Screening Mammography Adherence Improves After Bariatric Surgery

Abstract

Introduction

Poor adherence to mammography screening guidelines has been reported in women with obesity. However, bariatric surgery has been associated with lower incidence of breast cancer postoperatively. The mechanisms for this protective effect are unknown. We examined the relationship between bariatric surgery and screening mammography adherence.

Methods

Using a commercial health insurance claims database, all female patients between ages 40 and 64 who underwent bariatric surgery were identified and compared to three control groups who did not undergo bariatric surgery stratified across obesity-related billing codes. Screening mammography rates were calculated as the total number of screenings divided by the total person-years of follow-up. THe screening rate was standardized to a frequency of 1 exam every 2 y based on United States Preventative Services Taskforce guidelines. We ran multivariable Poisson regression models of the rate of mammography screening, adjusting for sociodemographic factors and comorbidities.

Results

The rates of screening were 0.91 of the recommended frequency in bariatric surgery patients prior to surgery and 1.22 of the recommended frequency after surgery (P < 0.001). In multivariable models, bariatric surgery patients had a significantly lower rate of mammogram screening in the presurgical period (incidence rate ratio 0.99, 95% CI 0.98-0.99, P = 0.025) and a significantly higher rate in the postsurgical period (incidence rate ratio 1.34, 95% CI 1.32-1.35, P < 0.001) relative to the “no obesity” control group.

Conclusions

The rate of adherence to recommended mammography screening for breast cancer increased following bariatric surgery. This suggests that women with obesity may experience improved mammography screening adherence following bariatric surgery.