Periodontal Disease Associated With Increased Cancer Risk

Roxanne Nelson May 28, 2008 — Periodontal disease is associated with a small but significant increase in cancer risk, researchers report. The association between periodontal disease and overall cancer risk was found in both smokers and nonsmokers, according to a study that appears in June issue of Lancet Oncology. The authors note that periodontal disease might be a marker of a susceptible immune system or might directly affect cancer risk. Periodontal infections have previously been found to have systemic implications; individuals with gum disease have increased concentrations of circulating inflammatory markers, and disease severity directly correlates with serum concentrations...
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Periodontal Disease Associated With Increased Cancer Risk Periodontal Disease Associated With Increased Cancer RiskRoxanne NelsonMay 28, 2008 — Periodontal disease is associated with a small but significantincrease in cancer risk, researchers report. The association between periodontaldisease and overall cancer risk was found in both smokers and nonsmokers,according to a study that appears in June issue of Lancet Oncology.The authors note that periodontal disease might be a marker of a susceptibleimmune system or might directly affect cancer risk.Periodontal infections have previously been found to have systemic implications;individuals with gum disease have increased concentrations of circulatinginflammatory markers, and disease severity directly correlates with serumconcentrations of inflammatory ma rkers. Treating periodontal infection can lowermarkers of systemic inflammatory and endothelial dysfunction, and data frommultidisciplinary studies add strength to the possibility of causal associations for anumber of health conditions, including diabetes, stroke, and cardiovasculardisease. However, there is no consensus on the relative roles of confounding andbias, or on the causal component of these associations.In this study, Dominique Michaud, ScD, a cancer epidemiologist from theImperial College London, United Kingdom, and colleagues assessed the role oforal health in cancer risk. Using data from the Health Professionals Follow -UpStudy (HPFS), they examined whether there was an association betweenperiodontal disease, number of teeth, tooth los s during follow-up, and cancerincidence.The HPFS is a large prospective-questionnaire study of male health professionalsthat was started in 1986 and included 51,529 American men between the ages 40to 75 years. Participants have responded to subsequent surveys every 2 years sincethe initial questionnaire. In the current analysis, data were available for 48,375men, with a median follow-up of 17.7 years.Among this group, there were 5720 incident cancer cases documented, excludingnonmelanoma skin cancer and nonaggressive prostate cancer. The researchersfound that the 5 most common cancers were colorectal (n = 1043), melanoma ofthe skin (n = 698), lung (n = 678), bladder (n = 543), and advanced prostate (n =541).Men who reported a history of periodontal disease at baseline had a slightly highertotal cancer incidence than men without periodontal disease (unadjusted hazardratio [HR], 1.28). After controlling for known risk factors, including smoking anddietary factors, men with a history of periodont al disease had a higher risk for totalcancer than men without such a history (HR, 1.14).When they looked at specific cancer sites, the researchers noted significantassociations between a history of periodontal disease and lung (HR, 1.36), kidney(HR, 1.49), pancreas (HR, 1.54), and hematological (HR, 1.30) cancers. Men withfewer teeth at baseline (0 to 16 teeth) had a higher risk for lung cancer (HR, 1.70)than men with 25 to 32 teeth. Although periodontal disease was associated withsignificant increases in total (HR, 1.21) and hematological (HR, 1.35) cancers inmen who never smoked, no association was observed for lung cancer.The study had several limitations, the authors note: periodontal disease was self -reported and it had inadequate power to study less-common cancers. The cohortalso consisted entirely of men; the findings might not be generalizable to women.A small increase in the risk for total cancer was seen in men who reported havingperiodontal disease, compared with those who did not, th e authors note. Theincrease in risk persisted in never-smokers for total cancer, but not for lung cancer,suggesting that the increase in risk of malignant disease overall is not because ofresidual confounding by smoking.Given the systemic effects of periodontal disease and the potential involvementof the immune system, as a marker of susceptibility or through changes in immunesurveillance, we believe that further research on the role of periodontal disease incancer, especially hematological cancers, is warranted, they conclude.