The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions

Miller, Kaia C.; Thomas, Samantha M.; Sergesketter, Amanda R.; Rosenberger, Laura H.; DiLalla, Gayle; Bruele, Astrid Botty Van den; Hwang, E. Shelley; Plichta, Jennifer K.

doi:10.1245/s10434-022-12313-6

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…In a comparative cohort study, bariatric surgery appears to reduce the risk of developing breast cancer in women with obesity to that equivalent to women without a history of obesity, suggesting the removal of “residual risk” of obesity for women . An important criticism of these studies is that they fail to stratify based on high-risk subgroups that have no association with BMI or weight loss, such as women who are BRCA variant carriers and those who have a history of atypical hyperplasia or lobular carcinoma in situ . Additionally, population studies estimating the risk of breast cancer after bariatric surgery are unable to account for hormone receptor status (estrogen or progesterone positivity).…”

Section: Risk Of Hormonally Associated Cancer After Bariatric Surgerymentioning

confidence: 99%

Bariatric Surgery and Longitudinal Cancer Risk

Lim,

Stucky,

Wasif

et al. 2024

JAMA Surg

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ImportanceCancer is one of the leading causes of death in the United States, with the obesity epidemic contributing to its steady increase every year. Recent cohort studies find an association between bariatric surgery and reduced longitudinal cancer risk, but with heterogeneous findings.ObservationsThis review summarizes how obesity leads to an increased risk of developing cancer and synthesizes current evidence behind the potential for bariatric surgery to reduce longitudinal cancer risk. Overall, bariatric surgery appears to have the strongest and most consistent association with decreased incidence of developing breast, ovarian, and endometrial cancers. The association of bariatric surgery and the development of esophageal, gastric, liver, and pancreas cancer is heterogenous with studies showing either no association or decreased longitudinal incidences. Conversely, there have been preclinical and cohort studies implying an increased risk of developing colon and rectal cancer after bariatric surgery. A review and synthesis of the existing literature reveals epidemiologic shortcomings of cohort studies that potentially explain incongruencies observed between studies.Conclusions and RelevanceStudies examining the association of bariatric surgery and longitudinal cancer risk remain heterogeneous and could be explained by certain epidemiologic considerations. This review provides a framework to better define subgroups of patients at higher risk of developing cancer who would potentially benefit more from bariatric surgery, as well as subgroups where more caution should be exercised.

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Section: Risk Of Hormonally Associated Cancer After Bariatric Surgerymentioning

confidence: 99%

Bariatric Surgery and Longitudinal Cancer Risk

Lim,

Stucky,

Wasif

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

show abstract

“…Conversely, a prospective evaluation of BRCA variant carriers found no association between BMI or weight change and risk of breast cancer . Similarly, studies assessing women with a history of atypical hyperplasia or lobular carcinoma in situ have also failed to find a significant association between BMI and subsequent breast cancer development . Further study to elucidate the underlying mechanism associated with obesity, weight loss, and breast cancer risk should help guide strategies for risk reduction that are specific to unique high-risk cohorts because modifiable risk factors may not portend the same benefit among all groups.…”

mentioning

confidence: 99%

“…5 Similarly, studies assessing women with a history of atypical hyperplasia or lobular carcinoma in situ have also failed to find a significant association between BMI and subsequent breast cancer development. 6,7 Further study to elucidate the underlying mechanism associated with obesity, weight loss, and breast cancer risk should help guide strategies for risk reduction that are specific to unique highrisk cohorts because modifiable risk factors may not portend the same benefit among all groups. Studies are currently underway to evaluate changes in breast tissue and blood biomarkers among women at high risk who are undergoing physical activity or bariatric surgery, and the findings will shed additional light on how we personalize prescriptions for lifestyle modifications related to breast cancer risk.…”

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confidence: 99%

Bariatric Surgery for Breast Cancer Risk Reduction—Benefit May Not Be One Size Fits All

Pilewskie

Dimick

2023

JAMA Surg

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In this issue of JAMA Surgery, Doumouras et al 1 add to the growing body of literature demonstrating the association of bariatric surgery with a reduced risk of cancer. This populationbased study, focused specifically on the risk of incident breast cancer, is unique compared with prior work because it focused on evaluating the "residual" risk of breast cancer in individuals with obesity after bariatric surgery. In other words, because most patients undergoing bariatric surgery do not reach a normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), the goal of this study was to compare patients after bariatric surgery with patients without obesity (BMI <25) to determine whether they have residual cancer risk. The study found that there was no difference in risk of incident breast cancer for patients after bariatric surgery compared with those with BMI less than 25, thus implying there is no residual risk for obesity in this group. 1 Unfortunately, the study is limited by a lack of data on weight loss after surgery, so the BMIs of patients after bariatric surgery are unknown. Nonetheless, because there are data on weight loss after bariatric surgery from many other studies (few patients reach a normal BMI), 2 the conclusions of the study are reasonable. These results imply that there is likely something about weight loss, or caloric restriction, independent of BMI that reduces cancer risk beyond what we would expect from matched BMI nonsurgical controls. A future study that had postsurgical BMI data to match and compare those risks would allow this result to be studied in more detail and would build nicely on the findings of the present work.Although these findings are important overall for the general population at risk for breast cancer, we raise an impor-

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