Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Having a prior tonsillectomy was correlated to a greater risk of developing esophageal adenocarcinoma, with an odds ratio of 1.7.

Evidence Rating Level: 2 (Good)

Esophageal adenocarcinoma (EAC) is a subtype of esophageal cancer that has gradually grown in incidence over the years, increasing six-fold in the United States between 1975 and 2001. Currently, Barrett’s Esophagus (BE) is the sole known lesion to be a precursor for EAC, and factors such as for obesity, use of tobacco, and gastroesophageal reflux disease (GERD) have been identified as associated risk factors. Currently however, the association between tonsillectomy and development of EAC is not well characterized, despite these procedures being relatively common and previously associated with greater risk for several diseases, including deep neck malignancy and infection. To analyze whether prior tonsillectomy was an independent risk factor for development of EAC, this retrospective cohort study examined the association between tonsillectomies and EAC or BE with high grade dysplasia (HGD). The study involved examining the records of 452 patients who underwent an esophagectomy procedure for EAC/HGD. The control group was 1102 patients who underwent a thoracic surgery not related to EAC/HGD. 19.9% of EAC/HGD patients had a prior tonsillectomy, whereas 12.7% of control patients had a prior tonsillectomy (p=0.0003). Patients who previously underwent a tonsillectomy were more likely to have EAC/HGD than those who did not (OR 1.7, 95% CI: 1.3-2.3). This association was still present after adjusting for covariates such as obesity, tobacco use, GERD history, male gender, and white race (OR 1.8, 95% CI: 1.2-2.7). A proposed biological mechanism is that removing the tonsils dampens the immune response by lowering IgA levels, so that when pathogens are encountered, cytokine production increases and chronic inflammation ensues, leading to EAC. As a retrospective cohort study, causality cannot be inferred from this study alone, and as such, further investigations are warranted to further characterize the mechanisms by which tonsillectomy may be associated with EAC development. Nonetheless, study findings reveal a possible novel independent risk factor for EAC development which may be used to inform clinical decision making in the future.

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