Avoiding Sexual and Reproductive Health Cancer Screenings: How Are Body Image and Weight Stigma Related?

Background: This study examined the role of body image and weight stigma in avoiding sexual and reproductive health (SRH) cancer screenings, including pap smears, clinical breast exams, and mammograms. Previous research has found that body image and weight stigma are related to avoiding healthcare, but this relationship with cancer screenings has not been previously examined.

Methods: We conducted a cross-sectional survey of 384 cisgender women over the age of 18 (mean age = 33 years) who lived in the United States at the time of the survey. Participants were recruited through social media and were compensated with a $5 gift card. We measured genital body image with the Female Genital Self-Image Scale, a 7-item scale (Herbenick & Reece, 2010), weight stigma with the Weight Self-Stigma Questionnaire, a 12-item scale (Lillis et al., 2012), and included three outcome variables, all measured with one item: ever avoided a pap smear, clinical breast exam, and mammogram for a reason related to weight (i.e., to avoid being weighed and to avoid discussing my weight and/or body mass index (BMI)). We included BMI and age as covariates.

Results: Using IBM SPSS 27, we tested our data for statistical assumptions and then ran descriptive analyses and a series of three logistic regression analyses to test our hypothesis: that the relationship between genital body image and avoiding SRH cancer screenings would be moderated by weight self-stigma. We found that 14.6% avoided a pap smear, 15.4% avoided a clinical breast exam, and 14.1% avoided a mammogram for weight-related reasons. The interaction term was significant for all three outcome variables (OR range = .98-.99), supporting our hypothesis.

Conclusions & Implications: This study provides additional evidence that body image and weight stigma are related to healthcare avoidance, but specifically extends this literature to include SRH cancer screenings. Additional research is needed to replicate our findings and to identify other confounding variables. However, given the importance of early screening and intervention for individuals with a uterus who are diagnosed with breast and genital cancers, this line of inquiry could have critical health implications. Importantly, social workers may have the opportunity to intervene through medical social work and as mental health care providers.