article-title>Long-term effects of mammography screening: updated overview of the Swedish randomised trials</article-title>
<source>Lancet</source>
<year>2002</year>
<volume>359</volume>
<issue>9310</issue>
<fpage>909</fpage>
<lpage>919</lpage>
<pub-id pub-id-type="doi">10.1016/S0140-6736(02)08020-0</pub-id>
</citation>
<citation citation-type="display-unstructured">Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet. 2002;359(9310):909–19. <pub-id pub-id-type="pmid">11918907</pub-id>
</citation>
</ref>
<ref id="CR7"><label>7.</label>
<citation citation-type="other">U.S. Preventive Services Task Force. Screening for breast cancer. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm">http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm</ext-link>
 Accessed February 6, 2009.</citation>
</ref>
<ref id="CR8"><label>8.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Smith</surname>
<given-names>RA</given-names>
</name>
<name><surname>Cokkinides</surname>
<given-names>V</given-names>
</name>
<name><surname>Eyre</surname>
<given-names>HJ</given-names>
</name>
</person-group>
<article-title>American cancer society guidelines for the early detection of cancer, 2006</article-title>
<source>CA Cancer J Clin.</source>
<year>2006</year>
<volume>56</volume>
<issue>1</issue>
<fpage>11</fpage>
<lpage>25</lpage>
<pub-id pub-id-type="doi">10.3322/canjclin.56.1.11</pub-id>
</citation>
<citation citation-type="display-unstructured">Smith RA, Cokkinides V, Eyre HJ. American cancer society guidelines for the early detection of cancer, 2006. CA Cancer J Clin. 2006;56(1):11–25. quiz 49–50. <pub-id pub-id-type="pmid">16449183</pub-id>
</citation>
</ref>
<ref id="CR9"><label>9.</label>
<citation citation-type="other">Centers for Disease Control and Prevention. Available at: <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm">http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm</ext-link>
. Accessed February 6, 2009.</citation>
</ref>
<ref id="CR10"><label>10.</label>
<citation citation-type="other"><bold>Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M.</bold>
 Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet;371(9612):569–78.</citation>
</ref>
<ref id="CR11"><label>11.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Reeves</surname>
<given-names>GK</given-names>
</name>
<name><surname>Pirie</surname>
<given-names>K</given-names>
</name>
<name><surname>Beral</surname>
<given-names>V</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort study</article-title>
<source>BMJ</source>
<year>2007</year>
<volume>335</volume>
<issue>7630</issue>
<fpage>1134</fpage>
<pub-id pub-id-type="doi">10.1136/bmj.39367.495995.AE</pub-id>
</citation>
<citation citation-type="display-unstructured">Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort study. BMJ. 2007;335(7630):1134. <pub-id pub-id-type="pmid">17986716</pub-id>
</citation>
</ref>
<ref id="CR12"><label>12.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Loi</surname>
<given-names>S</given-names>
</name>
<name><surname>Milne</surname>
<given-names>RL</given-names>
</name>
<name><surname>Friedlander</surname>
<given-names>ML</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Obesity and outcomes in premenopausal and postmenopausal breast cancer</article-title>
<source>Cancer Epidemiol Biomarkers Prev.</source>
<year>2005</year>
<volume>14</volume>
<issue>7</issue>
<fpage>1686</fpage>
<lpage>1691</lpage>
<pub-id pub-id-type="doi">10.1158/1055-9965.EPI-05-0042</pub-id>
</citation>
<citation citation-type="display-unstructured">Loi S, Milne RL, Friedlander ML, et al. Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev.. 2005;14(7):1686–91. <pub-id pub-id-type="pmid">16030102</pub-id>
</citation>
</ref>
<ref id="CR13"><label>13.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Calle</surname>
<given-names>EE</given-names>
</name>
<name><surname>Thun</surname>
<given-names>MJ</given-names>
</name>
</person-group>
<article-title>Obesity and cancer</article-title>
<source>Oncogene</source>
<year>2004</year>
<volume>23</volume>
<issue>38</issue>
<fpage>6365</fpage>
<lpage>6378</lpage>
<pub-id pub-id-type="doi">10.1038/sj.onc.1207751</pub-id>
</citation>
<citation citation-type="display-unstructured">Calle EE, Thun MJ. Obesity and cancer. Oncogene. 2004;23(38):6365–78. <pub-id pub-id-type="pmid">15322511</pub-id>
</citation>
</ref>
<ref id="CR14"><label>14.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Brandt</surname>
<given-names>PA</given-names>
</name>
<name><surname>Spiegelman</surname>
<given-names>D</given-names>
</name>
<name><surname>Yaun</surname>
<given-names>SS</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk</article-title>
<source>Am J Epidemiol</source>
<year>2000</year>
<volume>152</volume>
<issue>6</issue>
<fpage>514</fpage>
<lpage>527</lpage>
<pub-id pub-id-type="doi">10.1093/aje/152.6.514</pub-id>
</citation>
<citation citation-type="display-unstructured">van den Brandt PA, Spiegelman D, Yaun SS, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol. 2000;152(6):514–27. <pub-id pub-id-type="pmid">10997541</pub-id>
</citation>
</ref>
<ref id="CR15"><label>15.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname>
<given-names>Z</given-names>
</name>
<name><surname>Hankinson</surname>
<given-names>SE</given-names>
</name>
<name><surname>Colditz</surname>
<given-names>GA</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Dual effects of weight and weight gain on breast cancer risk</article-title>
<source>JAMA</source>
<year>1997</year>
<volume>278</volume>
<issue>17</issue>
<fpage>1407</fpage>
<lpage>1411</lpage>
<pub-id pub-id-type="doi">10.1001/jama.278.17.1407</pub-id>
</citation>
<citation citation-type="display-unstructured">Huang Z, Hankinson SE, Colditz GA, et al. Dual effects of weight and weight gain on breast cancer risk. JAMA. 1997;278(17):1407–11. <pub-id pub-id-type="pmid">9355998</pub-id>
</citation>
</ref>
<ref id="CR16"><label>16.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Carmichael</surname>
<given-names>AR</given-names>
</name>
</person-group>
<article-title>Obesity and prognosis of breast cancer</article-title>
<source>Obes Rev</source>
<year>2006</year>
<volume>7</volume>
<issue>4</issue>
<fpage>333</fpage>
<lpage>340</lpage>
<pub-id pub-id-type="doi">10.1111/j.1467-789X.2006.00261.x</pub-id>
</citation>
<citation citation-type="display-unstructured">Carmichael AR. Obesity and prognosis of breast cancer. Obes Rev. 2006;7(4):333–40. <pub-id pub-id-type="pmid">17038127</pub-id>
</citation>
</ref>
<ref id="CR17"><label>17.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Petrelli</surname>
<given-names>JM</given-names>
</name>
<name><surname>Calle</surname>
<given-names>EE</given-names>
</name>
<name><surname>Rodriguez</surname>
<given-names>C</given-names>
</name>
<name><surname>Thun</surname>
<given-names>MJ</given-names>
</name>
</person-group>
<article-title>Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women</article-title>
<source>Cancer Causes Control</source>
<year>2002</year>
<volume>13</volume>
<issue>4</issue>
<fpage>325</fpage>
<lpage>332</lpage>
<pub-id pub-id-type="doi">10.1023/A:1015288615472</pub-id>
</citation>
<citation citation-type="display-unstructured">Petrelli JM, Calle EE, Rodriguez C, Thun MJ. Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control. 2002;13(4):325–32. <pub-id pub-id-type="pmid">12074502</pub-id>
</citation>
</ref>
<ref id="CR18"><label>18.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bastarrachea</surname>
<given-names>J</given-names>
</name>
<name><surname>Hortobagyi</surname>
<given-names>GN</given-names>
</name>
<name><surname>Smith</surname>
<given-names>TL</given-names>
</name>
<name><surname>Kau</surname>
<given-names>SW</given-names>
</name>
<name><surname>Buzdar</surname>
<given-names>AU</given-names>
</name>
</person-group>
<article-title>Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer</article-title>
