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Periodontal Disease Associated With Increased Cancer Risk

Jun 3, 2008

Periodontal Disease is more common in those with diabetes and now we are seeing that it is also increases the risk of cancer. 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 of inflammatory markers. Treating periodontal infection can lower markers of systemic inflammatory and endothelial dysfunction, and data from multidisciplinary studies add strength to the possibility of causal associations for a number of health conditions, including diabetes, stroke, and cardiovascular disease. However, there is no consensus on the relative roles of confounding and bias, or on the causal component of these associations.

In this study, Dominique Michaud, ScD, a cancer epidemiologist from the Imperial College London, United Kingdom, assessed the role of oral health in cancer risk. Using data from the Health Professionals Follow-Up Study (HPFS), they examined whether there was an association between periodontal disease, number of teeth, tooth loss during follow-up, and cancer incidence.

The HPFS is a large prospective-questionnaire study of male health professionals that was started in 1986 and included 51,529 American men between the ages 40 to 75 years. Participants have responded to subsequent surveys every 2 years since the initial questionnaire. In the current analysis, data were available for 48,375 men, with a median follow-up of 17.7 years.

Among this group, there were 5720 incident cancer cases documented, excluding nonmelanoma skin cancer and nonaggressive prostate cancer. The researchers found that the 5 most common cancers were colorectal (n = 1043), melanoma of the 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 higher total cancer incidence than men without periodontal disease (unadjusted hazard ratio [HR], 1.28). After controlling for known risk factors, including smoking and dietary factors, men with a history of periodontal disease had a higher risk for total cancer than men without such a history (HR, 1.14).

When they looked at specific cancer sites, the researchers noted significant associations 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 with fewer 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 with significant increases in total (HR, 1.21) and hematological (HR, 1.35) cancers in men who never smoked, no association was observed for lung cancer.

"Given the systemic effects of periodontal disease and the potential involvement of the immune system, as a marker of susceptibility or through changes in immune surveillance, we believe that further research on the role of periodontal disease in cancer, especially hematological cancers, is warranted," they conclude.

Lancet Oncol. 2008;9:550-558.


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