Poor oral health is associated with an increased risk of esophageal squamous cell carcinoma - a population-based case-control study in China

Abstract

To further examine the association between oral hygiene and esophageal squamous cell carcinoma (ESCC) risk and the effect modification of other exposures, we conducted a population-based case-control study between 2010 and 2012 in Taixing, China, a high-risk area for ESCC. Cases were primarily recruited from endoscopy units at local hospitals, supplemented by linkage to the local Cancer Registry. Control subjects were frequency matched to cases by sex and age (5-year groups) and were randomly selected from the Taixing Population Registry. For the current analysis, data from 616 histopathologically confirmed cases and 770 controls with complete information on oral hygiene were analyzed. Unconditional logistic regression models, including oral hygiene indicators and potential behavioral confounders, were used to derive odds ratios (ORs) and 95% confidence intervals (CIs). Tooth loss was only marginally significantly associated with ESCC risk (yes vs. no, OR = 1.29, 95% CI 0.94-1.74). However, the excess risk increased with increasing numbers of lost teeth (more than 6 teeth lost vs. none, OR = 1.48, 95% CI 1.04-2.11). Tooth brushing once or less per day, compared with tooth brushing twice or more per day, was associated with a 1.81-fold increased risk of ESCC. In the stratification analyses, the increased risks associated with these indicators of oral health were more pronounced in older subjects (age ≥ 70 years), women, non-smokers, and non-drinkers. Further studies are warranted to verify these findings and to explore the underlying mechanisms, e.g., changed oral microbiota, associated with poor oral hygiene.

Alcohol Intake Interacts with Functional Genetic Polymorphisms of Aldehyde Dehydrogenase (ALDH2) and Alcohol Dehydrogenase (ADH) to Increase Esophageal Squamous Cell Cancer Risk

“…The study design has been described in earlier studies. [9][10][11] We attempted to enroll all individuals with incident esophageal cancer (i.e., patients with esophageal cancer that was newly diagnosed between October 2010 and September 2013). Inclusion in the study participation was limited to individuals who were 40 to 85 years old and had lived in Taixing for at least 5 years, so as to ensure enough of a time window for exposure to take effect and to exclude new migrants whose genetic background might be different from that of the original Taixing population.…”

Review of the gut microbiome and esophageal cancer: Pathogenesis and potential clinical implications

“…Given that poor oral health increases the risk of esophageal squamous cell carcinoma,64 these findings should be verified in prospective and long‐term cohort studies, along with functional studies. By establishing the association between the oral microbiome and risk of esophageal squamous cell carcinoma, we can better understand cancer etiology, and possibly develop a novel research paradigm for cancer chemoprevention.…”

Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China

“…Studies from China in the 1970s led to the hypothesis that high risk of ESCC could also result from poor oral health, poor oral hygiene practices, or tooth loss 40 . Recently, a study in China showed that toothbrushing exerts protective effects against ESCC and that tooth loss is associated with an elevated risk for ESCC 62 . Furthermore, in South America, Europe, and Japan, case-control studies have shown that tooth loss can increase the risk of ESCC 63 .…”