<source>Ann Intern Med</source>
<year>1994</year>
<volume>120</volume>
<issue>1</issue>
<fpage>18</fpage>
<lpage>25</lpage>
</citation>
<citation citation-type="display-unstructured">Bastarrachea J, Hortobagyi GN, Smith TL, Kau SW, Buzdar AU. Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer. Ann Intern Med. 1994;120(1):18–25. <pub-id pub-id-type="pmid">8250452</pub-id>
</citation>
</ref>
<ref id="CR19"><label>19.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Calle</surname>
<given-names>EE</given-names>
</name>
<name><surname>Rodriguez</surname>
<given-names>C</given-names>
</name>
<name><surname>Walker-Thurmond</surname>
<given-names>K</given-names>
</name>
<name><surname>Thun</surname>
<given-names>MJ</given-names>
</name>
</person-group>
<article-title>Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults</article-title>
<source>N Engl J Med</source>
<year>2003</year>
<volume>348</volume>
<issue>17</issue>
<fpage>1625</fpage>
<lpage>1638</lpage>
<pub-id pub-id-type="doi">10.1056/NEJMoa021423</pub-id>
</citation>
<citation citation-type="display-unstructured">Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38. <pub-id pub-id-type="pmid">12711737</pub-id>
</citation>
</ref>
<ref id="CR20"><label>20.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kroenke</surname>
<given-names>CH</given-names>
</name>
<name><surname>Chen</surname>
<given-names>WY</given-names>
</name>
<name><surname>Rosner</surname>
<given-names>B</given-names>
</name>
<name><surname>Holmes</surname>
<given-names>MD</given-names>
</name>
</person-group>
<article-title>Weight, weight gain, and survival after breast cancer diagnosis</article-title>
<source>J Clin Oncol</source>
<year>2005</year>
<volume>23</volume>
<issue>7</issue>
<fpage>1370</fpage>
<lpage>1378</lpage>
<pub-id pub-id-type="doi">10.1200/JCO.2005.01.079</pub-id>
</citation>
<citation citation-type="display-unstructured">Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol. 2005;23(7):1370–8. <pub-id pub-id-type="pmid">15684320</pub-id>
</citation>
</ref>
<ref id="CR21"><label>21.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Dignam</surname>
<given-names>JJ</given-names>
</name>
<name><surname>Wieand</surname>
<given-names>K</given-names>
</name>
<name><surname>Johnson</surname>
<given-names>KA</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer</article-title>
<source>Breast Cancer Res Treat</source>
<year>2006</year>
<volume>97</volume>
<issue>3</issue>
<fpage>245</fpage>
<lpage>254</lpage>
<pub-id pub-id-type="doi">10.1007/s10549-005-9118-3</pub-id>
</citation>
<citation citation-type="display-unstructured">Dignam JJ, Wieand K, Johnson KA, et al. Effects of obesity and race on prognosis in lymph node-negative, estrogen receptor-negative breast cancer. Breast Cancer Res Treat. 2006;97(3):245–54. <pub-id pub-id-type="pmid">16331345</pub-id>
</citation>
</ref>
<ref id="CR22"><label>22.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>El-Tamer</surname>
<given-names>MB</given-names>
</name>
<name><surname>Ward</surname>
<given-names>BM</given-names>
</name>
<name><surname>Schifftner</surname>
<given-names>T</given-names>
</name>
<name><surname>Neumayer</surname>
<given-names>L</given-names>
</name>
<name><surname>Khuri</surname>
<given-names>S</given-names>
</name>
<name><surname>Henderson</surname>
<given-names>W</given-names>
</name>
</person-group>
<article-title>Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care</article-title>
<source>Ann Surg</source>
<year>2007</year>
<volume>245</volume>
<issue>5</issue>
<fpage>665</fpage>
<lpage>671</lpage>
<pub-id pub-id-type="doi">10.1097/01.sla.0000245833.48399.9a</pub-id>
</citation>
<citation citation-type="display-unstructured">El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Khuri S, Henderson W. Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care. Ann Surg. 2007;245(5):665–71. <pub-id pub-id-type="pmid">17457156</pub-id>
</citation>
</ref>
<ref id="CR23"><label>23.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Werner</surname>
<given-names>RS</given-names>
</name>
<name><surname>McCormick</surname>
<given-names>B</given-names>
</name>
<name><surname>Petrek</surname>
<given-names>J</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Arm edema in conservatively managed breast cancer: obesity is a major predictive factor</article-title>
<source>Radiology</source>
<year>1991</year>
<volume>180</volume>
<issue>1</issue>
<fpage>177</fpage>
<lpage>184</lpage>
</citation>
<citation citation-type="display-unstructured">Werner RS, McCormick B, Petrek J, et al. Arm edema in conservatively managed breast cancer: obesity is a major predictive factor. Radiology. 1991;180(1):177–84. <pub-id pub-id-type="pmid">2052688</pub-id>
</citation>
</ref>
<ref id="CR24"><label>24.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Veen</surname>
<given-names>P</given-names>
</name>
<name><surname>Voogdt</surname>
<given-names>N</given-names>
</name>
<name><surname>Lievens</surname>
<given-names>P</given-names>
</name>
<name><surname>Duquet</surname>
<given-names>W</given-names>
</name>
<name><surname>Lamote</surname>
<given-names>J</given-names>
</name>
<name><surname>Sacre</surname>
<given-names>R</given-names>
</name>
</person-group>
<article-title>Lymphedema development following breast cancer surgery with full axillary resection</article-title>
<source>Lymphology</source>
<year>2004</year>
<volume>37</volume>
<issue>4</issue>
<fpage>206</fpage>
<lpage>208</lpage>
</citation>
<citation citation-type="display-unstructured">van der Veen P, De Voogdt N, Lievens P, Duquet W, Lamote J, Sacre R. Lymphedema development following breast cancer surgery with full axillary resection. Lymphology. 2004;37(4):206–8. <pub-id pub-id-type="pmid">15693539</pub-id>
</citation>
</ref>
<ref id="CR25"><label>25.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cui</surname>
<given-names>Y</given-names>
</name>
<name><surname>Whiteman</surname>
<given-names>MK</given-names>
</name>
<name><surname>Flaws</surname>
<given-names>JA</given-names>
</name>
<name><surname>Langenberg</surname>
<given-names>P</given-names>
</name>
<name><surname>Tkaczuk</surname>
<given-names>KH</given-names>
</name>
<name><surname>Bush</surname>
<given-names>TL</given-names>
</name>
</person-group>
<article-title>Body mass and stage of breast cancer at diagnosis</article-title>
<source>Int J Cancer</source>
<year>2002</year>
<volume>98</volume>
<issue>2</issue>
<fpage>279</fpage>
<lpage>283</lpage>
<pub-id pub-id-type="doi">10.1002/ijc.10209</pub-id>
</citation>
<citation citation-type="display-unstructured">Cui Y, Whiteman MK, Flaws JA, Langenberg P, Tkaczuk KH, Bush TL. Body mass and stage of breast cancer at diagnosis. Int J Cancer. 2002;98(2):279–83. <pub-id pub-id-type="pmid">11857420</pub-id>
</citation>
</ref>
<ref id="CR26"><label>26.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Chagpar</surname>
<given-names>AB</given-names>
</name>
<name><surname>Mcmasters</surname>
<given-names>KM</given-names>
</name>
<name><surname>Saul</surname>
<given-names>J</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Body mass index influences palpability but not stage of breast cancer at diagnosis</article-title>
<source>Am Surg</source>
<year>2007</year>
<volume>73</volume>
<issue>6</issue>
<fpage>555</fpage>
<lpage>560</lpage>
</citation>
<citation citation-type="display-unstructured">Chagpar AB, Mcmasters KM, Saul J, et al. Body mass index influences palpability but not stage of breast cancer at diagnosis. Am Surg. 2007;73(6):555–60. <pub-id pub-id-type="pmid">17658091</pub-id>
</citation>
</ref>
<ref id="CR27"><label>27.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Amonkar</surname>
<given-names>MM</given-names>
</name>
<name><surname>Madhavan</surname>
<given-names>S</given-names>
</name>
</person-group>
