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Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort
Open accessAbstract
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 [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]
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“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]
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“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]
In the citing paper
“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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Lee, E., Kawaguchi, E. S., Zhang, J., Kim, S. E., Deapen, D., Liu, L., Sheidaee, N., Hwang, A. E., Kang, I. M., Sandhu, K. K., et al. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.09.017 · Cited by 11
Breininger, S. P., Sabater, L., Malcomson, F. C., Afshar, S., Mann, J., & Mathers, J. C. (2021) · International Journal of Obesity · doi:10.1038/s41366-021-01005-y · Cited by 11
Sjöholm, K., Andersson‐Assarsson, J. C., Kristensson, F. M., Hjorth, S., Garelius, H. G., Jacobson, P., Svensson, P., Ahlin, S., Carlsson, B., Peltonen, M., et al. (2023) · The Lancet Healthy Longevity · doi:10.1016/s2666-7568(23)00141-1 · Cited by 11
Bariatric surgery and diabetes: Current challenges and perspectives
He, Y., Hu, X.-D., Liu, J., Li, H., & Lu, S.-F. (2024) · World Journal of Diabetes · doi:10.4239/wjd.v15.i8.1692 · Cited by 12
Angelidi, A. M., Martinou, E., & Karamanis, D. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3844 · Cited by 11
The Impact of Bariatric Surgery on Pancreatic Cancer Risk: a Systematic Review and Meta-Analysis
Fan, H.-D., Mao, Q., Zhang, W., Fang, Q., Zou, Q., & Gong, J. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06570-x · Cited by 10
Weight-loss thresholds after bariatric surgery and cardiovascular outcomes: more is better
Jiménez, A., Pané, A., Ibarzábal, A., de Hollanda, A., Tundidor, D., Balibrea, J. M., Andreu, A., Molero, J., Cañizares, S., Obach, A., et al. (2021) · International Journal of Obesity · doi:10.1038/s41366-021-00986-0 · Cited by 12
Akpinar, E. O., Nienhuijs, S. W., Liem, R. S. L., Greve, J. W. M., & de Mheen, P. J. M. (2022) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.04.003 · Cited by 10
Changes in mammographic density following bariatric surgery
Hosseini, A., Khoury, A. L., Varghese, F., Carter, J. T., Wong, J., & Mukhtar, R. A. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.03.037 · Cited by 10
Laïnas, P., Soueidy, T. E., Amor, I. B., Courie, R., Perlemuter, G., Gugenheim, J., & Dagher, I. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2020.07.034 · Cited by 9
Wei, Y., Wong, S. K., Wu, T., Law, B. T. T., Ng, E. K., Lam, C. L. K., & Wong, C. K. H. (2021) · Journal of Diabetes · doi:10.1111/1753-0407.13179 · Cited by 9
Desai, D., Singhal, S., & Koka, J. M. (2022) · Cureus · doi:10.7759/cureus.23976 · Cited by 9
Obesity, sleeve gastrectomy and gastro-esophageal reflux disease
Véziant, J., Benhalima, S., Piessen, G., & Slim, K. (2023) · Journal of Visceral Surgery · doi:10.1016/j.jviscsurg.2023.01.004 · Cited by 9
Dietary and pharmacological energy restriction and exercise for healthspan extension
Cagigas, M. L., Ciutiis, I. D., Masedunskas, A., & Fontana, L. (2025) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2025.04.001 · Cited by 12
Gómez, C. O., Funes, D. A. R., Blanco, D. G., Frieder, J. S., Fonseca-Mora, M., Menzo, E. L., Szomstein, S., & Rosenthal, R. J. (2019) · Surgical Endoscopy · doi:10.1007/s00464-019-07094-1 · Cited by 9
Ruze, R., Xiong, Y., Li, J., Zhong, M., Xu, Q., Yan, Z.-B., Zhu, J., Cheng, Y., Hu, S., & Zhang, G. (2020) · World Journal of Gastroenterology · doi:10.3748/wjg.v26.i20.2599 · Cited by 8
James, T. J., Sener, S. F., Nguyen, J. D., Rothschild, M., Hawley, L., Patel, T. A., Sargent, R. E., & Dobrowolsky, A. B. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05539-y · Cited by 9
The impact of bariatric surgery on qualitative and quantitative breast density
Hassinger, T. E., Mehaffey, J. H., Knisely, A. T., Contrella, B. N., Brenin, D. R., Schroen, A. T., Schirmer, B. D., Hallowell, P. T., Harvey, J. A., & Showalter, S. L. (2019) · The Breast Journal · doi:10.1111/tbj.13430 · Cited by 9
Cancer incidence, type, and survival after bariatric surgery
Miller, J., Borgert, A. J., Fitzsimmons, A. J., Mellion, K. M., Pfeiffer, J. D., & Grover, B. T. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.03.009 · Cited by 8
Cushing Syndrome Is Associated With a Higher Risk of Cancer—A Nationwide Cohort Study
Wu, W.-C., Wu, J.-L., Huang, T., Li, C., & Li, H. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae405 · Cited by 8
Does Bariatric Surgery Increase or Reduce Colorectal Cancer Risk—Is the Jury Still Out?
Davidson, L. E., & Adams, T. D. (2020) · JAMA Surgery · doi:10.1001/jamasurg.2020.0090 · Cited by 8
Liu, Y.-N., Gu, J., Zhang, J., Xing, D.-Y., & Wang, G. (2023) · World Journal of Gastrointestinal Surgery · doi:10.4240/wjgs.v15.i10.2331 · Cited by 9
Gastric Cancer After Laparoscopic Sleeve Gastrectomy: a Case Report and Literature Review
Orellana, M., Soto, P., Brañes, A., Pimentel, F., & Muñoz, R. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05307-y · Cited by 8
Financial Incentives to Improve Patient Follow-up and Weight Loss After Bariatric Surgery
Chao, G. F., Kullgren, J. T., Ross, R., Bonham, A. J., & Ghaferi, A. A. (2021) · Annals of Surgery · doi:10.1097/sla.0000000000005013 · Cited by 8
Madar, L.-O., Goldberg, N., Netz, U., Berenstain, I. F., Zeid, E. E. D. A., Avital, I., & Perry, Z. H. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.10.023 · Cited by 7
Phipps, D., & Helton, M. R. (2023) · Springer eBooks · doi:10.1007/978-3-031-29171-5_2 · Cited by 7
Metadata
- 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
- Published
- 2019-01
- Volume
- 269
- Issue
- 1
- Pages
- 95-101
- ISSN
- 0003-4932 (ISSN-L)
- 1528-1140
- 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
- FWCI
- 26.04
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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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