Potential implications of adjuvant endocrine therapy for the oral health of postmenopausal women with breast cancer

Abstract

Current adjuvant treatment modalities for breast cancer that express the estrogen receptor or progesterone receptor include adjuvant anti-estrogen therapies, and tamoxifen and aromatase inhibitors. Bone, including the jaw, is an endocrine-sensitive organ, as are other oral structures. This review examines the potential links between adjuvant anti-estrogen treatments in postmenopausal women with hormone receptor positive breast cancer and oral health. A search of PubMed, EMBASE, CENTRAL, and the Web of Knowledge was conducted using combinations of key terms “breast,” “cancer,” “neoplasm,” “Tamoxifen,” “Aromatase Inhibitor,” “chemotherapy,” “hormone therapy,” “alveolar bone loss,” “postmenopausal bone loss,” “estrogen,” “SERM,” “hormone replacement therapy,” and “quality of life.” We selected articles published in peer-reviewed journals in the English. The authors found no studies reporting on periodontal diseases, alveolar bone loss, oral health, or oral health-related quality of life in association with anti-estrogen breast cancer treatments in postmenopausal women. Periodontal diseases, alveolar bone density, tooth loss, and conditions of the soft tissues of the mouth have all been associated with menopausal status supporting the hypothesis that the soft tissues and bone of the oral cavity could be negatively affected by anti-estrogen therapy. As a conclusion, the impact of adjuvant endocrine breast cancer therapy on the oral health of postmenopausal women is undefined. The structures of the oral cavity are influenced by estrogen; therefore, anti-estrogen therapies may carry the risk of oral toxicities. Oral health care for breast cancer patients is an important but understudied aspect of cancer survivorship.

Drugs, medications and periodontal disease

“…However, perhaps surprisingly, a recent systematic review found no reports of the effects of this drug on the periodontal tissues. 106 A whole generation of novel drug treatments for cancer are now being introduced, which target cellular signalling mechanisms including inhibitors of growth factors such as vascular endothelial growth factor and inhibitors of their intra-cellular signalling pathways, known as protein kinase inhibitors. These drugs include bevacizumab, sunitinib, and pazopanib, but the list of such drugs is ever increasing.…”

Evaluation of periodontal health in breast cancer patients undergoing tamoxifen or aromatase inhibitors drugs therapy: A cross‐sectional study

“…When the effect of age is eliminated, women in the postmenopausal period who do not receive estrogen supplements are twice as likely to have alveolar bone loss as those who received drug supplements and 3 times more than women in the premenopausal period 8–10 . Drugs affecting the production and/or binding of estrogen to the receptor may affect bone and/or soft tissues in the oral mucosa 17 …”

A Comparative Analysis of Pre- and Postmenopausal Females with Periodontitis and Its Response to a Non Invasive Clinical Approach

“… 39 40 Apart from maintenance of a meticulous oral hygiene, several studies have indicated that estrogen therapy builds up mandibular bone mass and diminishes the severity of periodontal disease in postmenopausal women. 31 41 …”