confused bariatric surgeons fear cancer
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What Happens When Bariatric Surgeons Forget General Surgery Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics Most Bariatric Surgeons Do Not Know: General Surgery Basics Rate of Gastric Cancer Lifetime Risk of Gastric CancerTRANSCRIPT
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Bariatric Surgeons vs.General Surgeons;Confusion About
General Surgery Basics
What Happens When Bariatric Surgeons Forget General Surgery Basics
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What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon
Errors and Misunderstandings of General Surgery Basics
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Fear of Cancer
• Numerous Critics Bariatric Surgeons have raised Fears of Gastric Cancer after the Mini-Gastric Bypass
• ERRORS in Understanding Basic General Surgery
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Misplaced Understanding Magnitude
• Most Bariatric Surgeons Do Not Know:
• General Surgery Basics
• Rate of Gastric Cancer
• Lifetime Risk of Gastric Cancer
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Lifetime Risk Gastric Cancer
• The projected cumulative lifetime incidence of gastric cancer in
• H. pylori-infected males is 2.2% and 0.9% for females;
• This contrasts with
• 0.4 Males & 0.2%, Females, for those never infected.
• 2 - 4 / 1,000 patients Lifetime Risk
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Lifetime Risk Gastric Cancer
• Lifetime Risk gastric cancer 2-4%2 - 4 / 1,000
• Compared to:
• Lifetime risk breast cancer 12%120 / 1,000
• Prostate cancer risk 16 %160 / 1,000
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Most Bariatric Surgeons Do Not Know:
• Risk of Cancer from CAT Scans
• Computed Tomography (CT)-Abdomen and Pelvis, repeated with and without contrast material
• 20 mSv
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Most Bariatric Surgeons Do Not Know:
• Risk of Cancer from 1 CAT Scan
• 2006 report from the National Research Council has estimated that 20 mSv
• The approximate dose from 1 CT Abd+Pelvis w/wo contrast = 20 mSv => Inc Cancer Risk 0.2%
• 2 / 1000
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Now Having ReviewedMost Bariatric Surgeons
Do Not Know:Magnitude of Gastric and Other
Cancers
Risk of Cancer from CT Scan
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Most Bariatric Surgeons Do Not Know:
• Bariatric Surgeons
• Fear of Mice & Bile
• Critics of the Billroth II have referred to mouse studies showing increased risk of gastric cancer from "Bile"
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Fear of Mice & Bile
• Similarly Mouse/Rat Studies have shown
• Artificial Sweetener cause cancer• Cell phones cause brain cancer• Mouse virus causes breast cancer• Gingko biloba caused thyroid
cancer in mice• Power Lines
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Fear of Mice & Bile
• Similarly Mouse/Rat Studies have shown
• RFID Chips• Genetically Modified corn• Fluoride osteosarcoma • Soy Beans cause Breast Cancer • Bisphenol A Increases Mammary
Cancer Risk
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Fear of Mice & Bile
• Mouse/Rat Studies have that there may be a relation between
• Hundreds of things and cancer• RFID Chips, Corn, Fluoride, Soy Beans,
plastic, Artificial Sweeteners, Cell phones, Gingko, Power Lines and many more...
• and Bile
• Bariatric Surgeons Fear Bile(?)
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Review of the Basics General GI Surgery and
Gastric Cancer
What happens when Bariatric Surgeons Forget
their General Surgery
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GASTRIC CANCER RAPIDLY DECLINING
Bariatric Surgeons Do Not Know
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*1* GASTRIC CANCER RAPIDLY DECLINING
• The incidence of gastric cancer in the United States has
• Decreased four-fold since 1930
• Approximately 7 cases per 100,000 people.
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*2* WHAT CAUSES GASTRIC CANCER?ITS NOT BILLROTH II
• Diets rich in fried, salted, smoked or preserved foods increased cancer risk in many studies.
• Foods contain nitrites and these chemicals can be converted to more harmful compounds (carcinogens) by bacteria in the stomach.