<article-title>Compliance rates and predictors of cancer screening recommendations among Appalachian women</article-title>
<source>J Health Care Poor Underserved</source>
<year>2002</year>
<volume>13</volume>
<issue>4</issue>
<fpage>443</fpage>
<lpage>460</lpage>
<pub-id pub-id-type="doi">10.1177/104920802762475102</pub-id>
</citation>
<citation citation-type="display-unstructured">Amonkar MM, Madhavan S. Compliance rates and predictors of cancer screening recommendations among Appalachian women. J Health Care Poor Underserved. 2002;13(4):443–60. <pub-id pub-id-type="pmid">12407962</pub-id>
</citation>
</ref>
<ref id="CR28"><label>28.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Amy</surname>
<given-names>NK</given-names>
</name>
<name><surname>Aalborg</surname>
<given-names>A</given-names>
</name>
<name><surname>Lyons</surname>
<given-names>P</given-names>
</name>
<name><surname>Keranen</surname>
<given-names>L</given-names>
</name>
</person-group>
<article-title>Barriers to routine gynecological cancer screening for White and African-American obese women</article-title>
<source>Int J Obes (Lond)</source>
<year>2006</year>
<volume>30</volume>
<issue>1</issue>
<fpage>147</fpage>
<lpage>155</lpage>
<pub-id pub-id-type="doi">10.1038/sj.ijo.0803105</pub-id>
</citation>
<citation citation-type="display-unstructured">Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes (Lond). 2006;30(1):147–55. <pub-id pub-id-type="pmid">16231037</pub-id>
</citation>
</ref>
<ref id="CR29"><label>29.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Coughlin</surname>
<given-names>SS</given-names>
</name>
<name><surname>Uhler</surname>
<given-names>RJ</given-names>
</name>
<name><surname>Hall</surname>
<given-names>HI</given-names>
</name>
<name><surname>Briss</surname>
<given-names>PA</given-names>
</name>
</person-group>
<article-title>Nonadherence to breast and cervical cancer screening: what are the linkages to chronic disease risk?</article-title>
<source>Prev Chronic Dis</source>
<year>2004</year>
<volume>1</volume>
<issue>1</issue>
<fpage>A04</fpage>
</citation>
<citation citation-type="display-unstructured">Coughlin SS, Uhler RJ, Hall HI, Briss PA. Nonadherence to breast and cervical cancer screening: what are the linkages to chronic disease risk? Prev Chronic Dis. 2004;1(1):A04. <pub-id pub-id-type="pmid">15634366</pub-id>
</citation>
</ref>
<ref id="CR30"><label>30.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Fontaine</surname>
<given-names>KR</given-names>
</name>
<name><surname>Heo</surname>
<given-names>M</given-names>
</name>
<name><surname>Allison</surname>
<given-names>DB</given-names>
</name>
</person-group>
<article-title>Body weight and cancer screening among women</article-title>
<source>J Womens Health Gend Based Med</source>
<year>2001</year>
<volume>10</volume>
<issue>5</issue>
<fpage>463</fpage>
<lpage>470</lpage>
<pub-id pub-id-type="doi">10.1089/152460901300233939</pub-id>
</citation>
<citation citation-type="display-unstructured">Fontaine KR, Heo M, Allison DB. Body weight and cancer screening among women. J Womens Health Gend Based Med. 2001;10(5):463–70. <pub-id pub-id-type="pmid">11445045</pub-id>
</citation>
</ref>
<ref id="CR31"><label>31.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ostbye</surname>
<given-names>T</given-names>
</name>
<name><surname>Taylor</surname>
<given-names>DH</given-names>
<suffix>Jr</suffix>
</name>
<name><surname>Yancy</surname>
<given-names>WS</given-names>
<suffix>Jr</suffix>
</name>
<name><surname>Krause</surname>
<given-names>KM</given-names>
</name>
</person-group>
<article-title>Associations between obesity and receipt of screening mammography, Papanicolaou tests, and influenza vaccination: results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) study</article-title>
<source>Am J Public Health</source>
<year>2005</year>
<volume>95</volume>
<issue>9</issue>
<fpage>1623</fpage>
<lpage>1630</lpage>
<pub-id pub-id-type="doi">10.2105/AJPH.2004.047803</pub-id>
</citation>
<citation citation-type="display-unstructured">Ostbye T, Taylor DH Jr, Yancy WS Jr, Krause KM. Associations between obesity and receipt of screening mammography, Papanicolaou tests, and influenza vaccination: results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) study. Am J Public Health. 2005;95(9):1623–30. <pub-id pub-id-type="pmid">16051935</pub-id>
</citation>
</ref>
<ref id="CR32"><label>32.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wee</surname>
<given-names>CC</given-names>
</name>
<name><surname>McCarthy</surname>
<given-names>EP</given-names>
</name>
<name><surname>Davis</surname>
<given-names>RB</given-names>
</name>
<name><surname>Phillips</surname>
<given-names>RS</given-names>
</name>
</person-group>
<article-title>Obesity and breast cancer screening</article-title>
<source>J Gen Intern Med</source>
<year>2004</year>
<volume>19</volume>
<issue>4</issue>
<fpage>324</fpage>
<lpage>331</lpage>
<pub-id pub-id-type="doi">10.1111/j.1525-1497.2004.30354.x</pub-id>
</citation>
<citation citation-type="display-unstructured">Wee CC, McCarthy EP, Davis RB, Phillips RS. Obesity and breast cancer screening. J Gen Intern Med. 2004;19(4):324–31. <pub-id pub-id-type="pmid">15061741</pub-id>
</citation>
</ref>
<ref id="CR33"><label>33.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wee</surname>
<given-names>CC</given-names>
</name>
<name><surname>McCarthy</surname>
<given-names>EP</given-names>
</name>
<name><surname>Davis</surname>
<given-names>RB</given-names>
</name>
<name><surname>Phillips</surname>
<given-names>RS</given-names>
</name>
</person-group>
<article-title>Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care?</article-title>
<source>Ann Intern Med</source>
<year>2000</year>
<volume>132</volume>
<issue>9</issue>
<fpage>697</fpage>
<lpage>704</lpage>
</citation>
<citation citation-type="display-unstructured">Wee CC, McCarthy EP, Davis RB, Phillips RS. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med. 2000;132(9):697–704. <pub-id pub-id-type="pmid">10787362</pub-id>
</citation>
</ref>
<ref id="CR34"><label>34.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Winkleby</surname>
<given-names>MA</given-names>
</name>
<name><surname>Snider</surname>
<given-names>J</given-names>
</name>
<name><surname>Davis</surname>
<given-names>B</given-names>
</name>
<name><surname>Jennings</surname>
<given-names>MG</given-names>
</name>
<name><surname>Ahn</surname>
<given-names>DK</given-names>
</name>
</person-group>
<article-title>Cancer-related health behaviors and screening practices among Latinos: findings from a community and agricultural labor camp survey</article-title>
<source>Ethn Dis</source>
<year>2003</year>
<volume>13</volume>
<issue>3</issue>
<fpage>376</fpage>
<lpage>386</lpage>
</citation>
<citation citation-type="display-unstructured">Winkleby MA, Snider J, Davis B, Jennings MG, Ahn DK. Cancer-related health behaviors and screening practices among Latinos: findings from a community and agricultural labor camp survey. Ethn Dis. 2003;13(3):376–86. <pub-id pub-id-type="pmid">12894963</pub-id>
</citation>
</ref>
<ref id="CR35"><label>35.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Zhu</surname>
<given-names>K</given-names>
</name>
<name><surname>Wu</surname>
<given-names>H</given-names>
</name>
<name><surname>Jatoi</surname>
<given-names>I</given-names>
</name>
<name><surname>Potter</surname>
<given-names>J</given-names>
</name>
<name><surname>Shriver</surname>
<given-names>C</given-names>
</name>
</person-group>
<article-title>Body mass index and use of mammography screening in the United States</article-title>
<source>Prev Med</source>
<year>2006</year>
<volume>42</volume>
<issue>5</issue>
<fpage>381</fpage>
<lpage>385</lpage>
<pub-id pub-id-type="doi">10.1016/j.ypmed.2006.01.020</pub-id>
</citation>
<citation citation-type="display-unstructured">Zhu K, Wu H, Jatoi I, Potter J, Shriver C. Body mass index and use of mammography screening in the United States. Prev Med. 2006;42(5):381–5. <pub-id pub-id-type="pmid">16516284</pub-id>
