Association of bariatric surgery with cancer incidence in patients with obesity and diabetes: long-term results from the Swedish obese subjects study
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Abstract
OBJECTIVE: Obesity and type 2 diabetes are associated with serious adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study. RESEARCH DESIGN AND METHODS: The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of whom underwent bariatric surgery and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years). RESULTS: During follow-up, the incidence rate for first-time cancer was 9.1 per 1,000 person-years (95% CI 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1,000 person-years (95% CI 11.2-17.7) in patients treated with usual obesity care (adjusted hazard ratio 0.63 [95% CI 0.44-0.89], P = 0.008). Moreover, surgery was associated with reduced cancer incidence in women (0.58 [0.38-0.90], P = 0.016), although the sex-treatment interaction was nonsignificant (P = 0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (0.40 [0.22-0.74], P = 0.003). CONCLUSIONS: These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes and that durable diabetes remission is associated with reduced cancer risk.
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Many prospective studies have shown that bariatric surgery induces stable weight loss, remission of T2D, improvement in cardiovascular risk, and a reduction in cancer (including liver cancer) risk.
“Many prospective studies have shown that bariatric surgery induces stable weight loss, remission of T2D, 436 improvement in cardiovascular risk, 437 and a reduction in cancer (including liver cancer) risk.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [438]
Studies have been limited by small sample sizes in combination therapy subgroups and trials have not consistently shown benefit for the combination of SGLT2is and GLP-1RAs on cardiovascular and kidney outcomes.
“Studies have been limited by small sample sizes in combination therapy subgroups and trials have not consistently shown benefit for the combination of SGLT2is and GLP-1RAs on cardiovascular and kidney outcomes.73,112”
From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [112]
Expected benefits of metabolic surgery include improved quality of life, reduced cardiovascular events, and decreased risk of hepatocellular, colorectal, pancreatic, gallbladder, breast, endometrial, and ovarian cancers.
“In addition to weight reduction and decreased glycemia (with diabetes remission in some patients), expected benefits of metabolic surgery include improved quality of life, reduced cardiovascular events, and decreased risk of hepatocellular, colorectal, pancreatic, gallbladder, breast, endometrial, and ovarian cancers.14,123–126”
From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [125]
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- Authors
- Sjöholm, K., Carlsson, L. M. S., Svensson, P.-A., Andersson-Assarsson, J. C., Kristensson, F., Jacobson, P., Peltonen, M., & Taube, M.
- Affiliations
- University of Gothenburg (SE)
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Karolinska Institutet (SE)
- Corresponding author
- Taube, Magdalena
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-11-19
- Volume
- 45
- Issue
- 2
- Pages
- 444-450
- ISSN
- 0149-5992 (ISSN-L)
- PMC
- PMC8914410
- OpenAlex
- W3214007678
- Cited by
- 84
- References
- 42
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 20 · 2023: 18 · 2022: 14
- FWCI
- 12.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- Novo Nordisk Fonden (NNF 19OC0057184)
- 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 incidence, obesity, type 2 diabetes, diabetes remission, cancer risk reduction, Swedish Obese Subjects study, sex differences in cancer risk
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Neoplasms, Obesity, Prospective Studies, Sweden, Incidence, Bariatric Surgery
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