Reduce de peso y reduce riesgo de cancer

Journal Scan / Research · November 14, 2019

Association of Bariatric Surgery With Skin Cancer Incidence in Adults With Obesity

JAMA Dermatology

TAKE-HOME MESSAGE

• In this Swedish study of 4047 obese patients, 2007 individuals underwent bariatric surgery, and the remaining 2040 were treated conventionally for obesity in the primary care setting. The authors found a reduced risk of skin cancer (adjusted subhazard ratio, 0.59; P=.047) and a reduced risk of melanoma (adjusted subhazard ratio, 0.43; P=.02; median follow-up, 18.1 years) among obese patients who underwent bariatric surgery.

• Obesity is a known risk factor for many cancers; however, this study provides evidence that it is also associated with skin cancers, including melanoma, and that undergoing bariatric surgery was associated with a significantly decreased risk of skin cancer.

– Caroline K. Crabtree, MD

 Dermatology

Written by

 

 

Robert T Brodell MD, FAAD

There is a growing literature linking melanoma and nonmelanoma skin cancer to obesity. While the molecular mechanisms underlying the association are not perfectly understood, it has been hypothesized that changes in the tumor microenvironment, including aberrant cell signaling and genomic instability related to a chronic inflammatory state, may explain this association. Of course, behavioral factors (weight loss leading to more time in the sun at the swimming pool) may also play a role. Of note, the morbidly obese patients who find it hardest to get into the doctor's office and who are the most difficult to get undressed, may be the most important to examine!

Reference

1. Karimi K, Lindgren TH, Koch CA, Brodell RT. Obesity as a risk factor for malignant melanoma and non-melanoma skin cancer. Rev EndocrMetab Disord. 2016;17(3):389-403. https://link.springer.com/article/10.1007%2Fs11154-016-9393-9

Abstract

IMPORTANCE

Obesity is a cancer risk factor, and bariatric surgery in patients with obesity is associated with reduced cancer risk. However, evidence of an association among obesity, bariatric surgery, and skin cancer, including melanoma, is limited.

OBJECTIVE

To investigate the association of bariatric surgery with skin cancer (squamous cell carcinoma and melanoma) and melanoma incidence.

DESIGN, SETTING, AND PARTICIPANTS

This nonrandomized controlled trial, the Swedish Obese Subjects (SOS) study, is ongoing at 25 surgical departments and 480 primary health care centers in Sweden and was designed to examine outcomes after bariatric surgery. The study included 2007 patients with obesity who underwent bariatric surgery and 2040 contemporaneously matched controls who received conventional obesity treatment. Patients were enrolled between September 1, 1987, and January 31, 2001. Data analysis was performed from June 29, 2018, to November 22, 2018.

INTERVENTIONS

Patients in the surgery group underwent gastric bypass (n = 266), banding (n = 376), or vertical banded gastroplasty (n = 1365). The control group (n = 2040) received the customary treatment for obesity at their primary health care centers.

MAIN OUTCOMES AND MEASURES

The SOS study was cross-linked to the Swedish National Cancer Registry, the Cause of Death Registry, and the Registry of the Total Population for data on cancer incidence, death, and emigration.

RESULTS

The study included 4047 participants (mean [SD] age, 47.9 [6.1] years; 2867 [70.8%] female). Information on cancer events was available for 4042 patients. The study found that bariatric surgery was associated with a markedly reduced risk of melanoma (adjusted subhazard ratio, 0.43; 95% CI, 0.21-0.87; P = .02; median follow-up, 18.1 years) and risk of skin cancer in general (adjusted subhazard ratio, 0.59; 95% CI, 0.35-0.99; P = .047). The skin cancer risk reduction was not associated with baseline body mass index or weight; insulin, glucose, lipid, and creatinine levels; diabetes; blood pressure; alcohol intake; or smoking.

CONCLUSIONS AND RELEVANCE

The results of this study suggest that bariatric surgery in individuals with obesity is associated with a reduced risk of skin cancer, including melanoma.

JAMA Dermatology

Association of Bariatric Surgery With Skin Cancer Incidence in Adults With Obesity: A Nonrandomized Controlled Trial

JAMA Dermatol 2019 Oct 30;[EPub Ahead of Print], M Taube, M Peltonen, K Sjöholm, Å Anveden, JC Andersson-Assarsson, P Jacobson, PA Svensson, MO Bergo, LMS Carlsson 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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