Tonsillectomy And Adenoidectomy modestly increase risk of developing cancer later

New research published in BMC Medicine suggests that the surgical removal of tonsils and adenoids, which are among the most common surgical procedures worldwide, may be associated with a modestly increased risk of developing cancer later in life. The study, a population-based, sibling-controlled cohort study conducted in Sweden, aimed to examine the potential link between these surgical procedures and cancer risk.

The study which was conducted by Jinfeng Liang and colleagues included a total of 4,953,583 individuals in Sweden, with data collected from 1980 to 2016. Information on tonsillectomy, adenotonsillectomy, and adenoidectomy was obtained from the Swedish Patient Register, while incident cases of cancer during the follow-up period were identified from the Swedish Cancer Register. The researchers utilized Cox models to calculate hazard ratios (HR) with 95% confidence intervals (CI) to assess the risk of cancer in both the general population and sibling comparisons, which helped account for familial confounding factors.

The findings of the study were:

● A recent study examining the relationship between tonsillectomy, adenoidectomy, or adenotonsillectomy and cancer risk found a slight increase in cancer incidence following these procedures.

● The increased risk was observed in both the general population (HR 1.10; 95%CI 1.07–1.12) and sibling comparisons (HR 1.15; 95%CI 1.10–1.20).

● The association remained consistent regardless of the type of surgery, age at surgery, or the reason for the procedure.

● The elevated cancer risk persisted for over two decades after the surgery.The study identified several specific types of cancer that showed an excess risk following these surgical procedures.

● Breast, prostate, thyroid, and lymphoma cancers exhibited consistently higher incidences in both the general population and sibling comparisons.

● In the general population comparison, pancreatic cancer, kidney cancer, and leukaemia also showed a positive association.

● In the sibling comparison, esophageal cancer demonstrated a positive association.

The findings suggest that undergoing tonsillectomy, adenoidectomy, or adenotonsillectomy may be linked to a slight increase in the long-term risk of developing cancer. This association was not significantly influenced by the type of surgery, age at the time of the procedure, or the underlying reason for surgery. It is worth noting that the study accounted for familial factors by comparing cancer risk between siblings, indicating that the observed association is unlikely to be solely due to shared genetic or non-genetic factors within families.

Further research is needed to explore the underlying mechanisms and replicate these findings in different populations. The study highlights the importance of considering potential long-term effects when evaluating the benefits and risks of tonsillectomy, adenoidectomy, and adenotonsillectomy. Patients and healthcare professionals should be aware of this potential association and engage in informed discussions when considering these surgical interventions.

Reference:

Liang, J., Huang, Y., Yin, L., Sadeghi, F., Yang, Y., Xiao, X., Adami, H.-O., Ye, W., Zhang, Z., & Fang, F. (2023). Cancer risk following surgical removal of tonsils and adenoids - a population-based, sibling-controlled cohort study in Sweden. BMC Medicine, 21(1), 194. https://doi.org/10.1186/s12916-023-02902-x.