Oral Health and Risk of Upper Gastrointestinal Cancers in a Large Prospective Study from a High-risk Region: Golestan Cohort Study

Abstract

Tooth loss and periodontal disease have been associated with several cancers, and poor oral health may be an important risk factor for upper gastrointestinal (UGI, i.e., esophageal and gastric) cancers. We assessed the relationship between oral health and UGI cancers using a large prospective study of over 50,000 adults living in Golestan Province, Iran, a high-incidence area for these cancers. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated for the association between three different measures of oral health [frequency of tooth brushing; number of missing teeth; and the sum of decayed, missing, and filled teeth (DMFT)] and UGI cancers. During a median follow-up duration of 13 years, there were 794 incident UGI cancers (396 esophageal and 398 gastric cancers). Daily tooth brushing was associated with a decreased risk of developing both esophageal (HR = 0.670; 95% CI: 0.486–0.924) and gastric (HR = 0.741; 95% CI: 0.544–1.01) cancers (combined UGI cancer HR = 0.697; 95% CI: 0.558–0.871) compared with never brushing. Tooth loss in excess of the loess smoothed, age- and sex-specific median number of teeth lost was significantly associated with esophageal (HR = 1.64; 95% CI: 1.08–2.47) and gastric cancers (HR = 1.58; 95% CI: 1.05–2.38). There were some adverse associations between DMFT and UGI cancers but most were not statistically significant. These results suggest increased risk of developing UGI cancers among individuals with poor oral health, and those who do not perform regular oral hygiene. Prevention Relevance: Poor oral health is associated with the risk of upper gastrointestinal cancers, and oral hygiene practices may help prevent these cancers.

Microbiome and Cancers of the Esophagus: A Review

“…Similar findings have been found in other high-risk areas such as Kashmir, India [ 72 ], Taixing, China [ 71 ], and Kenya [ 75 , 76 ], in addition to Japan [ 77 ] and parts of Latin America and Europe [ 78 ]. Regular tooth brushing has been shown to have a protective effect against ESCC in various studies [ 71 , 72 , 73 , 74 ]. Recent meta-analyses suggest an odds ratio (OR) of 1.3 to 1.5 comparing the highest versus lowest number of teeth lost [ 79 , 80 , 81 ] and an OR of around 0.60 when comparing high- versus low-frequency of tooth brushing [ 79 , 82 ] for overall EC risk (estimates were slightly weaker for tooth loss [ 79 , 80 ] and slightly stronger for tooth brushing [ 79 ] when the analysis was restricted to ESCC).…”

“…In fact, poor oral hygiene has been identified as one of the agents recommended for evaluation, with high priority for an upcoming IARC Monographs on the identification of carcinogenic hazards to humans [67]. Oral health-assessed by tooth loss; the sum of decayed, missing, or filled teeth (DMFT score); periodontal health; and oral hygiene practices (e.g., tooth brushing)-has been examined as a risk factor for ESCC in numerous epidemiologic studies [68][69][70][71][72][73][74][75][76][77][78]. A positive association between tooth loss and ESCC risk has been found repeatedly in both case-control and large-scale prospective cohort studies conducted in Linxian [68][69][70] and Golestan [73,74].…”

“…Oral health-assessed by tooth loss; the sum of decayed, missing, or filled teeth (DMFT score); periodontal health; and oral hygiene practices (e.g., tooth brushing)-has been examined as a risk factor for ESCC in numerous epidemiologic studies [68][69][70][71][72][73][74][75][76][77][78]. A positive association between tooth loss and ESCC risk has been found repeatedly in both case-control and large-scale prospective cohort studies conducted in Linxian [68][69][70] and Golestan [73,74]. Similar findings have been found in other high-risk areas such as Kashmir, India [72], Taixing, China [71], and Kenya [75,76], in addition to Japan [77] and parts of Latin America and Europe [78].…”

Relationship between maximum occlusal force and gastrointestinal cancer in community-dwelling older Japanese adults

“…Several prospective cohort studies from the United Kingdom, the United States, and other Asian countries have demonstrated the association of oral health with gastrointestinal or related cancers 5 , 6 , 13 , 17 . This study supports these results with added perspective, as the relationship between oral health and gastrointestinal cancer was confirmed purely in community-dwelling older adults.…”

“…Another prospective cohort study using data from the United Kingdom Biobank found that self-reported poor oral health (i.e., mouth ulcers, painful gums, bleeding gums, loose teeth, and toothaches) was associated with the incidence of hepatobiliary cancer 6 . Further, several other reports have shown that oral health indicators, such as tooth loss, periodontal disease, and poor oral hygiene, are associated with esophageal, stomach, colorectal, liver, and pancreatic cancers [7][8][9][10][11][12][13][14][15][16][17] . However, these relationships remain controversial because several studies reported contradictory results [18][19][20] .…”