</citation>
</ref>
<ref id="CR36"><label>36.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cohen</surname>
<given-names>SS</given-names>
</name>
<name><surname>Signorello</surname>
<given-names>LB</given-names>
</name>
<name><surname>Gammon</surname>
<given-names>MD</given-names>
</name>
<name><surname>Blot</surname>
<given-names>WJ</given-names>
</name>
</person-group>
<article-title>Obesity and recent mammography use among black and white women in the Southern Community Cohort Study (United States)</article-title>
<source>Cancer Causes Control</source>
<year>2007</year>
<volume>18</volume>
<issue>7</issue>
<fpage>765</fpage>
<lpage>773</lpage>
<pub-id pub-id-type="doi">10.1007/s10552-007-9019-3</pub-id>
</citation>
<citation citation-type="display-unstructured">Cohen SS, Signorello LB, Gammon MD, Blot WJ. Obesity and recent mammography use among black and white women in the Southern Community Cohort Study (United States). Cancer Causes Control. 2007;18(7):765–73. <pub-id pub-id-type="pmid">17569015</pub-id>
</citation>
</ref>
<ref id="CR37"><label>37.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ferrante</surname>
<given-names>JM</given-names>
</name>
<name><surname>Chen</surname>
<given-names>PH</given-names>
</name>
<name><surname>Crabtree</surname>
<given-names>BF</given-names>
</name>
<name><surname>Wartenberg</surname>
<given-names>D</given-names>
</name>
</person-group>
<article-title>Cancer screening in women: body mass index and adherence to physician recommendations</article-title>
<source>Am J Prev Med</source>
<year>2007</year>
<volume>32</volume>
<issue>6</issue>
<fpage>525</fpage>
<lpage>531</lpage>
<pub-id pub-id-type="doi">10.1016/j.amepre.2007.02.004</pub-id>
</citation>
<citation citation-type="display-unstructured">Ferrante JM, Chen PH, Crabtree BF, Wartenberg D. Cancer screening in women: body mass index and adherence to physician recommendations. Am J Prev Med. 2007;32(6):525–31. <pub-id pub-id-type="pmid">17533069</pub-id>
</citation>
</ref>
<ref id="CR38"><label>38.</label>
<citation citation-type="other"><bold>Berz D, Sikov W, Colvin G, Weitzen S.</bold>
 ‘Weighing in’ on screening mammography. Breast Cancer Res Treat. 2008.</citation>
</ref>
<ref id="CR39"><label>39.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rosenberg</surname>
<given-names>L</given-names>
</name>
<name><surname>Wise</surname>
<given-names>LA</given-names>
</name>
<name><surname>Palmer</surname>
<given-names>JR</given-names>
</name>
<name><surname>Horton</surname>
<given-names>NJ</given-names>
</name>
<name><surname>Adams-Campbell</surname>
<given-names>LL</given-names>
</name>
</person-group>
<article-title>A multilevel study of socioeconomic predictors of regular mammography use among African-American women</article-title>
<source>Cancer Epidemiol Biomarkers Prev</source>
<year>2005</year>
<volume>14</volume>
<issue>11 Pt 1</issue>
<fpage>2628</fpage>
<lpage>2633</lpage>
<pub-id pub-id-type="doi">10.1158/1055-9965.EPI-05-0441</pub-id>
</citation>
<citation citation-type="display-unstructured">Rosenberg L, Wise LA, Palmer JR, Horton NJ, Adams-Campbell LL. A multilevel study of socioeconomic predictors of regular mammography use among African-American women. Cancer Epidemiol Biomarkers Prev. 2005;14(11 Pt 1):2628–33. <pub-id pub-id-type="pmid">16284388</pub-id>
</citation>
</ref>
<ref id="CR40"><label>40.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ferrante</surname>
<given-names>JM</given-names>
</name>
<name><surname>Chen</surname>
<given-names>PH</given-names>
</name>
<name><surname>Jacobs</surname>
<given-names>A</given-names>
</name>
</person-group>
<article-title>Breast and cervical cancer screening in obese minority women</article-title>
<source>J Womens Health (Larchmt)</source>
<year>2006</year>
<volume>15</volume>
<issue>5</issue>
<fpage>531</fpage>
<lpage>541</lpage>
<pub-id pub-id-type="doi">10.1089/jwh.2006.15.531</pub-id>
</citation>
<citation citation-type="display-unstructured">Ferrante JM, Chen PH, Jacobs A. Breast and cervical cancer screening in obese minority women. J Womens Health (Larchmt). 2006;15(5):531–41. <pub-id pub-id-type="pmid">16796480</pub-id>
</citation>
</ref>
<ref id="CR41"><label>41.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Fontaine</surname>
<given-names>KR</given-names>
</name>
<name><surname>Faith</surname>
<given-names>MS</given-names>
</name>
<name><surname>Allison</surname>
<given-names>DB</given-names>
</name>
<name><surname>Cheskin</surname>
<given-names>LJ</given-names>
</name>
</person-group>
<article-title>Body weight and health care among women in the general population</article-title>
<source>Arch Fam Med</source>
<year>1998</year>
<volume>7</volume>
<issue>4</issue>
<fpage>381</fpage>
<lpage>384</lpage>
<pub-id pub-id-type="doi">10.1001/archfami.7.4.381</pub-id>
</citation>
<citation citation-type="display-unstructured">Fontaine KR, Faith MS, Allison DB, Cheskin LJ. Body weight and health care among women in the general population. Arch Fam Med. 1998;7(4):381–4. <pub-id pub-id-type="pmid">9682694</pub-id>
</citation>
</ref>
<ref id="CR42"><label>42.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gorin</surname>
<given-names>SS</given-names>
</name>
<name><surname>Jacobson</surname>
<given-names>J</given-names>
</name>
</person-group>
<article-title>Diet and breast cancer surveillance behaviors among Harlem women</article-title>
<source>Ann N Y Acad Sci</source>
<year>2001</year>
<volume>952</volume>
<fpage>153</fpage>
<lpage>160</lpage>
</citation>
<citation citation-type="display-unstructured">Gorin SS, Jacobson J. Diet and breast cancer surveillance behaviors among Harlem women. Ann N Y Acad Sci. 2001;952:153–60. <pub-id pub-id-type="pmid">11795435</pub-id>
</citation>
</ref>
<ref id="CR43"><label>43.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Satia</surname>
<given-names>JA</given-names>
</name>
<name><surname>Galanko</surname>
<given-names>JA</given-names>
</name>
</person-group>
<article-title>Demographic, behavioral, psychosocial, and dietary correlates of cancer screening in African Americans</article-title>
<source>J Health Care Poor Underserved</source>
<year>2007</year>
<volume>18</volume>
<issue>4 Suppl</issue>
<fpage>146</fpage>
<lpage>164</lpage>
<pub-id pub-id-type="doi">10.1353/hpu.2007.0114</pub-id>
</citation>
<citation citation-type="display-unstructured">Satia JA, Galanko JA. Demographic, behavioral, psychosocial, and dietary correlates of cancer screening in African Americans. J Health Care Poor Underserved. 2007;18(4 Suppl):146–64. <pub-id pub-id-type="pmid">18065857</pub-id>
</citation>
</ref>
<ref id="CR44"><label>44.</label>
<citation citation-type="other">STROBE Group. STROBE statement: Checklist of essential items version 3 (September 2005). Available at: <ext-link ext-link-type="uri" xlink:href="http://www.strobe-statement.org/PDF%20hochladen/STROBE-Checklist-Version3.pdf">http://www.strobe-statement.org/PDF%20hochladen/STROBE-Checklist-Version3.pdf</ext-link>
. Accessed February 6, 2009.</citation>
</ref>
<ref id="CR45"><label>45.</label>
<citation citation-type="other"><bold>von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP.</bold>
 The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. The Lancet. ;370(9596):1453–7.</citation>
</ref>
<ref id="CR46"><label>46.</label>
<citation citation-type="other">World Health Organization. Obesity: Preventing and managing the global epidemic. Part 1: The problem of overweight and obesity. 2004;894:1–33.</citation>
</ref>
<ref id="CR47"><label>47.</label>
<citation citation-type="other">NHLBI Obesity Education Intiative Panel on the Identification, Treatment, and Management of Overweight and Obesity in Adults. Clinical guidelines on the identification, treatment, and management of overweight and obesity in adults. The evidence report. 1998;98–4083:1–126.</citation>
