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Bariatric Surgery and Breast Cancer Incidence: a Population-Based, Matched Cohort Study

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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 Methods

This 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.

Results

A 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).

Conclusion

Bariatric 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.

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Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health. This study was also supported by the Ontario Bariatric Registry. Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health, Ontario Health, and the Canadian Institute for Health Information. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Author information

Authors and Affiliations

  1. Division of General Surgery, McMaster University, Hamilton, ON, L8V 1C3, Canada

    Aristithes G. Doumouras, Olivia Lovrics & Mehran Anvari

  2. ICES, Toronto, ON, M4N 3M5, Canada

    Aristithes G. Doumouras, J. Michael Paterson, Rinku Sutradhar, Lawrence Paszat, Branavan Sivapathasundaram & Mehran Anvari

  3. Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, L8S 4K1, Canada

    Aristithes G. Doumouras & Jean-Eric Tarride

  4. Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, L8S 4L8, Canada

    Jean-Eric Tarride

  5. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada

    J. Michael Paterson, Rinku Sutradhar & Lawrence Paszat

  6. Department of Family Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada

    J. Michael Paterson

  7. Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada

    Lawrence Paszat

  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

    Jean-Eric Tarride

  9. Division of General Surgery, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Aristithes G. Doumouras & Mehran Anvari

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  1. Aristithes G. Doumouras
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  2. Olivia Lovrics
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Correspondence to Mehran Anvari.

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Consent to Participate

ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without individual consent, for health system evaluation and improvement. These datasets were linked using unique encoded identifiers and analyzed at ICES. For this type of study, formal consent is not required.

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Key Points

1. Bariatric surgery is associated with lower incidence of breast cancer compared to a highly matched non-surgery group.

2. Bariatric surgery is associated with more favorable tumor grade.

3. No effect was found for stage at diagnosis or tumor hormone receptor status.

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Doumouras, A.G., Lovrics, O., Paterson, J.M. et al. Bariatric Surgery and Breast Cancer Incidence: a Population-Based, Matched Cohort Study. OBES SURG 32, 1261–1269 (2022). https://doi.org/10.1007/s11695-022-05946-9

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  • DOI: https://doi.org/10.1007/s11695-022-05946-9

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