1. Surgical removal of the tonsils and adenoids was associated with slightly increased risk of subsequent cancer development, even at 20 or more years after surgery.
Evidence Rating Level: 2 (Good)
Tonsils and adenoids are immune system organs that are routinely removed surgically, for indications such as sleep apnea and recurrent infections. However, there is unclear evidence supporting an association between tonsillectomy and adenoidectomy with risk of cancer broadly, with studies reporting an increased risk or decreased risk, even for the same type of cancer. In general, previous work did not appear to examine all types of cancer in one study. Therefore, this population-based cohort study based in Sweden aimed to elucidate the association between tonsil or adenoid removal and any type of malignancy. In the population-based cohort, there were 589,229 patients with surgical tonsil or adenoid removal, and 4,364,354 individuals without surgical removal, to comprise the comparison cohort. Furthermore, a sibling comparison was done to control for familial confounders: These cohorts were comprised of 107,910 individuals with surgical removal, and 186,093 of their full siblings without surgical removal. The results showed a mildly increased risk of any cancer in the population-based cohort individuals with surgical removal (adjusted hazards ratio 1.10, 95% CI 1.07-1.12). Specific types of cancer with significant associations included cancer of the pancreas (HR 1.23, 95% CI 1.05-1.44), breast (HR 1.06, 95% CI 1.01–1.10), prostate (HR 1.15, 95% CI 1.09–1.22), kidney (HR 1.33, 95% CI 1.16–1.52), thyroid (HR 1.18, 95%CI 1.00–1.38), non-melanoma skin cancer (HR 1.14, 95% CI 1.01-1.29), other endocrine (HR 1.15, 95% CI 1.02-1.29), lymphoma (HR 1.11, 95% CI 1.00-1.23), and leukemia (HR 1.22, 95% CI 1.08-1.37). Additionally, the sibling comparison found an association between surgical removal and overall cancer (HR 1.15, 95% CI 1.10-1.20), and specific associations with cancer of the esophagus (HR 2.09, 95% CI 1.02–4.31), breast (HR 1.16, 95% CI 1.02–1.32), prostate (HR 1.24, 95% CI 1.05–1.48), thyroid (HR 1.63, 95% CI 1.11–2.40), and lymphoma (HR 1.28, 95%CI 1.03–1.61). There were no differences based on the type of surgery or indication, and the associations with cancer were present beyond 20 years after surgery. Overall, this study demonstrated a slightly increased risk of developing several forms of cancer, following tonsil or adenoid surgical removal.
Click to read the study in BMC Medicine
Image: PD
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