February 09, 2016
Annals of Oncology
TAKE-HOME MESSAGE
- The authors of this study investigated the association between periodontal disease and cancer in nonsmoking men. They identified a 13% increase in cancer incidence among men reporting periodontitis. Advanced periodontitis in men was further associated with a 45% increased cancer risk. For cancers known to be associated with smoking, advanced periodontitis was associated with a 2.5-fold increased risk.
- The authors conclude that advanced periodontitis may influence cancer risk through regulatory effects on immune responses.
Abstract
BACKGROUND
Periodontal disease has a direct impact on the immune response and has been linked to several chronic diseases, including atherosclerosis and stroke. Few studies have examined the association between periodontal disease and cancer.
METHODS
19,933 men reported being never smokers (of cigarette, pipes or cigars) in the Health Professionals’ Follow-up Study. Periodontal disease status and teeth number were self-reported at baseline and during follow-up. All cancers were ascertained during 26 years of follow-up. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) adjusting for risk factors.
RESULTS
A 13% increase in total cancer was observed among men reporting periodontitis at baseline, and a 45% increase in risk was observed among men with advanced periodontitis (periodontitis with <17 remaining teeth). Periodontitis was not associated with prostate cancer, colorectal cancer, or melanoma, the three most common cancers in this cohort of never smokers, but a 33% increase in risk was observed for smoking-related cancers (lung, bladder, oropharnygeal, esophageal, kidney, stomach, and liver cancers; HR=1.33, 95% CI: 1.07, 1.65). Men with advanced periodontitis had a HR of 2.57 (95% CI: 1.56, 4.21; p=0.0002) for smoking-related cancers, compared with men who did not have periodontitis and had 17 teeth or more. Advanced periodontitis was associated with elevated risks of esophageal and head and neck cancers (HR=6.29, 95% CI: 2.13-18.6; based on 5 cases with advanced periodontitis) and bladder cancer (HR=5.06, 95% CI: 2.32-11.0; based on 9 cases with advanced periodontitis).
CONCLUSIONS
Advanced periodontitis was associated with a 2.5-fold increase in smoking-related cancers among never smokers. Periodontitis may impact cancer risk through system immune dysregulation. Further studies need to examine the immune impact of advanced periodontitis on cancer, especially for cancers known to be caused by smoking.