TABLE 1.

Studies included in the review

Ref	Title and author	Year	Country	Aim of study	Participant type and number	Type of study	Type of screening	Main findings	Recommendations
18	Family physicians' barriers to cancer screening in extremely obese patients Ferrante JM, Fyffe DC, Vega ML, et al.Obesity, 18(4):1153‐1159	2010	USA	To better understand the barriers that family physicians face in performing breast and cervical screening examination in women living with higher levels of obesity	Family physicians (n = 270)	Mixed methods (interviews, n = 15 and surveys, n = 255)	Breastcervical	Main barriers: Difficulty performing breast and pelvic exams Inadequate equipment, Challenges overcoming patient barriers and refusal of screening	Future interventions should focus on educating physicians on specific exam techniques, provision of adequate equipment and supplies, and identifying resources to assist with patient barriers and refusal of screening
19	The determinants of cervical cancer screening uptake in women with obesity: Application of the Andersen's behavioral model to the CONSTANCES survey Franck JE, Ringa V, Coeuret‐Pellicer et al. Cancer Causes and Control, 31(1):51‐62	2020	France	To explore the clinical and healthcare related determinants of CCS uptake among women living with obesity	Women aged 25–65 years living with obesity (n = 2934)	Survey	Cervical	Women with obesity were more likely to uptake CCS if they had regular follow‐up by a gynecologist, good quality of primary care, and comorbidities. Being older, single, having no children, having limited literacy, and financial strain were barriers to screening uptake.	Further efforts are needed to increase CCS uptake, including reducing obstacles to CCS among women living with obesity
20	Patterns of gynecological check‐up and their association with Body Mass Index within the CONSTANCES cohort Franck JE, Ringa V, Rigal L, et al.Journal of Medical Screening, 10.1177/0969141320914323	2020	France	To identify patterns of gynecological check‐up and regularity of breast and cervical cancer screening and the association of body mass index	Women aged 54–65 years (n = 6182)	Survey	CervicalBreast	Women living with obesity were most commonly found to have no or inappropriate check‐ups. Women living with obesity and overweight were screened for breast cancer more than cervical cancer and were not over‐screened as often as normal weight women.	The healthcare system should adapt to be a more supportive and welcoming environment for women with obesity in order to increase cancer screening uptake.
21	Obese women's barriers to mammography and Pap smear: The possible role of personality Friedman AM, Hemler JR, Rossetti E, et al.Obesity, 24(8) 1611‐1617	2012	USA	To explore the perspectives of obese women in relation to barriers to both cervical and breast cancer screening	Women with obesity aged ≥40 (n = 51)	Qualitative (interviews n = 33, focus groups n = 18)	Breastcervical	Barriers to screening included fear, modesty, competing demands, low perceived risk of cancer, insensitive comments from healthcare professionals, embarrassment, and unsuitable gowns and equipment. Personality traits such as self‐motivation and self‐discipline may play a role in some women with obesity overcoming barriers to screening.	Interventions are warranted to decrease weight bias in healthcare settings. Future research should explore the role of personality as a potential mediator in health behavior, including cancer screening uptake
22	Body mass index and participation in organized mammographic screening: a prospective cohort study Hellman SS, Njor SH, Lynge E et al.BMC Cancer, 15:294	2015	Denmark	To explore the association between BMI and breast cancer screening participation	Women aged 50–64 and free of cancer (n = 5134)	Prospective cohort	Breast	Underweight and postmenopausal women with obesity were less likely to participate in breast screening than women of normal weight. BMI was not related to screening uptake in premenopausal women.	Targeted information about breast cancer screening should be provided for women living with obesity and underweight postmenopausal women in an attempt to increase breast cancer screening uptake.