</ref>
<ref id="CR48"><label>48.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>DerSimonian</surname>
<given-names>R</given-names>
</name>
<name><surname>Laird</surname>
<given-names>N</given-names>
</name>
</person-group>
<article-title>Meta-analysis in clinical trials</article-title>
<source>Control Clin Trials</source>
<year>1986</year>
<volume>7</volume>
<issue>3</issue>
<fpage>177</fpage>
<lpage>188</lpage>
<pub-id pub-id-type="doi">10.1016/0197-2456(86)90046-2</pub-id>
</citation>
<citation citation-type="display-unstructured">DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88. <pub-id pub-id-type="pmid">3802833</pub-id>
</citation>
</ref>
<ref id="CR49"><label>49.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname>
<given-names>J</given-names>
</name>
<name><surname>Yu</surname>
<given-names>KF</given-names>
</name>
</person-group>
<article-title>What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes</article-title>
<source>JAMA</source>
<year>1998</year>
<volume>280</volume>
<issue>19</issue>
<fpage>1690</fpage>
<lpage>1691</lpage>
<pub-id pub-id-type="doi">10.1001/jama.280.19.1690</pub-id>
</citation>
<citation citation-type="display-unstructured">Zhang J, Yu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280(19):1690–1. <pub-id pub-id-type="pmid">9832001</pub-id>
</citation>
</ref>
<ref id="CR50"><label>50.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Higgins</surname>
<given-names>JP</given-names>
</name>
<name><surname>Thompson</surname>
<given-names>SG</given-names>
</name>
</person-group>
<article-title>Quantifying heterogeneity in a meta-analysis</article-title>
<source>Stat Med</source>
<year>2002</year>
<volume>21</volume>
<issue>11</issue>
<fpage>1539</fpage>
<lpage>1558</lpage>
<pub-id pub-id-type="doi">10.1002/sim.1186</pub-id>
</citation>
<citation citation-type="display-unstructured">Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. <pub-id pub-id-type="pmid">12111919</pub-id>
</citation>
</ref>
<ref id="CR51"><label>51.</label>
<citation citation-type="other"><bold>Deeks JJ, Higgins JPT, Altman DG, editors.</bold>
 Analyzing and presenting results. In: Higgins JPT, Green S, editors, editors. Cochrane handbook for systematic reviews of interventions 4.2.5 [updated May 2005]; Section 8; 2005.</citation>
</ref>
<ref id="CR52"><label>52.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Begg</surname>
<given-names>CB</given-names>
</name>
<name><surname>Mazumdar</surname>
<given-names>M</given-names>
</name>
</person-group>
<article-title>Operating characteristics of a rank correlation test for publication bias</article-title>
<source>Biometrics</source>
<year>1994</year>
<volume>50</volume>
<issue>4</issue>
<fpage>1088</fpage>
<lpage>1101</lpage>
<pub-id pub-id-type="doi">10.2307/2533446</pub-id>
</citation>
<citation citation-type="display-unstructured">Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101. <pub-id pub-id-type="pmid">7786990</pub-id>
</citation>
</ref>
<ref id="CR53"><label>53.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Egger</surname>
<given-names>M</given-names>
</name>
<name><surname>Davey Smith</surname>
<given-names>G</given-names>
</name>
<name><surname>Schneider</surname>
<given-names>M</given-names>
</name>
<name><surname>Minder</surname>
<given-names>C</given-names>
</name>
</person-group>
<article-title>Bias in meta-analysis detected by a simple, graphical test</article-title>
<source>BMJ</source>
<year>1997</year>
<volume>315</volume>
<issue>7109</issue>
<fpage>629</fpage>
<lpage>634</lpage>
</citation>
<citation citation-type="display-unstructured">Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. <pub-id pub-id-type="pmid">9310563</pub-id>
</citation>
</ref>
<ref id="CR54"><label>54.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ogden</surname>
<given-names>CL</given-names>
</name>
<name><surname>Carroll</surname>
<given-names>MD</given-names>
</name>
<name><surname>Curtin</surname>
<given-names>LR</given-names>
</name>
<name><surname>McDowell</surname>
<given-names>MA</given-names>
</name>
<name><surname>Tabak</surname>
<given-names>CJ</given-names>
</name>
<name><surname>Flegal</surname>
<given-names>KM</given-names>
</name>
</person-group>
<article-title>Prevalence of overweight and obesity in the United States, 1999–2004</article-title>
<source>JAMA</source>
<year>2006</year>
<volume>295</volume>
<issue>13</issue>
<fpage>1549</fpage>
<lpage>1555</lpage>
<pub-id pub-id-type="doi">10.1001/jama.295.13.1549</pub-id>
</citation>
<citation citation-type="display-unstructured">Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55. <pub-id pub-id-type="pmid">16595758</pub-id>
</citation>
</ref>
<ref id="CR55"><label>55.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Olson</surname>
<given-names>CL</given-names>
</name>
<name><surname>Schumaker</surname>
<given-names>HD</given-names>
</name>
<name><surname>Yawn</surname>
<given-names>BP</given-names>
</name>
</person-group>
<article-title>Overweight women delay medical care</article-title>
<source>Arch Fam Med</source>
<year>1994</year>
<volume>3</volume>
<issue>10</issue>
<fpage>888</fpage>
<lpage>892</lpage>
<pub-id pub-id-type="doi">10.1001/archfami.3.10.888</pub-id>
</citation>
<citation citation-type="display-unstructured">Olson CL, Schumaker HD, Yawn BP. Overweight women delay medical care. Arch Fam Med. 1994;3(10):888–92. <pub-id pub-id-type="pmid">8000560</pub-id>
</citation>
</ref>
<ref id="CR56"><label>56.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Adams</surname>
<given-names>CH</given-names>
</name>
<name><surname>Smith</surname>
<given-names>NJ</given-names>
</name>
<name><surname>Wilbur</surname>
<given-names>DC</given-names>
</name>
<name><surname>Grady</surname>
<given-names>KE</given-names>
</name>
</person-group>
<article-title>The relationship of obesity to the frequency of pelvic examination: do physician and patient attitudes make a difference?</article-title>
<source>Women & health</source>
<year>1993</year>
<volume>20</volume>
<fpage>45</fpage>
<lpage>57</lpage>
<pub-id pub-id-type="doi">10.1300/J013v20n02_04</pub-id>
</citation>
<citation citation-type="display-unstructured">Adams CH, Smith NJ, Wilbur DC, Grady KE. The relationship of obesity to the frequency of pelvic examination: do physician and patient attitudes make a difference? Women & health. 1993;20:45–57. </citation>
</ref>
<ref id="CR57"><label>57.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hunt</surname>
<given-names>KA</given-names>
</name>
<name><surname>Sickles</surname>
<given-names>EA</given-names>
</name>
</person-group>
<article-title>Effect of obesity on screening mammography: outcomes analysis of 88,346 consecutive examinations</article-title>
<source>AJR Am J Roentgenol</source>
<year>2000</year>
<volume>174</volume>
<issue>5</issue>
<fpage>1251</fpage>
<lpage>1255</lpage>
</citation>
<citation citation-type="display-unstructured">Hunt KA, Sickles EA. Effect of obesity on screening mammography: outcomes analysis of 88,346 consecutive examinations. AJR Am J Roentgenol. 2000;174(5):1251–5. <pub-id pub-id-type="pmid">10789771</pub-id>
</citation>
</ref>
<ref id="CR58"><label>58.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kerlikowske</surname>
<given-names>K</given-names>
</name>
<name><surname>Grady</surname>
<given-names>D</given-names>
</name>
<name><surname>Barclay</surname>
<given-names>J</given-names>
</name>
<name><surname>Sickles</surname>
<given-names>EA</given-names>
</name>
<name><surname>Ernster</surname>
<given-names>V</given-names>
</name>
</person-group>
<article-title>Effect of age, breast density, and family history on the sensitivity of first screening mammography</article-title>
<source>JAMA</source>
<year>1996</year>
<volume>276</volume>
<issue>1</issue>
<fpage>33</fpage>
<lpage>38</lpage>
<pub-id pub-id-type="doi">10.1001/jama.276.1.33</pub-id>
</citation>
