Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study.

BACKGROUND

The association between obesity surgery (OS) and cancer risk remains unclear. We investigated this association across the English National Health Service. A population-based Swedish study has previously suggested that OS may increase the risk of developing colorectal cancer (CRC).

METHODS

A retrospective observational study of individuals who underwent OS (surgery cohort) or diagnosed with obesity, but had no OS (no-surgery cohort) (1997-2013) were identified using Hospital Episode Statistics. Subsequent diagnosis of CRC, breast, endometrial, kidney and lung cancer, as well as time 'at risk', were determined by linkage to National Cancer Registration & Analysis Service and Office of National Statistics data, respectively. Standardised incidence ratios (SIR) in relation to OS were calculated.

RESULTS

1 002 607 obese patients were identified, of whom 3.9% (n = 39 747) underwent OS. In the no-surgery obese population, 3 237 developed CRC (SIR 1.12 [95% CI 1.08-1.16]). In those who underwent OS, 43 developed CRC (SIR 1.26 [95% CI 0.92-1.71]). The OS cohort demonstrated decreased breast cancer risk (SIR 0.76 [95% CI 0.62-0.92]), unlike the no surgery cohort (SIR 1.08 [95% CI 1.04-1.11]). Increased risk of endometrial and kidney cancer was observed in surgery and no-surgery cohorts.

CONCLUSIONS

CRC risk is increased in individuals diagnosed as obese. Prior obesity surgery was not associated with an increased CRC risk. However, the OS population was small, with limited follow-up. Risk of breast cancer after OS is reduced compared with the obese no-surgery population, while the risk of endometrial and kidney cancers remained elevated after OS.