Recurrent aphthous stomatitis may be a precursor or risk factor for specific cancers: A case‐control frequency‐matched study

Abstract

BackgroundRecurrent aphthous stomatitis (RAS) is considered a prophase symptom in patients with specific cancers. This study assessed the association between RAS and subsequent onset of cancer based on a nationwide population‐based database in Taiwan.Materials and MethodsWe selected study participants from the National Health Insurance Research Database from January 2000 to December 2008. Patients in the non‐RAS cohort were matched to case study patients at a 1:1 ratio through frequency matching. All participants were followed up for at least 5 years, and those who received cancer diagnoses during follow‐up were identified.ResultsAmong 52 307 patients with and 52 304 patients without RAS, the combined hazard ratio (HR) of all subsequent cancer cases was 1.3 (95% confidence interval [CI]: 1.25‐1.35, P = 0). RAS diagnosis was associated with risk for cancers of the head and neck (aHR = 2, 95% CI: 1.8‐2.3), colon (aHR = 1.2, 95% CI: 1.1‐1.4), liver (aHR = 1.1, 95% CI: 1‐1.3), pancreas (aHR = 1.4, 95% CI: 1.1‐1.7), skin (aHR = 1.4, 95% CI: 1.2‐1.7), breast (aHR = 1.2, 95% CI: 1.1‐1.4), and prostate (aHR = 1.5, 95% CI: 1.3‐1.8), as well as hematologic cancers (aHR = 1.6, 95% CI: 1.3‐1.9). A higher risk was observed for male patients (aHR = 1.35, 95% CI: 1.28‐1.42) than for female patients (aHR = 1.25, 95% CI: 1.18‐1.31) with RAS.Conclusions RAS was associated with specific cancers. Susceptible RAS patients should be screened for specific cancers.

Exploring the Relationship Between Psychiatric Traits and the Risk of Mouth Ulcers Using Bi-Directional Mendelian Randomization

“…While the precise mechanism linking depression to mouth ulcers is not well understood, the immune system or inflammatory response is suggested to be involved (Al-Omiri et al, 2012;Huling et al, 2012;Alshahrani and Baccaglini, 2014). Depression can increase the number of leukocytes, which exhibit increased motility and enhanced adhesion to endothelial cells and thus induce endothelial dysfunction and mouth ulcers ultimately (Gavic et al, 2014;Demir et al, 2015;Qin et al, 2018). Besides, a serotonin transporter gene polymorphism (5-HTTLPR), which is commonly found in depressed patients, is also significantly enriched in patients with mouth ulcers (Victoria et al, 2005).…”

“…Furthermore, mouth ulcers are one of the common clinical signals of several serious diseases, such as oral cancer, gastrointestinal diseases, and human immunodeficiency virus infection (Paleri et al, 2010;Bilodeau and Lalla, 2019). Besides, mouth ulcers have been reported to associate with head and neck cancer, pancreatic cancer, breast cancer, and prostate cancer by a recent epidemiology study (Qin et al, 2018).…”

Risk of cancer in patients with recurrent aphthous stomatitis in Korea

“…[ 1 ] The simplest form of RAS usually lasts 1 to 2 weeks, sometimes longer if the lesion is large. [ 1 , 2 ] The triggering factor is not clearly known, but several factors such as genetic, environmental, and immunological factors are known to be related. [ 1 , 2 ]…”

“…[ 1 ] It is known to occur mainly in women in their teens and twenties. [ 1 , 2 ] Epithelial necrosis and neutrophilic infiltration are observed in the lesion center and C3, and immunoglobulin M can be deposited in blood vessels. [ 3 ] It is assumed that various factors such as viral or bacterial infections, eating habits, allergens, stress, and malnutrition are likely to affect RAS development.…”

“…[ 5 ] Several studies have been conducted on the relationship between oral ulcers and cancer, but only 1 study on the relationship between RAS and cancer has been reported. [ 2 – 4 , 6 ] This study analyzed the link between RAS and cancer in a group of 1 million Korean citizens based on data from the National Health Insurance Sharing Service (NHISS), which is a large enough sample to predict the risk of cancer.…”