Doumouras Aristithes G, Lovrics Olivia, Paterson J Michael, Sutradhar Rinku, Paszat Lawrence, Sivapathasundaram Branavan, Tarride Jean-Eric, Anvari Mehran
Division of General Surgery, McMaster University, Hamilton, ON, L8V 1C3, Canada.
ICES, Toronto, ON, M4N 3M5, Canada.
Obes Surg. 2022 Apr;32(4):1261-1269. doi: 10.1007/s11695-022-05946-9. Epub 2022 Feb 25.
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.
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.
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).
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.
肥胖与女性乳腺癌风险增加相关。减肥手术可导致显著体重减轻。然而，这种体重减轻对肥胖女性后续乳腺癌风险的影响尚不清楚。本研究旨在探讨接受减肥手术的肥胖女性的乳腺癌发病率及相关结局。
这是一项基于人群的匹配队列研究，利用加拿大安大略省的相关临床数据库对乳腺手术结局进行分析。接受减肥手术的肥胖女性与非手术对照组按倾向得分进行1:1匹配，匹配因素包括年龄和乳腺癌筛查史。主要结局为1年、2年和5年滞后时间后的乳腺癌发病率。其他结局包括肿瘤激素受体状态、癌症分期及所采取的治疗措施。采用考虑随访期间筛查情况的时变Cox比例风险模型对癌症发病率进行建模。
每组共纳入12724名女性，平均年龄45.09岁。1年滞后时间后，对照组和手术组的乳腺癌发病率分别为1.09%和