• Diets high in fruit and vegetables protects against Cancer
• Stomach cancer is much more common in smokers and in those with heavy alcohol intake.
• H. Pylori, No H. Pylori No Cancer
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DIET CAN PREVENT GASTRIC CANCER
• Avoid ETOH, Tobacco, Processed & Preserved Meats, Salt
• RX H. Pylori, • Eat Fruits and Veggies,
Yogurt and • Drink Green Tea
•Gonzalez CA, Cancer Research, Institut Català d'Oncologia, Av. Gran Via s/n, km 2.7, 08907 L'Hospitalet, Barcelona, Spain.
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CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B
AA BB
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CANCER QUIZ: MORE DEADLY Hot Dog or Mini-Gastric Bypass
AA
• American Institute for Cancer Research
• Hot Dog / day • Increase the
risk cancer 21%
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Many Large Studies: No Increased RiskThousands of patients followed for Decades
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Many Large Studies: No Increased Risk
• Mayo Clinic Study (Example)
• 338 Billroth II patients
• Followed 25-years
• 5,635 person-years
• Only 2 Cancers in 5,000+ pt years of Follow Up
• Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309
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BARIATRIC SURGEONS FEAR BILLROTH IIMAGNITUDE OF THE PROBLEM
• Population based study, 338 Billroth II pts
• Followed 25-years
• 5,635 person-years
• Only 2 Cancers Found in 5,000 years• Predicted 2.6 cancers (relative risk 0.8)
Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309
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BARIATRIC SURGEONS FEAR BILLROTH IIMAGNITUDE OF THE PROBLEM
• 338 Billroth II pts, Followed 25-years
• 5,635 person-years
• Only 2 Cancers in 5,000 pt years follow up
• RATE of Gastric Cancer is Declining
• 24 - 50% Expected Decrease from 1983
• Future risk ~1 patient / 5,000 pt years
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There are some HUMAN studies that show an increased risk of Gastric Cancer after Billroth II
Bariatric Surgeons Forget:
These Billroth II operations were done for ULCERS!
Ulcers => Increased Risk of Gastric Ca!
Both Related to H. Pylori
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ULCERS INCREASE RISK CANCER
• Meta-analysis: 7 studies Small increased risk 5 studies No Increased Risk
• Studies with increased Risk; Flawed
• Billroth II = Surgery Rx Ulcers
• ULCERS increase risk of Gastric Cancer!
• Ulcers and Gastric Cancer Common Etiology =H. Pylori=
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ULCERS INCREASE RISK CANCER
•3,078 gastric cancer vs. 89,082 controls•Ulcer increases risk gastric cancer =(relative risk 1.53)=•Same as Increased Risk reported Billroth II •Many other studies confirm these findings: •Ulcer Increases Risk Gastric Cancer•Ulcers & Gastric Cancer:•Common Etiology = H. Pylori
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General, Trauma and Oncologic surgeons routinely use the Billroth II (Thousands of publications)
UNINFORMED FEAR BILLROTH IIEDUCATED USE BILLROTH II
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UNINFORMED FEAR BILLROTH IIEDUCATED USE BILLROTH II
• Billroth II and the Mini-Gastric BypassExcellent, Safe and Effective
• Fear Cancer? CAT Scan much more likely to cause cancer!
• FEAR Gastric Cancer? Avoid ETOH, Tobacco, Processed & Preserved Meats, Rx H. Pylori, Eat Fruits and Veggies, Yogurt
• A Billroth II probably makes NO difference
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Rational Data Analysis vs.Irrational FEAR Gastric Cancer
• 1. Gastric Cancer Declining Rapidly
• 2. GC Environmental Causes; Easily Prevented
• 3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori
• 4. Many large studies: NO increased risk
• 5. Endoscopic Screening: Not Recommended
• 6. General, Trauma & Oncologic Surgeons Use Billroth II
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Bariatric Surgeons Fear of Cancer after MGB Misplaced!
Fear Cancer After Bariatric Surgery
Fear Esophageal Cancer After
Sleeve, Band and Plication