Gum disease, such as periodontis or gingivitis, is associated with increased concentrations of inflammatory markers in the blood. There is some debate, however, about whether this systemic inflammation, the pathogenic invasion into the blood stream, or the immune response to gum infection could possibly affect cancer risk, overall or at specific sites.
To explore the potential association between gum disease and cancer, Dr. Dominique Michaud, Imperial College London, UK, and colleagues began a study of male health professionals aged 40-75 years in 1986. Questionnaires were sent to the living participants every two years, and dietary questionnaires were sent every four years. The data collected through these surveys included: baseline gum disease, bone loss, the number of natural teeth, tooth loss, smoking history, food intake, and any cancer diagnoses. The data were examined for the overall cancer risk and compared to individual cancers, and more than 100 cases were documented.
In total, 48,375 men were considered eligible for the study and followed for a median follow-up period of 17.7 years. In this group, there were 5,720 cases of incident cancer, excluding non-melanoma skin cancer and non-aggressive prostate cancer. Of these, the most common cancers were colorectal (18% or 1043), melanoma of the skin (12% or 698), lung (12% or 678), bladder (9.5% or 543) and advanced prostate cancer (9.5% or 541). After adjusting for many known risk factors, including accounting for smoking and dietary histories, the subjects who had a history of gum disease had a risk of cancer that was 14% higher than those with no history of gum disease.
Patients with a history of gum disease, in comparison with those without a history of gum disease, had an increased risk of cancer in certain specific sites as well, including: 36% increased in the lung, 49% increased in the kidney, 54% increased in the pancreas, and 30% increased in hematological cancers. Patients with 0-16 natural teeth at the baseline were also 70% more likely to have lunch cancer than those with 25-32 teeth. In subjects who did not smoke, gum disease was associated with a 21% overall cancer risk above those without gum disease. In contrast, nonsmoker subjects had no difference in risk based on lung disease.
In conclusion, the authors summarize their results: “Gum disease was associated with a small, but significant, increase in overall cancer risk, which persisted in never-smokers. The associations recorded for lung cancer are probably because of residual confounding by smoking. The increased risks noted for haematological, kidney, and pancreatic cancers need confirmation, but suggest that gum disease might be a marker of a susceptible immune system or might directly affect cancer risk.”
Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study
Dominique S Michaud, Yan Liu, Mara Meyer, Edward Giovannucci, Kaumudi Joshipura
Lancet Oncol 2008; 9: 550-58
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Written by Anna Sophia McKenney