ABSTRACT
Cancer is a principal cause of morbidity and mortality for persons living with obesity. Obesity increases the risk of developing at least 13 types of cancer. Meta-analyses of cohort studies observe that bariatric surgery is independently associated with a 44% lower relative risk of invasive cancer than non-surgical obesity care. Breast and endometrial cancers are associated with bariatric surgery's largest relative risk reductions. Emerging data also indicate that bariatric surgery may be associated with a lower risk of death from cancer. The anti-cancer mechanisms of bariatric surgery remain incompletely understood; hypothesized mechanisms relate to correcting the metabolic dysfunction caused by excess adipose tissue, including insulin resistance and insulin-like growth factors, inflammation, adipokine and lipid synthesis, oxidative stress, and sex steroid hormones. There exist tremendous research opportunities to advance our understanding of how bariatric surgery can be utilized as a modality for cancer prevention and control. Modern bariatric surgical procedures have strong evidence of safety and efficacy in reducing body weight and improving metabolic health. Patients and their physicians should engage in a shared decision-making conversation about surgical risk and potential benefits, including cancer risk reduction, compared with non-surgical care for obesity.
