Cancer Risk After Bariatric Surgery in a Cohort Study from the Five Nordic Countries
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Cancer Risk After Bariatric Surgery in a Cohort Study from the Five Nordic Countries Wenjing Tao 1 & Giola Santoni 1 & My von Euler-Chelpin 2 & Rickard Ljung 3 & Elsebeth Lynge 2 & Eero Pukkala 4,5 & Eivind Ness-Jensen 1,6 & Pål Romundstad 6 & Laufey Tryggvadottir 7,8 & Jesper Lagergren 1,9 Received: 24 April 2020 / Revised: 22 May 2020 / Accepted: 28 May 2020 # The Author(s) 2020
Abstract Purpose Obesity increases the risk of several cancers, but the influence of bariatric surgery on the risk of individual obesityrelated cancers is unclear. This study aimed to assess the impact of bariatric surgery on cancer risk in a multi-national setting. Materials and Methods This cohort study included all adults with an obesity diagnosis identified from national patient registries in all Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) from 1980 to 2012. Cancer risk in bariatric surgery patients was compared with non-operated patients with obesity. Multivariable Cox regression provided adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Age, sex, calendar year, country, length of follow-up, diabetes, chronic obstructive pulmonary disease and alcohol-related diseases were evaluated as confounders. Results Among 482,572 participants with obesity, 49,096 underwent bariatric surgery. Bariatric surgery was followed by a decreased overall cancer risk in women (HR 0.86, 95% CI 0.80–0.92), but not in men (HR 0.98, 95% CI 0.95–1.01). The risk reduction was observed only within the first five post-operative years. Among specific tumours, HRs decreased for breast cancer (HR 0.81, 95% CI 0.69–0.95), endometrial cancer (HR 0.69, 95% CI 0.56–0.84) and non-Hodgkin lymphoma (HR 0.64, 95% CI 0.42–0.97) in female bariatric surgery patients, while the risk of kidney cancer increased in both sexes (HR 1.44, 95% CI 1.13– 1.84). Conclusion Bariatric surgery may decrease overall cancer risk in women within the first five years after surgery. This decrease may be explained by a decreased risk of breast and endometrial cancer and non-Hodgkin lymphoma in women. Keywords Obesity . Metabolic surgery . Neoplasm . Scandinavian and Nordic countries . Registries
Introduction Substantial evidence supports an association between obesity and cancer at thirteen sites, including oesophagus (adenocarcinoma), gastric cardia, colon, rectum, liver, gallbladder, pancreas, breast (postmenopausal), corpus uteri, ovary, kidney (renal cell), meningioma, thyroid and multiple myeloma [1]. * Jesper Lagergren [email protected] 1
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Retzius väg 13a, 171 77 Stockholm, Sweden
2
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
3
Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
4
Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
There is also some evidenc
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