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Cited by 171Oral microbiology and periodontitis researchOral Health Pathology and TreatmentHead and Neck Cancer Studies

Periodontal disease assessed using clinical dental measurements and cancer risk in the ARIC study

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Michaud, Dominique S, Lu, Jiayun, Peacock-Villada, Alexandra Y, Barber, John R, Joshu, Corinne E, Prizment, Anna E, Beck, James D, Offenbacher, Steven +1 more·2018·JNCI Journal of the National Cancer Institute
DOI 10.1093/jnci/djx278PMC PMC6093423
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Abstract

Background: While evidence is increasingly consistent with a positive association between periodontitis and cancer risk, most studies have relied on self-reported periodontitis.In this study, we prospectively evaluated the association of periodontal disease severity with cancer risk in black and white older adults in a cohort study that included a dental examination.Methods: Included were 7466 participants in the Atherosclerosis Risk in Communities study cohort who at visit 4 (1996)(1997)(1998) reported being edentulous or underwent the dental examination.Probing depth and gingival recession were measured at six sites on all teeth; these measurements were used to define periodontal disease severity.Incident cancers (n ¼ 1648) and cancer deaths (n ¼ 547) were ascertained during a median of 14.7 years of follow-up.All statistical tests were two-sided.Results: An increased risk of total cancer (hazard ratio [HR] ¼ 1.24, 95% confidence interval [CI] ¼ 1.07 to 1.44, P trend ¼ .004)was observed for severe periodontitis (>30% of sites with attachment loss >3 mm) compared with no/mild periodontitis (<10% of sites with attachment loss >3 mm), adjusting for smoking and other factors.Strong associations were observed for lung cancer (HR ¼ 2.33, 95% CI ¼ 1.51 to 3.60, P trend < .001),and elevated risks were noted for colorectal cancer for severe periodontitis, which were significant among never smokers (HR ¼ 2.12, 95% CI ¼ 1.00 to 4.47).Associations were generally weaker, or not apparent among black participants, except for lung and colorectal cancers, where associations were similar by race.No associations were observed for breast, prostate, or hematopoietic and lymphatic cancer risk.Conclusions: This study provides additional evidence that cancer risk, especially for lung and colorectal cancer, is elevated in individuals with periodontitis.Additional research is needed to understand cancer site-specific and racial differences in findings.Evidence is mounting that periodontal disease is associated with cancer risk, but questions remain regarding the magnitude of the associations and which cancers are impacted.Existing studies examining periodontal disease and cancer risk have various limitations, including use of self-reported diagnosis of periodontal disease (1-3), lack of adjustment for smoking (4,5), or few cancer cases (6).Despite limitations, all six prospective cohort studies evaluating total cancer reported positive associations, with increased risks of 14% to 20% (3,7) in those adjusting for smoking, the major risk factor for both periodontal disease and cancer.Periodontitis, an advanced inflammatory gum disease caused by oral bacterial dysbiosis (8), affects both local and systemic immune response (9).Periodontitis may influence cancer risk through changes in immune response, or alternatively, through dissemination of harmful bacteria (10).Given that half of US adults have periodontal disease (11), the public health

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Authors
Michaud, D. S., Lu, J., Peacock-Villada, A. Y., Barber, J. R., Joshu, C. E., Prizment, A. E., Beck, J. D., Offenbacher, S., & Platz, E. A.
Affiliations
  • Tufts University (US)
  • Johns Hopkins University (US)
  • University of Minnesota (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Michaud, Dominique S
ORCID
Venue
JNCI Journal of the National Cancer Institute
Publisher
Oxford University Press (OUP)
Published
2018-01-12
Volume
110
Issue
8
Pages
843-854
ISSN
  • 0027-8874 (ISSN-L)
  • 1460-2105
DOI
10.1093/jnci/djx278
PMC
PMC6093423
OpenAlex
W2783423687
Cited by
171
References
27
Citations by year
2026: 18 · 2025: 18 · 2024: 25 · 2023: 23 · 2022: 27 · 2021: 17 · 2020: 21 · 2019: 14 · 2018: 8
FWCI
16.23
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/about_us/legal/notices (vor)
Locations
  • JNCI Journal of the National Cancer Institute (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Cancer Institute (R01 CA166150)
  • NCI (U01 CA164975)
  • NCI Cancer Center (P30 CA006973)
  • National Heart, Lung, and Blood Institute
  • National Institutes of Health, and Department of Health and Human Services (HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN268201700002I)
  • National Institutes of Health
Topics
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Dentistry › Periodontics › Oral Health Pathology and Treatment
  • Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
Keywords
periodontitis, periodontal disease severity, cancer risk, lung cancer, colorectal cancer, probing depth, gingival recession, attachment loss, racial differences, older adults, Atherosclerosis Risk in Communities Study, cancer mortality, never smokers, breast cancer, prostate cancer, edentulism
MeSH terms
Age Factors, Aged, Diagnosis, Oral, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Periodontal Diseases, Periodontitis, Risk Factors, Severity of Illness Index, Cohort Studies, Black People, White People

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