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Gum disease increases risk for cancer in older women
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A history of periodontal disease increased risk for total cancer among postmenopausal women, regardless of smoking status, according to results of a prospective cohort study.
Periodontal disease is a risk factor for certain cancers, including breast, oral and esophageal cancers. However, few epidemiologic studies have evaluated the relationship between periodontal disease and incidence of total cancer and cancer-specific site risk, and none focused on older, postmenopausal women.
“This study is the first national study focused on women, particularly older women,” Jean Wactawski-Wende, PhD, dean of School of Public Health and Health Professions and professor of epidemiology and environmental health at University at Buffalo, said in a press release. “Our study was sufficiently large and detailed enough to examine not just overall risk for cancer among older women with periodontal disease, but also to provide useful information on a number of cancer-specific sites.”
Wactawski-Wende, Ngozi N. Nwizu, BDS, MMSc, PhD, assistant professor of oral and maxillofacial pathology at The University of Texas Health Science Center at Houston, and colleagues investigated factors that affected morbidity and mortality among 65,869 older women (aged 54 to 86 years; mean age, 68.3 years) enrolled in the Women’s Health Initiative Observational Study.
Women completed self-reported questionnaires on periodontal disease between 1999 and 2003. During follow-up, the researchers asked the women whether a dentist or dental hygienist had ever told them they presented with periodontal or gum disease. Most participants reported visits to the dentist at least twice annually.
Researchers monitored cancer outcomes through September 2013.
A total of 7,149 cancers occurred among all women during a mean follow-up of 8.32 years (standard deviation ± 3.95).
Breast cancers represented the majority of cases (n = 2,416), followed by lung and bronchus (n = 855), and colon and rectum (n = 639).
Multivariate analyses adjusted for pack-years of smoking and BMI linked periodontal disease with a 14% increased risk for total cancer (HR = 1.14; 95% CI, 1.08-1.2). Similar results persisted in unadjusted models (HR = 1.17; 95% CI, 1.12-1.23) and age-adjusted models (HR = 1.2; 95% CI, 1.14-1.26).
Periodontal disease increased risk for breast cancer (HR = 1.13; 95% CI, 1.14-1.51), lung cancer (HR = 1.31; 95% CI, 1.14-1.51) and skin melanomas (HR = 1.23; 95% CI, 1.02-1.48).
The analyses also suggested an increased risk for all upper-digestive organ cancers combined (HR = 1.19; 95% CI, 0.98-1.46), with a strong increased risk in upper gastrointestinal tract region (HR for esophagus and stomach cancers = 2.04; 95% CI, 1.35-3.09).
The greater risk occurred for esophageal cancer (HR = 3.28; 95% CI, 1.64-6.53).
“Esophageal cancer ranks among the most deadly cancers and its etiology is not well known, but chronic inflammation has been implicated,” Nwizu said in the release. “It is important to establish if periodontal disease is an important risk for esophageal cancer, so that appropriate preventive measures can be promoted.”
Researchers noted the risk for gall bladder cancer also was highly significant (HR = 1.73; 95% CI, 1.01-2.95), whereas stomach cancer risk appeared high but not statistically significant (HR = 1.58; 95% CI, 0.94-2.67).
Analyses stratified according to smoking status showed a positive association between history of periodontal disease and total cancer risk among former smokers (HR = 1.21; 95% CI, 1.13-1.3) and current smokers (HR = 1.2; 95% CI, 0.98-1.46). The association persisted among women who never smoked (HR = 1.12; 95% CI, 1.04-1.22).
“Our study findings serve to provide further evidence that periodontal disease is linked to cancer, and support the need for further investigation into how periodontal disease contributes to increased cancer risk,” Nwizu said. – by Melinda Stevens
Disclosure: Wactawski-Wende and Nwizu report no relevant financial disclosures. One researcher reports a commercial research grant from Sunstar, and is a consultant for and received honoraria from Cigna, Colgate Palmolive and Sunstar.
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