Pancreatic cancer is one of the leading causes of cancer mortality. It is mostly diagnosed at advanced stages, leading to low survival rates. Only a few factors have yet to be identified as risks, of these, cigarette smoking is the most consistent.
The oral cavity serves as the initiator of digestion, and is a gateway between the external environment and the gastrointestinal tract. Oral hygiene and tooth loss has the ability to affect the gastrointestinal flora and nutritional status, and therefore may have implications for the development of chronic disease. Poor oral hygiene and dental health have been associated with increased risk of gastrointestinal cancers. Furthermore, several studies have suggested that dental plaque is a reservoir for Helicobacter pylori and gastric carriage of H. pylori is a known risk factor for gastric cancer. Scientists hypothesize that tooth loss may be associated with pancreatic cancer, as well as H. pylori seropositivity. The purpose of a recent investigation was to examine the association between dentition history and pancreatic cancer in a prospective cohort of male smokers, and that between dentition history and H. pylori seropositivity, in a cross-sectional sample from the same cohort.
The cohort were part of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, which was a placebo-controlled, double-blinded, 2x2 factorial design, primary prevention trial that tested the hypothesis of whether alpha-tocopherol or beta-carotene reduced the incidence of lung cancer in male smokers. The study included 29,133 men aged 50 years to 69 years, in southwestern Finland, who smoked greater than or equal to 5 cigarettes per day. At baseline, the participants completed questionnaires on general background characteristics, including self-reported medical, dentition, smoking and dietary history. Cases of pancreatic cancer were identified from the Finnish Cancer Registry. Cox proportional hazard models were used to estimate age-, smoking-, education-, urban living-, and height-adjusted odds ratios for H. pylori carriage.
Tooth loss was positively associated with pancreatic cancer (edentulous compared with missing zero to ten teeth; hazard ration = 1.63; 95% CI: 1.09, 2.46; P for trend = 0.02) but was not significantly associated with H. pylori seropositivity (edentulous compared with missing zero to ten teeth: odds ratio = 1.30; 95% CI: 0.73, 2.32; P for trend = 0.37).
In this study, tooth loss appears to be a risk for pancreatic cancer. However, further research is needed to evaluate the association between tooth loss and pancreatic cancer, and if an association is present, the biological mechanisms require exploration.
R. Stolzenber-Solomon, K. Dodd, M. Blaser, et al. Tooth loss, pancreatic cancer, and Helicobacter pylori. Am J Clin Nutr; 78:176-181 (August. 2003). [Correspondence: RX Stolzenberg-Solomon, Nutritional Epidemiology Branch, National Cancer Institute, 6120 Executive Boulevard, EPS, Suite 320, Bethesda, MD 20892. E-mail: rs221z@nih.gov].
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