Background
Periodontal pathogens have been isolated from pre-cancerous and cancerous lesions and also shown to promote a pro-carcinogenic microenvironment. Few studies have examined periodontal disease as a risk factor for total cancer and none has focused on older women. We examined whether periodontal disease is associated with incident cancer among postmenopausal women in the Women’s Health Initiative Observational Study.
Methods
Our prospective cohort study comprised 65,869 women, aged 54–86 years. Periodontal disease information was obtained via self-report questionnaires administered between 1999 and 2003, while ascertainment of cancer outcomes occurred through September 2013, with a maximum follow-up period of 15 years. Physician-adjudicated incident total cancer were the main outcomes and site-specific cancers were secondary outcomes. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. All analyses were conducted two-sided.
Results
During a mean follow-up of 8.32 years, 7,149 cancers were identified. Periodontal disease history was associated with increased total cancer risk [multivariable adjusted HR 1.14, 95% CI 1.08–1.20]; findings were similar in analyses limited to 34,097 never smokers [HR 1.12, 95% CI 1.04–1.22]. Associations were observed for breast [HR 1.13, 95% CI 1.03–1.23]; lung [HR 1.31, 95% CI 1.14–1.51]; esophagus [HR 3.28, 95% CI 1.64–6.53]; gallbladder [HR 1.73, 95% CI 1.01–2.95]; and melanoma skin [HR 1.23, 95% CI 1.02–1.48] cancers; Stomach cancer was borderline [HR 1.58, 95% CI 0.94–2.67].
Conclusions and Impact
Periodontal disease increases risk of total cancer among older women, irrespective of smoking. Certain anatomic sites appear to be vulnerable and warrant further investigation.