23	Race moderates the relationship between obesity and colorectal cancer screening in women Leone LA, Campbell MK, Satia JA, et alCancer Causes Control, 21(3):373‐385	2010	USA	To determine whether or not race moderates the relationship between CRC screening and obesity in women	White and African‐American women aged ≥50 years of age (n = 7469)	Survey	Colorectal	White women with obesity were less likely to participate in colorectal cancer screening than white women of a normal weight (excluding fecal occult blood test where participation rates did not differ). Conversely, African‐American women with obesity had a higher rate of colonoscopy than African‐American women without obesity. White women with obesity had the lowest colonoscopy rates. Physician recommendation had the largest impact on screening uptake across all participants.	Further qualitative research is warranted to explore how weight affects women's decisions regarding cancer screening.
24	Double discourse: qualitative perspectives on breast screening participation among obese women and their healthcare providers. McBride KA, Fleming CAK, George ES, et al/International Journal of Environmental Research and Public Health, 16:534	2019	Australia	To identify facilitators and barriers in the uptake of breast cancer screening among obese women and to explore healthcare provider perspectives on service provision for breast cancer screening among obese women	Women aged 45–80 with obesity/healthcare providers (n = 29)	Qualitative	Breast	3 key themes were identified from women living with obesity which impacted on screening uptake: Women living with obesity's awareness and understanding of screening Body image concerns among women with obesity Women living with obesity's negative screening experiences2 key themes were identified from healthcare providers: Provider reported experiences with women living with obesity attending screening Providers do not see obesity as a barrier to screening	Novel health promotion strategies should be trialled to raise awareness of the increased risk of cancer among obese women. Improvements to the healthcare system are warranted including the provision of appropriate equipment for women with obesity, education for staff, and information for women living with obesity regarding issues like longer screening times due to increased weight.
25	Body Mass Index and screening for colorectal cancer: gender and attitudinal factors Messina CR, Lane DS, Anderson JCCancer Epidemiology, 35:400‐408	2012	USA	To explore the association between BMI and colorectal cancer screening uptake, the role of gender in this relationship, and the impact of attitudes and perception about colorectal cancer and screening.	Women and men aged 50–75 (n = 1098)	Survey	Colorectal	Women with obesity and overweight were less likely to partake in colorectal cancer screening than women with normal weight. BMI category did not influence screening uptake in men. Women with obesity were less aware of the increased risk of colorectal cancer among people with obesity, and were less worried about colorectal cancer.	Future research is warranted to fully understand the process by which BMI affects colorectal cancer screening uptake. There is a need for interventions to increase awareness of the need for colorectal cancer screening, including discussions about weight‐associated risk for colorectal cancer.
26	National disparities in colorectal cancer screening among obese adults Seibert RG, Hanchate AD, Berz JP, et al American Journal of Preventive Medicine, 53(2):e41‐49	2017	USA	To explore the uptake of colorectal screening among obese older adults and identify obesity‐specific screening barriers.	Men and women aged 50–75 (n = 8550)	Survey	Colorectal	Men with severe and complex obesity were less likely to be up to date with screening. There was no difference in screening uptake among women according to weight status. Men living with obesity reported a lack of physician screening recommendation as the most important screening barrier. Women with obesity were more likely than women with normal body weight to report pain and embarrassment as a barrier to screening uptake.	Healthcare providers should recognize obesity‐specific screening barriers and tailor strategies to encourage screening uptake in this population.
27	Use of mammography, Pat test and prostrate examination by body mass index during the development period of cancer screening in Estonia Tekkel M, Veideman T, Rahu MPublic Health, 125:697‐703	2011	Estonia	To explore the uptake of breast, cervical and prostate cancer screening according to BMI	Men aged 50–64, women aged 25–64 (n = 7286)	Survey	CervicalBreastProstate	Women with overweight were more likely to partake in breast cancer screening compared to normal weight women. women living with severe and complex obesity were less likely to partake in cervical cancer screening. Prostate examination did not differ according to BMI.	Clinicians should ensure people living with obesity are referred for cancer screening due to the increased risk and worse prognosis people with a higher BMI