Periodontal disease and cancer risk in women

Cancer risk higher in older women with periodontal disease

A study of more than 65,000 postmenopausal women has revealed that if they have a record of gum or periodontal disease they may be at a higher risk of cancer. The research is unique as the national study involved women, especially older women, for the first time when studying the periodontal-cancer connection.

It’s also the first fact-finding effort to see if men and women have a periodontal disease and gallbladder cancer connection, reported the University at Buffalo. “This study is the first national study focused on women, particularly older women,” said Jean Wactawski-Wende, the study’s senior author. The research was published in August 2017 in the journal Cancer Epidemiology, Biomarkers & Prevention.

“Our study was sufficiently large and detailed enough to examine not just an overall risk of cancer among older women with periodontal disease, but also to provide useful information on a number of cancer-specific sites,” added Wactawski-Wende, professor of epidemiology and environmental health and dean of UB’s School of Public Health and Health Professions.

Postmenopausal women, numbering 65,869, were enrolled in the Women’s Health Initiative, a continuing national prospective study to investigate factors impacting disease and risk of death in older American women.

The participants’ average age was 68, and most were non-Hispanic white women. In the questionnaire, participants were asked, “Has a dentist or dental hygienist ever told you that you had periodontal or gum disease?” Women reporting a history of gum disease had a 14 percent higher risk of overall cancer.

The study looked at 7,149 cancers occurring in the participants, and a significant portion of them, 2,416, was breast cancer. “There is increasing evidence that periodontal disease may be linked to an increased cancer risk and this association warrants further investigation,” said Ngozi Nwizu, the paper’s first author. Nwizu worked on the research while working in residency in oral and maxillofacial pathology in UB’s School of Dental Medicine, and her doctorate in cancer epidemiology at UB’s Roswell Park Cancer Institute Graduate Division. Presently, Nwizu is an assistant professor of oral and maxillofacial pathology at the University of Texas Health Science Center, Houston.

Esophageal cancer risk highest due to gum disease

The researcher reported that the risk associated with periodontal disease was the maximum for esophageal cancer. “The esophagus is in close proximity to the oral cavity, and so periodontal pathogens may more easily gain access to and infect the esophageal mucosa and promote cancer risk at that site,” said Wactawski-Wende.

Women who had a history of gum disease were at a higher risk of gallbladder cancer. “Chronic inflammation has also been implicated in gallbladder cancer, but there has been no data on the association between periodontal disease and gallbladder risk. Ours is the first study to report on such an association,” said Nwizu, who also indicated that the gallbladder and esophageal and cancer findings are important.

“Esophageal cancer ranks among the most deadly cancers and its etiology is not well known, but chronic inflammation has been implicated,” she said.

“Certain periodontal bacteria have been shown to promote inflammation even in tiny amounts, and these bacteria have been isolated from many organ systems and some cancers including esophageal cancers. It is important to establish if periodontal disease is an important risk of esophageal cancer, so that appropriate preventive measures can be promoted.”

An association was also found between periodontal disease and cancer among current and former smokers.

The findings of the study are important for another reason for the older women age group as people live longer lives in the US. “The elderly are more disproportionately affected by periodontal disease than other age groups, and for most types of cancers, the process of carcinogenesis usually occurs over many years,” said Nwizu. “So the adverse effects of periodontal disease are more likely to be seen among postmenopausal women, simply because of their older age.”