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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]
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“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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Pachimatla, A. G., Gee, K. N., Hsiao, H.-H., Yendamuri, S., & Rosario, S. R. (2024) · Annals of Surgical Oncology · doi:10.1245/s10434-024-16402-6 · Cited by 2
Sleeve Gastrectomy in Mice using Surgical Clips
Wei, J.-H., Yeh, C.-H., Lee, W., Lin, S., & Huang, P. (2020) · Journal of Visualized Experiments · doi:10.3791/60719 · Cited by 2
Bariatric Surgery in Older Adults
Giordano, S. A., Oranges, C. M., Cherubino, M., & Summa, P. G. D. (2020) · Springer eBooks · doi:10.1007/978-3-319-90761-1_30-1 · Cited by 2
Paccou, J., Genser, L., Lespessailles, É., Bertin, É., Javier, R., Duclos, M., Joly, A.-S., Boirie, Y., Pattou, F. N., Delarue, J., et al. (2022) · Revue du Rhumatisme · doi:10.1016/j.rhum.2022.10.005 · Cited by 1
Valera, R. J., Sarmiento-Cobos, M. F., Montorfano, L. M., Patnaik, R., Liang, H., Menzo, E. L., Szomstein, S., & Rosenthal, R. J. (2023) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2023.04.327 · Cited by 1
Long-Term Cancer Outcomes Following Bariatric Surgery: A Comparative Analysis of Surgical Procedures
Kim, J., Ben‐Umeh, K. C., Kelley, J. J., Davidson, L. E., Hashibe, M., Smith, K. R., Richards, N. G., & Adams, T. D. (2024) · Cancers · doi:10.3390/cancers16223730 · Cited by 1
Bariatrische Chirurgie im Vergleich zu GLP-1- und dualen GIP/GLP-1-Rezeptor-Agonisten
Ordemann, J., & Elbelt, U. (2025) · Herz · doi:10.1007/s00059-025-05319-9 · Cited by 1
Preoperative endoscopy in revisional bariatric surgery: who should hold the scope?
Carandina, S., Avallone, S., Zulian, V., Angrisani, F., Angrisani, L., & Iannelli, A. (2025) · Journal of Gastrointestinal Surgery · doi:10.1016/j.gassur.2025.102303 · Cited by 2
Upper gastrointestinal cancer risk following bariatric surgery: meta-analysis
Cooke, H., Harewood, R., Hossain, N., Cross, A. J., & Murphy, G. A. (2026) · BJS Open · doi:10.1093/bjsopen/zrag006 · Cited by 1
Risk of pancreatic cancer associated with GLP-1 receptor agonist therapy
Krishna, S., Dungan, K. M., Shah, R., Cruz‐Monserrate, Z., DelGiorno, K. E., Tan, M., & Hart, P. A. (2026) · npj gut and liver. · doi:10.1038/s44355-026-00069-9 · Cited by 1
Colon Cancer After One Anastomosis Gastric Bypass: a Case Report
Atarodi, H., Karami, R., Aghajani, E., Kermansaravi, M., & Pazouki, A. (2020) · Obesity Surgery · doi:10.1007/s11695-020-05063-5 · Cited by 1
Mazaheri, T., Ansari, S., Nallagonda, M., Kollmann, L., Nickel, F., Seyfried, F., & Miras, A. D. (2023) · Die Chirurgie · doi:10.1007/s00104-023-01830-z · Cited by 2
A review of the impact of energy balance on triple-negative breast cancer
Akingbesote, N. D., Owusu, D., Liu, R., Cartmel, B., Ferrucci, L. M., Zupa, M., Lustberg, M. B., Sanft, T. B., Blenman, K., Irwin, M. L., et al. (2023) · JNCI Monographs · doi:10.1093/jncimonographs/lgad011 · Cited by 1
Intentional obesity reduction and the occurrence of gastric cancer – literature review
Gryta, J., Bielak, A., Iwan, K., Janczewska, M., Kania, K., Kalicka, M., Krysa, T., Kolasa, A., Radziejowska, Z., & Szklarz, M. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.20.01.019 · Cited by 1
Surgical treatment of obesity for NAFLD
Goens, D., Johnson-Mann, C. N., Zarrinpar, A., & Patton, H. M. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99649-5.00015-7 · Cited by 1
Diabetes Mellitus and Metformin Are Not Associated With Breast Cancer Pathologic Complete Response
Hassinger, T. E., Berger, A. C., Christopher, A. N., Knisely, A. T., Mehaffey, J. H., Brenin, D. R., Schroen, A. T., & Showalter, S. L. (2019) · Journal of Surgical Research · doi:10.1016/j.jss.2019.10.043 · Cited by 1
Could metabolic risk factors contribute to the development of cervical cancer?
Noda, M. F., Eduardo, C.-R., Hernández-Menéndez, M., & Raque, D.-B. (2019) · Annals of Clinical Endocrinology and Metabolism · doi:10.29328/journal.acem.1001011 · Cited by 1
Güzel, K., Ocak, Ö. K., Ergenç, H., Ergenç, Z., & Gökosmanoğlu, F. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05747-6 · Cited by 1
Bariatric Surgery in Older Adults
Giordano, S. A., Oranges, C. M., Cherubino, M., & Summa, P. G. D. (2021) · Springer eBooks · doi:10.1007/978-3-030-30192-7_30 · Cited by 1
Auge, M., Menahem, B., Savey, V., Bion, A. L., & Alvès, A. (2022) · Journal de Chirurgie Viscérale · doi:10.1016/j.jchirv.2021.12.008 · Cited by 1
Obesity and female malignancies
Gajjar, K. B., & Shafi, M. I. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817919-2.00024-3 · Cited by 1
Gastroesophageal Reflux Disease after Bariatric Surgery. A New Way for the Treatment and Prevention
(2017) · Journal of Obesity and Bariatrics · doi:10.13188/2377-9284.1000024 · Cited by 1
Cancer, Obesity and Bariatric Surgery
Vyas, R., & Cheruvu, C. V. N. (2023) · Springer eBooks · doi:10.1007/978-3-030-60596-4_70 · Cited by 1
Metabolic syndrome and cancer risk
Majumder, A., & Acharya, S. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-85732-1.00052-9 · Cited by 1
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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