<citation citation-type="display-unstructured">Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA. 1996;276(1):33–8. <pub-id pub-id-type="pmid">8667536</pub-id>
</citation>
</ref>
<ref id="CR59"><label>59.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>McLaren</surname>
<given-names>L</given-names>
</name>
</person-group>
<article-title>Socioeconomic status and obesity</article-title>
<source>Epidemiol Rev</source>
<year>2007</year>
<volume>29</volume>
<issue>1</issue>
<fpage>29</fpage>
<lpage>48</lpage>
<pub-id pub-id-type="doi">10.1093/epirev/mxm001</pub-id>
</citation>
<citation citation-type="display-unstructured">McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29(1):29–48. <pub-id pub-id-type="pmid">17478442</pub-id>
</citation>
</ref>
<ref id="CR60"><label>60.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ostbye</surname>
<given-names>T</given-names>
</name>
<name><surname>Yarnall</surname>
<given-names>KS</given-names>
</name>
<name><surname>Krause</surname>
<given-names>KM</given-names>
</name>
<name><surname>Pollak</surname>
<given-names>KI</given-names>
</name>
<name><surname>Gradison</surname>
<given-names>M</given-names>
</name>
<name><surname>Michener</surname>
<given-names>JL</given-names>
</name>
</person-group>
<article-title>Is there time for management of patients with chronic diseases in primary care?</article-title>
<source>Ann Fam Med</source>
<year>2005</year>
<volume>3</volume>
<issue>3</issue>
<fpage>209</fpage>
<lpage>214</lpage>
<pub-id pub-id-type="doi">10.1370/afm.310</pub-id>
</citation>
<citation citation-type="display-unstructured">Ostbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3(3):209–14. <pub-id pub-id-type="pmid">15928223</pub-id>
</citation>
</ref>
<ref id="CR61"><label>61.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Yarnall</surname>
<given-names>KS</given-names>
</name>
<name><surname>Pollak</surname>
<given-names>KI</given-names>
</name>
<name><surname>Ostbye</surname>
<given-names>T</given-names>
</name>
<name><surname>Krause</surname>
<given-names>KM</given-names>
</name>
<name><surname>Michener</surname>
<given-names>JL</given-names>
</name>
</person-group>
<article-title>Primary care: is there enough time for prevention?</article-title>
<source>Am J Public Health</source>
<year>2003</year>
<volume>93</volume>
<issue>4</issue>
<fpage>635</fpage>
<lpage>641</lpage>
<pub-id pub-id-type="doi">10.2105/AJPH.93.4.635</pub-id>
</citation>
<citation citation-type="display-unstructured">Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93(4):635–41. <pub-id pub-id-type="pmid">12660210</pub-id>
</citation>
</ref>
<ref id="CR62"><label>62.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hebl</surname>
<given-names>MR</given-names>
</name>
<name><surname>Xu</surname>
<given-names>J</given-names>
</name>
</person-group>
<article-title>Weighing the care: Physicians’ reactions to the size of a patient</article-title>
<source>Int J Obes Relat Metab Disord</source>
<year>2001</year>
<volume>25</volume>
<issue>8</issue>
<fpage>1246</fpage>
<lpage>1252</lpage>
<pub-id pub-id-type="doi">10.1038/sj.ijo.0801681</pub-id>
</citation>
<citation citation-type="display-unstructured">Hebl MR, Xu J. Weighing the care: Physicians’ reactions to the size of a patient. Int J Obes Relat Metab Disord. 2001;25(8):1246–52. <pub-id pub-id-type="pmid">11477511</pub-id>
</citation>
</ref>
<ref id="CR63"><label>63.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Price</surname>
<given-names>JH</given-names>
</name>
<name><surname>Desmond</surname>
<given-names>SM</given-names>
</name>
<name><surname>Krol</surname>
<given-names>RA</given-names>
</name>
<name><surname>Snyder</surname>
<given-names>FF</given-names>
</name>
<name><surname>O'Connell</surname>
<given-names>JK</given-names>
</name>
</person-group>
<article-title>Family practice physicians’ beliefs, attitudes, and practices regarding obesity</article-title>
<source>Am J Prev Med</source>
<year>1987</year>
<volume>3</volume>
<issue>6</issue>
<fpage>339</fpage>
<lpage>345</lpage>
</citation>
<citation citation-type="display-unstructured">Price JH, Desmond SM, Krol RA, Snyder FF, O'Connell JK. Family practice physicians’ beliefs, attitudes, and practices regarding obesity. Am J Prev Med. 1987;3(6):339–45. <pub-id pub-id-type="pmid">3452374</pub-id>
</citation>
</ref>
<ref id="CR64"><label>64.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Teachman</surname>
<given-names>BA</given-names>
</name>
<name><surname>Brownell</surname>
<given-names>KD</given-names>
</name>
</person-group>
<article-title>Implicit anti-fat bias among health professionals: is anyone immune?</article-title>
<source>Int J Obes Relat Metab Disord</source>
<year>2001</year>
<volume>25</volume>
<issue>10</issue>
<fpage>1525</fpage>
<lpage>1531</lpage>
<pub-id pub-id-type="doi">10.1038/sj.ijo.0801745</pub-id>
</citation>
<citation citation-type="display-unstructured">Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: is anyone immune? Int J Obes Relat Metab Disord. 2001;25(10):1525–31. <pub-id pub-id-type="pmid">11673776</pub-id>
</citation>
</ref>
<ref id="CR65"><label>65.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Stevens</surname>
<given-names>J</given-names>
</name>
<name><surname>Kumanyika</surname>
<given-names>SK</given-names>
</name>
<name><surname>Keil</surname>
<given-names>JE</given-names>
</name>
</person-group>
<article-title>Attitudes toward body size and dieting: differences between elderly black and white women</article-title>
<source>Am J Public Health</source>
<year>1994</year>
<volume>84</volume>
<issue>8</issue>
<fpage>1322</fpage>
<lpage>1325</lpage>
<pub-id pub-id-type="doi">10.2105/AJPH.84.8.1322</pub-id>
</citation>
<citation citation-type="display-unstructured">Stevens J, Kumanyika SK, Keil JE. Attitudes toward body size and dieting: differences between elderly black and white women. Am J Public Health. 1994;84(8):1322–5. <pub-id pub-id-type="pmid">8059896</pub-id>
</citation>
</ref>
<ref id="CR66"><label>66.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Anderson</surname>
<given-names>LA</given-names>
</name>
<name><surname>Eyler</surname>
<given-names>AA</given-names>
</name>
<name><surname>Galuska</surname>
<given-names>DA</given-names>
</name>
<name><surname>Brown</surname>
<given-names>DR</given-names>
</name>
<name><surname>Brownson</surname>
<given-names>RC</given-names>
</name>
</person-group>
<article-title>Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States</article-title>
<source>Prev Med</source>
<year>2002</year>
<volume>35</volume>
<issue>4</issue>
<fpage>390</fpage>
<lpage>396</lpage>
<pub-id pub-id-type="doi">10.1006/pmed.2002.1079</pub-id>
</citation>
<citation citation-type="display-unstructured">Anderson LA, Eyler AA, Galuska DA, Brown DR, Brownson RC. Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States. Prev Med. 2002;35(4):390–6. <pub-id pub-id-type="pmid">12453717</pub-id>
</citation>
</ref>
<ref id="CR67"><label>67.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Flynn</surname>
<given-names>KJ</given-names>
</name>
<name><surname>Fitzgibbon</surname>
<given-names>M</given-names>
</name>
</person-group>
<article-title>Body images and obesity risk among black females: a review of the literature</article-title>
<source>Ann Behav Med</source>
<year>1998</year>
<volume>20</volume>
<issue>1</issue>
<fpage>13</fpage>
<lpage>24</lpage>
<pub-id pub-id-type="doi">10.1007/BF02893804</pub-id>
</citation>
<citation citation-type="display-unstructured">Flynn KJ, Fitzgibbon M. Body images and obesity risk among black females: a review of the literature. Ann Behav Med. 1998;20(1):13–24. <pub-id pub-id-type="pmid">9755347</pub-id>
</citation>
</ref>
<ref id="CR68"><label>68.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Smigal</surname>
<given-names>C</given-names>
</name>
<name><surname>Jemal</surname>
<given-names>A</given-names>
