Bariatric surgery in patients with breast and endometrial cancer in California: population-based prevalence and survival

Abstract

Background: The number of bariatric surgeries performed in the United States has increased substantially since the 1990's. However, the prevalence and prognostic impact of bariatric surgery, or weight loss surgery (WLS), among patients with cancer are not known.

Objectives: We investigated the population-based prevalence of WLS in women with breast or endometrial cancer and conducted exploratory analysis to examine whether postdiagnosis WLS is associated with survival.

Setting: Administrative statewide database.

Methods: WLS records for women with nonmetastasized breast (n = 395,146) or endometrial (n = 69,859) cancer were identified from the 1991-2014 California Cancer Registry data linked with the California Office of Statewide Health Planning and Development database. Characteristics of the patients were examined according to history of WLS. Using body mass index data available since 2011, a retrospective cohort of patients with breast or endometrial cancer and obesity (n = 12,540) was established and followed until 2017 (5% lost to follow-up). Multivariable cause-specific Cox proportional hazards models were used to examine the associations between postdiagnostic WLS and time to death.

Results: WLS records were identified for 2844 (.7%) patients with breast cancer and 1140 (1.6%) patients with endometrial cancer; about half of the surgeries were performed after cancer diagnosis. Postdiagnosis WLS was performed in ∼1% of patients with obesity and was associated with a decreased hazard for death (cause-specific hazard ratio = .37; 95% confidence interval = .014-.99; P = .049), adjusting for age, stage, co-morbidity, race/ethnicity, and socioeconomic status.

Conclusion: About 2000 patients with breast or endometrial cancer in California underwent post-diagnosis WLS between 1991 and 2014. Our data support survival benefits of WLS after breast and endometrial cancer diagnosis.

Keywords: Bariatric surgery; Breast cancer; Endometrial cancer; Obesity; Survival.

Figure 1.

Forest plot for the association between bariatric surgery and time to death among subgroups of patients with obesity diagnosed with breast cancer and endometrial cancer between 2011 and 2014* Abbreviations: BMI, body mass index; NHW, non-Hispanic white; NHB, non-Hispanic black; SES, socio-economic status * Stratified by cancer site and adjusted for stage (localized, regional), age at cancer diagnosis (<40, 40–49, 50–59, 60–69, 70–79, ≥80), Charlson Comorbidity Index (0, ≥1, unknown), race/ethnicity (NHW, NHB, Hispanic, Asian/Pacific Islanders/Other), SES (quintiles)