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Bariatric Surgery is Associated With Reduced Risk of Breast Cancer in Both Premenopausal and Postmenopausal Women

Feigelson, Heather Spencer, PhD, MPH*; Caan, Bette, DrPH; Weinmann, Sheila, PhD, MPH; Leonard, Anthony C., PhD§; Powers, J. David, MS*; Yenumula, Panduranga R., MD; Arterburn, David E., MD, MPH; Koebnick, Corinna, MSc, PhD||; Altaye, Mekibib, PhD**; Schauer, Daniel P., MD, MSc††

doi: 10.1097/SLA.0000000000003331
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Mini We examined risk of breast cancer among 17,998 women who had bariatric surgery and 53,889 women matched on body mass index with no surgery. We found bariatric surgery was associated with a reduced risk of both premenopausal [hazard ratio (HR) = 0.72, 95% confidence interval (CI), 0.54–0.94] and postmenopausal (HR = 0.55, 95% CI, 0.42–0.72) breast cancer.

Objective: This retrospective cohort study examined whether bariatric surgery is associated with reduced risk of breast cancer among pre- and postmenopausal women.

Background: Obesity is associated with increased risk of breast cancer, but the impact of weight loss on breast cancer risk has been difficult to quantify.

Methods: The cohort included obese (body mass index ≥35 kg/m2) patients enrolled in an integrated health care delivery system between 2005 and 2012 (with follow-up through 2014). Female bariatric surgery patients (N = 17,998) were matched on body mass index, age, study site, and comorbidity index to 53,889 women with no bariatric surgery. Kaplan–Meier curves and Cox proportional hazards models were used to examine incident breast cancer up to 10 years after bariatric surgery. Pre- and postmenopausal women were examined separately, and further classified by estrogen receptor (ER) status.

Results: The analysis included 301 premenopausal and 399 postmenopausal breast cancer cases. In multivariable adjusted models, bariatric surgery was associated with a reduced risk of both premenopausal (HR = 0.72, 95% CI, 0.54–0.94) and postmenopausal (HR = 0.55, 95% CI, 0.42–0.72) breast cancer. Among premenopausal women, the effect of bariatric surgery was more pronounced among ER-negative cases (HR = 0.36, 95% CI, 0.16–0.79). Among postmenopausal women, the effect was more pronounced in ER-positive cases (HR = 0.52, 95% CI, 0.39–0.70).

Conclusions: Bariatric surgery was associated with a reduced risk of breast cancer among severely obese women. These findings have significant public health relevance because the prevalence of obesity continues to rise, and few modifiable breast cancer risk factors have been identified, especially for premenopausal women.

*Kaiser Permanente Colorado, Denver, CO

Kaiser Permanente Northern California, Oakland, CA

Kaiser Permanente Northwest, Portland, OR

§Department of Family and Community Medicine, University of Cincinnati Medical Center, Cincinnati, OH

Kaiser Permanente, Seattle, WA

||Kaiser Permanente Southern California, Pasadena, CA

**Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH

††Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH.

Reprints: Heather Spencer Feigelson, PhD, MPH, Kaiser Permanente, Institute for Health Research, 2550 S. Parker Road, Suite 200, Aurora, CO 80014. E-mail: heather.s.feigleson@kp.org.

This work was supported by the National Institutes of Health (NIH/NCI 1R01CA175346-01A1).

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

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