</name>
<name><surname>Ward</surname>
<given-names>E</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Trends in breast cancer by race and ethnicity: update 2006</article-title>
<source>CA Cancer J Clin</source>
<year>2006</year>
<volume>56</volume>
<issue>3</issue>
<fpage>168</fpage>
<lpage>183</lpage>
<pub-id pub-id-type="doi">10.3322/canjclin.56.3.168</pub-id>
</citation>
<citation citation-type="display-unstructured">Smigal C, Jemal A, Ward E, et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin. 2006;56(3):168–83. <pub-id pub-id-type="pmid">16737949</pub-id>
</citation>
</ref>
<ref id="CR69"><label>69.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Chlebowski</surname>
<given-names>RT</given-names>
</name>
<name><surname>Chen</surname>
<given-names>Z</given-names>
</name>
<name><surname>Anderson</surname>
<given-names>GL</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Ethnicity and breast cancer: Factors influencing differences in incidence and outcome</article-title>
<source>J Natl Cancer Inst</source>
<year>2005</year>
<volume>97</volume>
<issue>6</issue>
<fpage>439</fpage>
<lpage>448</lpage>
</citation>
<citation citation-type="display-unstructured">Chlebowski RT, Chen Z, Anderson GL, et al. Ethnicity and breast cancer: Factors influencing differences in incidence and outcome. J Natl Cancer Inst. 2005;97(6):439–48. <pub-id pub-id-type="pmid">15770008</pub-id>
</citation>
</ref>
<ref id="CR70"><label>70.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Polednak</surname>
<given-names>AP</given-names>
</name>
</person-group>
<article-title>Racial differences in mortality from obesity-related chronic diseases in US women diagnosed with breast cancer</article-title>
<source>Ethn Dis</source>
<year>2004</year>
<volume>14</volume>
<issue>4</issue>
<fpage>463</fpage>
<lpage>468</lpage>
</citation>
<citation citation-type="display-unstructured">Polednak AP. Racial differences in mortality from obesity-related chronic diseases in US women diagnosed with breast cancer. Ethn Dis. 2004;14(4):463–8. <pub-id pub-id-type="pmid">15724763</pub-id>
</citation>
</ref>
<ref id="CR71"><label>71.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Li</surname>
<given-names>CI</given-names>
</name>
<name><surname>Malone</surname>
<given-names>KE</given-names>
</name>
<name><surname>Daling</surname>
<given-names>JR</given-names>
</name>
</person-group>
<article-title>Differences in breast cancer stage, treatment, and survival by race and ethnicity</article-title>
<source>Arch Intern Med</source>
<year>2003</year>
<volume>163</volume>
<issue>1</issue>
<fpage>49</fpage>
<lpage>56</lpage>
<pub-id pub-id-type="doi">10.1001/archinte.163.1.49</pub-id>
</citation>
<citation citation-type="display-unstructured">Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163(1):49–56. <pub-id pub-id-type="pmid">12523916</pub-id>
</citation>
</ref>
<ref id="CR72"><label>72.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jones</surname>
<given-names>BA</given-names>
</name>
<name><surname>Patterson</surname>
<given-names>EA</given-names>
</name>
<name><surname>Calvocoressi</surname>
<given-names>L</given-names>
</name>
</person-group>
<article-title>Mammography screening in African American women: Evaluating the research</article-title>
<source>Cancer</source>
<year>2003</year>
<volume>97</volume>
<issue>1 Suppl</issue>
<fpage>258</fpage>
<lpage>272</lpage>
<pub-id pub-id-type="doi">10.1002/cncr.11022</pub-id>
</citation>
<citation citation-type="display-unstructured">Jones BA, Patterson EA, Calvocoressi L. Mammography screening in African American women: Evaluating the research. Cancer. 2003;97(1 Suppl):258–72. <pub-id pub-id-type="pmid">12491490</pub-id>
</citation>
</ref>
<ref id="CR73"><label>73.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cui</surname>
<given-names>Y</given-names>
</name>
<name><surname>Whiteman</surname>
<given-names>MK</given-names>
</name>
<name><surname>Langenberg</surname>
<given-names>P</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Can obesity explain the racial difference in stage of breast cancer at diagnosis between black and white women?</article-title>
<source>J Womens Health Gend Based Med</source>
<year>2002</year>
<volume>11</volume>
<issue>6</issue>
<fpage>527</fpage>
<lpage>536</lpage>
<pub-id pub-id-type="doi">10.1089/152460902760277886</pub-id>
</citation>
<citation citation-type="display-unstructured">Cui Y, Whiteman MK, Langenberg P, et al. Can obesity explain the racial difference in stage of breast cancer at diagnosis between black and white women? J Womens Health Gend Based Med. 2002;11(6):527–36. <pub-id pub-id-type="pmid">12225626</pub-id>
</citation>
</ref>
<ref id="CR74"><label>74.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Moorman</surname>
<given-names>PG</given-names>
</name>
<name><surname>Jones</surname>
<given-names>BA</given-names>
</name>
<name><surname>Millikan</surname>
<given-names>RC</given-names>
</name>
<name><surname>Hall</surname>
<given-names>IJ</given-names>
</name>
<name><surname>Newman</surname>
<given-names>B</given-names>
</name>
</person-group>
<article-title>Race, anthropometric factors, and stage at diagnosis of breast cancer</article-title>
<source>Am J Epidemiol</source>
<year>2001</year>
<volume>153</volume>
<issue>3</issue>
<fpage>284</fpage>
<lpage>291</lpage>
<pub-id pub-id-type="doi">10.1093/aje/153.3.284</pub-id>
</citation>
<citation citation-type="display-unstructured">Moorman PG, Jones BA, Millikan RC, Hall IJ, Newman B. Race, anthropometric factors, and stage at diagnosis of breast cancer. Am J Epidemiol. 2001;153(3):284–91. <pub-id pub-id-type="pmid">11157416</pub-id>
</citation>
</ref>
<ref id="CR75"><label>75.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Zhu</surname>
<given-names>K</given-names>
</name>
<name><surname>Caulfield</surname>
<given-names>J</given-names>
</name>
<name><surname>Hunter</surname>
<given-names>S</given-names>
</name>
<name><surname>Roland</surname>
<given-names>CL</given-names>
</name>
<name><surname>Payne-Wilks</surname>
<given-names>K</given-names>
</name>
<name><surname>Texter</surname>
<given-names>L</given-names>
</name>
</person-group>
<article-title>Body mass index and breast cancer risk in African American women</article-title>
<source>Ann Epidemiol</source>
<year>2005</year>
<volume>15</volume>
<issue>2</issue>
<fpage>123</fpage>
<lpage>128</lpage>
<pub-id pub-id-type="doi">10.1016/j.annepidem.2004.05.011</pub-id>
</citation>
<citation citation-type="display-unstructured">Zhu K, Caulfield J, Hunter S, Roland CL, Payne-Wilks K, Texter L. Body mass index and breast cancer risk in African American women. Ann Epidemiol. 2005;15(2):123–8. <pub-id pub-id-type="pmid">15652717</pub-id>
</citation>
</ref>
<ref id="CR76"><label>76.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lannin</surname>
<given-names>DR</given-names>
</name>
<name><surname>Mathews</surname>
<given-names>HF</given-names>
</name>
<name><surname>Mitchell</surname>
<given-names>J</given-names>
</name>
<name><surname>Swanson</surname>
<given-names>MS</given-names>
</name>
<name><surname>Swanson</surname>
<given-names>FH</given-names>
</name>
<name><surname>Edwards</surname>
<given-names>MS</given-names>
</name>
</person-group>
<article-title>Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer</article-title>
<source>JAMA</source>
<year>1998</year>
<volume>279</volume>
<issue>22</issue>
<fpage>1801</fpage>
<lpage>1807</lpage>
<pub-id pub-id-type="doi">10.1001/jama.279.22.1801</pub-id>
</citation>
<citation citation-type="display-unstructured">Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998;279(22):1801–7. <pub-id pub-id-type="pmid">9628711</pub-id>
</citation>
</ref>
<ref id="CR77"><label>77.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lantz</surname>
<given-names>PM</given-names>
</name>
<name><surname>Mujahid</surname>
<given-names>M</given-names>
