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Bariatric Surgery and Breast Cancer Incidence: a Population-Based,Matched Cohort Study |
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| Authors: | Doumouras Aristithes G. Lovrics Olivia Paterson J. Michael Sutradhar Rinku Paszat Lawrence Sivapathasundaram Branavan Tarride Jean-Eric Anvari Mehran |
| Affiliation: | 1.Division of General Surgery, McMaster University, Hamilton, ON, L8V 1C3, Canada ;2.ICES, Toronto, ON, M4N 3M5, Canada ;3.Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada ;4.Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, L8S 4L8, Canada ;5.Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada ;6.Department of Family Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada ;7.Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada ;8.Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada ;9.Division of General Surgery, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada ; |
| Abstract: | Purpose Obesity is associated with increased breast cancer risk in women. Bariatric surgery induces substantial weight loss. However, the effects of such weight loss on subsequent breast cancer risk in women with obesity are poorly understood. To examine breast cancer incidence and related outcomes in women with obesity undergoing bariatric surgery. Materials and MethodsThis was a population-based matched cohort study of breast surgery outcomes utilizing linked clinical databases in Ontario, Canada. Women with obesity who underwent bariatric surgery were 1:1 matched using a propensity score to non-surgical controls for age and breast cancer screening history. The main outcomes were incidence of breast cancer after lag periods of 1, 2, and 5 years. Additional outcomes included tumor hormone receptor status, cancer stage, and treatments undertaken. Time-varying Cox proportional hazard models accounting for screening during follow-up were used to model cancer incidence. ResultsA total of 12,724 women per group were included, average age 45.09. After a 1-year lag, breast cancer incidence occurred in 1.09% and 0.79% of the control and surgery groups, respectively (adjusted hazard ratio, 0.81 [95%CI 0.69–0.95]; p = 0.01). This association was maintained after lag periods of 2 and 5 years. Women in the surgical cohort diagnosed with breast cancer were more likely to have low-grade tumors and less likely to have high-grade tumors (overall p < 0.01). No association was found for tumor hormone receptor status, although the surgical group was more likely to have her2neu-negative tumors (p = 0.01). ConclusionBariatric surgery was associated with a lower incidence of breast cancer and lower tumor grade in women with obesity. Further evaluation of outcomes, including mortality, is required. Graphical abstract |
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