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Cited by 373Bariatric Surgery and OutcomesCancer Risks and FactorsEsophageal Cancer Research and Treatment

Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort

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Schauer, Daniel P., Feigelson, Heather Spencer, Koebnick, Corinna, Caan, Bette, Weinmann, Sheila, Leonard, Anthony C., Powers, J. David, Yenumula, Panduranga R. +1 more·2019·Annals of Surgery
DOI 10.1097/sla.0000000000002525PMC PMC6201282
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Abstract

Objective: To determine whether bariatric surgery is associated with a lower risk of cancer. Background: Obesity is strongly associated with many types of cancer. Few studies have examined the relationship between bariatric surgery and cancer risk. Methods: We conducted a retrospective cohort study of patients undergoing bariatric surgery between 2005 and 2012 with follow-up through 2014 using data from a large integrated health insurance and care delivery systems with 5 study sites. The study included 22,198 subjects who had bariatric surgery and 66,427 nonsurgical subjects matched on sex, age, study site, body mass index, and Elixhauser comorbidity index. Multivariable Cox proportional-hazards models were used to examine incident cancer up to 10 years after bariatric surgery compared to the matched nonsurgical patients. Results: After a mean follow-up of 3.5 years, we identified 2543 incident cancers. Patients undergoing bariatric surgery had a 33% lower hazard of developing any cancer during follow-up [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.60, 0.74, P < 0.001) compared with matched patients with severe obesity who did not undergo bariatric surgery, and results were even stronger when the outcome was restricted to obesity-associated cancers (HR 0.59, 95% CI 0.51, 0.69, P < 0.001). Among the obesity-associated cancers, the risk of postmenopausal breast cancer (HR 0.58, 95% CI 0.44, 0.77, P < 0.001), colon cancer (HR 0.59, 95% CI 0.36, 0.97, P = 0.04), endometrial cancer (HR 0.50, 95% CI 0.37, 0.67, P < 0.001), and pancreatic cancer (HR 0.46, 95% CI 0.22, 0.97, P = 0.04) was each statistically significantly lower among those who had undergone bariatric surgery compared with matched nonsurgical patients. Conclusions: In this large, multisite cohort of patients with severe obesity, bariatric surgery was associated with a lower risk of incident cancer, particularly obesity-associated cancers, such as postmenopausal breast cancer, endometrial cancer, and colon cancer. More research is needed to clarify the specific mechanisms through which bariatric surgery lowers cancer risk.

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  • Multiple studies have shown that MBS reduces the risk of developing cancer in the population with class II/III obesity, ranging from 11% to 50% for all cancer types.

    “Multiple studies have shown that MBS reduces the risk of developing cancer in the population with class II/III obesity, ranging from 11% to 50% for all cancer types [130, 134–137].”

    From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [130]

    The Results (page not available) report a 33% lower hazard of developing any cancer after bariatric surgery in a cohort with BMI ≥35 kg/m². The Discussion (page not available) also reports lower total cancer incidence in prior studies. This source supports the general finding, but not the full stated 11%–50% range; as an observational study, it describes an association rather than establishing that surgery causes the reduction. (LLM, conf=0.87)

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  • After bariatric surgery, cardiometabolic health, cancer risk, and life expectancy may improve dramatically even if BMI remains in the obesity range.

    “Maintaining a so-called normal body weight or BMI is unnecessary after having bariatric surgery as cardiometabolic health, cancer risk, and life expectancy may improve dramatically even if BMI remains in the obesity range (104–106).”

    From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [106]

    The Results (page not supplied) report a 33% lower hazard of cancer after bariatric surgery than in matched controls. The Introduction says diabetes and metabolic syndrome often improve and mentions a possible mortality benefit, but the study does not establish improved life expectancy or show that these benefits occur when postoperative BMI remains in the obesity range. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Reductions in incident cancer cases were most notable for obesity-associated cancers such as postmenopausal breast, endometrial, and colon cancer.

    “The reductions in incident cancer cases were most notable for obesity-associated cancers such as postmenopausal breast and endometrial cancer, and colon cancer.”

    From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [94]

  • Prospective cohort study by Schauer et al. revealed marked reduction in incident cancer cases in obese subjects who underwent bariatric surgery compared with nonsurgical counterparts.

    “Consistent with the data on reduced cancer mortality following bariatric surgery is the prospective cohort study by Schauer et al., which revealed a marked reduction in the incident cases of cancer in obese subjects who underwent bariatric surgery compared with their nonsurgical counterparts [94].”

    From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [94]

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  1. [23]Sjostrom L, Gummesson A, Sjostrom CD, Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. The Lancet. Oncology 2009; 10: 653– 62. 19556163

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Authors
Schauer, D. P., Feigelson, H. S., Koebnick, C., Caan, B., Weinmann, S., Leonard, A. C., Powers, J. D., Yenumula, P. R., & Arterburn, D. E.
Affiliations
  • University of Cincinnati (US)
  • Kaiser Permanente (US)
  • Kaiser Permanente Northern California (US)
  • University of Cincinnati Medical Center (US)
  • Kaiser Permanente Washington Health Research Institute (US)
Corresponding author
  • Schauer, Daniel P.
  • Arterburn, David E.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-01
Volume
269
Issue
1
Pages
95-101
ISSN
  • 0003-4932 (ISSN-L)
  • 1528-1140
DOI
10.1097/sla.0000000000002525
PMC
PMC6201282
OpenAlex
W2760432946
Cited by
373
References
38
Citations by year
2026: 20 · 2025: 25 · 2024: 41 · 2023: 64 · 2022: 61 · 2021: 66 · 2020: 45 · 2019: 27 · 2018: 19 · 2017: 2
FWCI
26.04
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R01CA175346)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Health Sciences › Medicine › Surgery › Esophageal Cancer Research and Treatment
Keywords
bariatric surgery, cancer risk, obesity, obesity-related cancer, postmenopausal breast cancer, colon cancer, endometrial cancer, pancreatic cancer, morbid obesity, cancer incidence, matched cohort comparison, Elixhauser comorbidity index, body mass index, postoperative follow-up, health insurance claims data, health care costs
MeSH terms
Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Obesity, Morbid, Prognosis, Retrospective Studies, Time Factors, United States, Body Mass Index, Incidence, Bariatric Surgery, Young Adult

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