Ulcer surgery 'raises cancer risk'

Thousands of Britons have ulcer surgery each year

Patients who have surgery to remove stomach ulcers may be at increased risk of developing pancreatic cancer.

Research carried out by doctors at the University of Amsterdam has found that people who undergo peptic ulcer surgery are twice as likely to develop this type of cancer.

But it also reveals that the risks increase continuously over time - tripling after 35 years.

The increase in risk may not be great enough for there to be a benefit from targeting screening at this group of people

Prof John P Neoptolemos, Cancer Research UK

Pancreatic cancer is the fifth leading cause of death from cancer, largely because the prognosis is so poor. An estimated 7,000 develop the disease in the UK each year.

Dr Johan Offerhaus and colleagues studied the progress of 2,633 patients who underwent surgery for the removal of a peptic or duodenal ulcer between 1931 and 1960.

Increased risks

They completed a preliminary analysis of these cases in 1988 and have spent the past decade trying to determine whether the risks of pancreatic cancer increased over time.

Since then a further 361 patients have died, leaving just 462 survivors. To date, 39 patients have died of pancreatic cancer - 35 of these died five or more years after surgery.

Their analysis showed that the risks increase significantly over time.

Writing in the Journal of Clinical Pathology, they said: "There is a trend of increasing pancreatic cancer risk with increasing time since surgery; in our cohort the risk gradually increases to a significant 3.6 fold of the expected rate after 35 years or more."

The authors suggested that the increased risk might be linked to the fact that this type of surgery deprives the stomach of its acid and creates an environment in which nitrate-producing bacteria can thrive.

This boosts the production of cancer-causing compounds, such as nitrosamines, which have been associated with pancreatic cancer in animals.

But they added that other factors, such as smoking, could also play a role.

They said: "Smoking is the strongest established risk factor for conventional pancreatic cancer. Unfortunately, detailed information on smoking behaviour in our study population is not available."

Screening suggestion

The authors suggested the findings could be used to support arguments to screen people who have had ulcer surgery for pancreatic cancer.

However, Professor John P Neoptolemos, who is based at the Royal Liverpool University Hospital and also works with Cancer Research UK, expressed doubts about a screening programme.

"This finding supports earlier research indicating that people who've had surgery for a stomach ulcer are at increased risk of pancreatic cancer.

"However, the increase in risk may not be great enough for there to be a benefit from targeting screening at this group of people," he said.