We know the link between obesity and the risk of certain cancers, including female cancers. We also know that weight loss through a calorie restriction diet can reverse this risk. This study from the University of Manchester tells us that this effect is also seen with weight loss surgery. Thus, in obese women, bariatric surgery prevents cancer of the uterus. A benefit of weight loss surgery, one more, to add to those better documented on metabolism and in particular against the risk of diabetes or heart disease.
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Doctors have long known that obesity is a major contributor to uterine cancer. However, until now, the effect of weight loss on precancerous changes in the uterus has remained relatively understudied, particularly when this weight loss is achieved by surgery.
The study carried out on 72 patients with a BMI > 50 (morbid obesity +++) who underwent surgery by sleeve gastrectomy or gastric bypass surgery (bypass) revealed, by biopsy of the uterus, that the precancerous tissue located at the Belly level returned to normal healthy tissue after weight loss.
- Of the 72 participants, 4 developed cancer of the uterus, treated by hysterectomy;
- in 6 other patients, atypical endometrial hyperplasia with precancerous lesion (excessive proliferation of cells in the uterus) was reported;
- in these 6 patients with endometrial hyperplasia,
- 3 no longer show any signs of this lesion when tested 8 weeks later, after a loss of about 3 kilos,
- and of the 3 others treated with a Mirena IUD releasing progesterone in the uterus, 2 turned out to be free of the disease 6 months later.
- Controls carried out every 6 months for 4 years reveal that the precancerous tissue does not "recur" in these 5 women. The last participant underwent a hysterectomy.
- Finally, the remaining 62 patients with normal uterine tissue at the time of weight loss surgery with, nevertheless, a high risk of abnormality, including high cell growth rate, activated carcinogenic pathways and extinguished anticancer pathways, see this risk and its reversed markers, at 1 year and after a loss of about 7 kilos.
Obesity surgery can thus reverse precancerous tissue changes: lead author Dr Emma Crosbie, Clinical Lecturer at the University of Manchester summarizes: "We know that super obese women are at risk much higher incidence of uterine cancer than women of normal weight. But we didn't expect such a high proportion of women to be at risk for uterine cancer and pre-cancer they didn't know existed. Thanks to this study, we now know that helping obese women lose weight, including through surgery, can reverse precancerous tissue changes.”
An important point, because losing weight by dieting can be very difficult for these morbidly obese patients and weight maintenance is also a challenge. Obese postmenopausal women produce estrogen from their fat stores. But since they no longer ovulate, the lack of progesterone allows cells in the uterus to grow – increasing the risk of cancer.
It remains to “do it faster”: “Many patients wait up to 2 years for their bariatric surgery. In these morbidly obese patients, speeding up the process could undoubtedly save lives”.