</name>
<name><surname>Schwartz</surname>
<given-names>K</given-names>
</name>
<etal></etal>
</person-group>
<article-title>The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis</article-title>
<source>Am J Public Health</source>
<year>2006</year>
<volume>96</volume>
<issue>12</issue>
<fpage>2173</fpage>
<lpage>2178</lpage>
<pub-id pub-id-type="doi">10.2105/AJPH.2005.072132</pub-id>
</citation>
<citation citation-type="display-unstructured">Lantz PM, Mujahid M, Schwartz K, et al. The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis. Am J Public Health. 2006;96(12):2173–8. <pub-id pub-id-type="pmid">17077391</pub-id>
</citation>
</ref>
<ref id="CR78"><label>78.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Smith-Bindman</surname>
<given-names>R</given-names>
</name>
<name><surname>Miglioretti</surname>
<given-names>DL</given-names>
</name>
<name><surname>Lurie</surname>
<given-names>N</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Does utilization of screening mammography explain racial and ethnic differences in breast cancer?</article-title>
<source>Ann Intern Med</source>
<year>2006</year>
<volume>144</volume>
<issue>8</issue>
<fpage>541</fpage>
<lpage>553</lpage>
</citation>
<citation citation-type="display-unstructured">Smith-Bindman R, Miglioretti DL, Lurie N, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 2006;144(8):541–53. <pub-id pub-id-type="pmid">16618951</pub-id>
</citation>
</ref>
<ref id="CR79"><label>79.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>McCarthy</surname>
<given-names>EP</given-names>
</name>
<name><surname>Burns</surname>
<given-names>RB</given-names>
</name>
<name><surname>Coughlin</surname>
<given-names>SS</given-names>
</name>
<etal></etal>
</person-group>
<article-title>Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women</article-title>
<source>Ann Intern Med</source>
<year>1998</year>
<volume>128</volume>
<issue>9</issue>
<fpage>729</fpage>
<lpage>736</lpage>
</citation>
<citation citation-type="display-unstructured">McCarthy EP, Burns RB, Coughlin SS, et al. Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women. Ann Intern Med. 1998;128(9):729–36. <pub-id pub-id-type="pmid">9556466</pub-id>
</citation>
</ref>
<ref id="CR80"><label>80.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jones</surname>
<given-names>BA</given-names>
</name>
<name><surname>Kasl</surname>
<given-names>SV</given-names>
</name>
<name><surname>Curnen</surname>
<given-names>MG</given-names>
</name>
<name><surname>Owens</surname>
<given-names>PH</given-names>
</name>
<name><surname>Dubrow</surname>
<given-names>R</given-names>
</name>
</person-group>
<article-title>Can mammography screening explain the race difference in stage at diagnosis of breast cancer?</article-title>
<source>Cancer</source>
<year>1995</year>
<volume>75</volume>
<issue>8</issue>
<fpage>2103</fpage>
<lpage>2113</lpage>
<pub-id pub-id-type="doi">10.1002/1097-0142(19950415)75:8<2103::AID-CNCR2820750813>3.0.CO;2-2</pub-id>
</citation>
<citation citation-type="display-unstructured">Jones BA, Kasl SV, Curnen MG, Owens PH, Dubrow R. Can mammography screening explain the race difference in stage at diagnosis of breast cancer? Cancer. 1995;75(8):2103–13. <pub-id pub-id-type="pmid">7697601</pub-id>
</citation>
</ref>
<ref id="CR81"><label>81.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jacobellis</surname>
<given-names>J</given-names>
</name>
<name><surname>Cutter</surname>
<given-names>G</given-names>
</name>
</person-group>
<article-title>Mammography screening and differences in stage of disease by race/ethnicity</article-title>
<source>Am J Public Health</source>
<year>2002</year>
<volume>92</volume>
<issue>7</issue>
<fpage>1144</fpage>
<lpage>1150</lpage>
<pub-id pub-id-type="doi">10.2105/AJPH.92.7.1144</pub-id>
</citation>
<citation citation-type="display-unstructured">Jacobellis J, Cutter G. Mammography screening and differences in stage of disease by race/ethnicity. Am J Public Health. 2002;92(7):1144–50. <pub-id pub-id-type="pmid">12084699</pub-id>
</citation>
</ref>
<ref id="CR82"><label>82.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gill</surname>
<given-names>KS</given-names>
</name>
<name><surname>Yankaskas</surname>
<given-names>BC</given-names>
</name>
</person-group>
<article-title>Screening mammography performance and cancer detection among black women and white women in community practice</article-title>
<source>Cancer</source>
<year>2004</year>
<volume>100</volume>
<issue>1</issue>
<fpage>139</fpage>
<lpage>148</lpage>
<pub-id pub-id-type="doi">10.1002/cncr.11878</pub-id>
</citation>
<citation citation-type="display-unstructured">Gill KS, Yankaskas BC. Screening mammography performance and cancer detection among black women and white women in community practice. Cancer. 2004;100(1):139–48. <pub-id pub-id-type="pmid">14692034</pub-id>
</citation>
</ref>
<ref id="CR83"><label>83.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Burkhauser</surname>
<given-names>RV</given-names>
</name>
<name><surname>Cawley</surname>
<given-names>J</given-names>
</name>
</person-group>
<article-title>Beyond BMI: The value of more accurate measures of fatness and obesity in social science research</article-title>
<source>J Health Econ</source>
<year>2008</year>
<volume>27</volume>
<issue>2</issue>
<fpage>519</fpage>
<lpage>529</lpage>
<pub-id pub-id-type="doi">10.1016/j.jhealeco.2007.05.005</pub-id>
</citation>
<citation citation-type="display-unstructured">Burkhauser RV, Cawley J. Beyond BMI: The value of more accurate measures of fatness and obesity in social science research. J Health Econ. 2008 3;27(2):519–29. <pub-id pub-id-type="pmid">18166236</pub-id>
</citation>
</ref>
<ref id="CR84"><label>84.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rowland</surname>
<given-names>ML</given-names>
</name>
</person-group>
<article-title>Self-reported weight and height</article-title>
<source>Am J Clin Nutr</source>
<year>1990</year>
<volume>52</volume>
<fpage>1125</fpage>
<lpage>1133</lpage>
</citation>
<citation citation-type="display-unstructured">Rowland ML. Self-reported weight and height. Am J Clin Nutr. 1990;52:1125–33. <pub-id pub-id-type="pmid">2239790</pub-id>
</citation>
</ref>
<ref id="CR85"><label>85.</label>
<citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rauscher</surname>
<given-names>GH</given-names>
</name>
<name><surname>Johnson</surname>
<given-names>TP</given-names>
</name>
<name><surname>Cho</surname>
<given-names>YI</given-names>
</name>
<name><surname>Walk</surname>
<given-names>JA</given-names>
</name>
</person-group>
<article-title>Accuracy of self-reported cancer-screening histories: a meta-analysis</article-title>
<source>Cancer Epidemiol Biomarkers Prev</source>
<year>2008</year>
<volume>17</volume>
<issue>4</issue>
<fpage>748</fpage>
<lpage>757</lpage>
<pub-id pub-id-type="doi">10.1158/1055-9965.EPI-07-2629</pub-id>
</citation>
<citation citation-type="display-unstructured">Rauscher GH, Johnson TP, Cho YI, Walk JA. Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2008;17(4):748–57. <pub-id pub-id-type="pmid">18381468</pub-id>
</citation>
</ref>
</ref-list>
<fn-group><fn><p>Preliminary results from this project were presented in a poster at the 2007 Society of General Internal Medicine national meeting in Toronto on April 26, 2007.</p>
</fn>
<fn><p>Dr. Maruthur was supported by a training grant (5 T32 HL007024–31) from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH). Dr. Brancati was supported by a mid-career investigator award (5 K24 DK062222–05) from the National Institute of Diabetes and Digestive and Kidney Diseases, NIH.</p>
</fn>
</fn-group>
</back>
</pmc>
</record>

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Obesity and Mammography: A Systematic Review and Meta-Analysis

Obesity and Mammography: A Systematic Review and Meta-Analysis

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