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Clinical Summary

Obesity surgery linked to increased colorectal cancer risk in patients ≥50 years

Takeaway

  • Obesity surgery (OS) was not associated with increased colorectal cancer (CRC) risk, except in patients aged ≥50 years at the time of surgery.
  • Post-OS, breast cancer (BCa) risk was reduced but endometrial and kidney cancer risk remained elevated.

Why this matters

  • There is evidence that OS may increase CRC risk despite weight loss, but other studies have found reduced risk after OS.
  • Most previous studies are limited by sample size and follow-up.

Key results

  • Overall, standardised incidence ratio (SIR) for CRC in the surgery cohort was not significantly increased compared with the background English population (SIR, 1.26; 95% CI, 0.92-1.71) but was increased in patients ≥50 years old at surgery (SIR, 1.47; 95% CI, 1.02-2.06).
  • Slightly increased CRC risk was seen in no-surgery patients (SIR, 1.12; 95% CI, 1.08-1.16) vs background population; risk was higher in males (SIR, 1.21; 95% CI, 1.15-1.26) than females (SIR, 1.02; 95% CI, 0.97-1.08).
  • There was a decreased risk for BCa after OS (SIR, 0.76; 95% CI, 0.62-0.92).
  • BCa risk was slightly increased in the no-surgery group (SIR, 1.08; 95% CI, 1.04-1.11).
  • Risk for endometrial cancer was increased in the surgery (SIR, 2.98; 95% CI, 2.25-3.90) and no-surgery (SIR, 2.60; 95% CI, 2.48-2.73) groups vs background population.
  • Renal cancer risk was increased in both the groups (SIRs, 3.06 [95% CI, 2.08-4.34] and 1.78 [95% CI, 1.68-1.89], respectively).
  • Lung cancer risk was reduced in the OS group (SIR, 0.70; 95% CI, 0.46-1.03) and was slightly raised in no-surgery patients (SIR, 1.09; 95% CI, 1.05-1.13).

Study design

  • Retrospective observational study of obese adults who underwent OS (surgery cohort) or not (no-surgery cohort) during 1997-2013.
  • Funding: World Cancer Research Fund; Cancer Research UK. 

Limitations

  • No-surgery cohort limited to patients with obesity-related hospitalisation, outpatient or accident and emergency attendance.
  • No data on BMI and other CRC risk factors. 

References


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