Gum Disease and Cancer Risk

dental exam oral cavity white male head and neck oropharynx

New data supports the need to further investigate an association between periodontal disease and cancer risk.

Background: Previous studies have found periodontal disease is a risk factor for breast, oral, and esophageal cancers. Case-control studies have shown a link between tooth loss and the risk for esophagus and stomach cancers.

The Study: Investigators examined periodontal disease information in 65,869 women ages 54 to 86 at 40 centers in the USA. Mean age 68 years. Most were non-Hispanic whites with some college education. Participants answered this question: “Has a dentist or dental hygienist ever told you that you had periodontal or gum disease?”

The Results: This large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gall bladder, and melanoma skin cancers.Although periodontal disease and cancer share important risk factors (such as increased risk with increasing age and increased in smokers), this study showed that after adjustment for age, the risk of periodontal disease history and cancer persists regardless of smoking history.

My Take: This study adds to a growing body of evidence from smaller studies that link periodontal disease to total cancer risk. Oral hygiene is important not only in preventing tooth loss, but may have important implications for prevention of systemic diseases, including cancer. I’m Dr. Michael Hunter.

Cancer Epidemiol Biomark Prev. Published online 01 Aug 2017.

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Hot flashes: Risk Factors

Mature woman white smiling

Over the next several issues, I’ll turn to hot flashes: What are the risk factors, what is the pathophysiology, and management. Today, we begin with factors associated with hot flashes for patients with or without cancer.

Risk Factors: Both men and women can get hot flashes due to hormonal changes that occur during the natural aging process, although hot flashes are more common among midlife women. Age, race, ethnicity, educational level (equivocal), smoking, genetics, and body mass index can play roles. Some of  my patients see exacerbations with alcohol, exposure to heat, stress, spicy foods, and caffeine.

Race: Some studies point to African Americans having a greater risk for hot flashes (in addition to greater severity) as compared to other races. Here are the results from the Study of Women’s Health Across the Nation for combined hot flash and night sweat prevalence: Japanese 18%; Chinese-Americans 21%; whites 31%; Latinas 21%, and blacks 46%.

Smoking: The few studies that address the issue suggest a link between smoking and hot flashes. Smoking can alter estrogen metabolism in at least 4 ways.

Heart: Women who have hot flashes for 6 days or more over 2 weeks (especially those who are overweight or obese) have a higher cardiovascular risk. The role of weight and body mass index is less clear.

Genes: Research into the link between genetics (estrogen metabolism and receptor genes) and hot flashes appears promising. For example, women with a change (polymorphism) in a gene spot called CYP1B1 are at a 1/3 greater risk of reporting more severe and persistent hot flashes.

Cancer-related risk factors: These are predominantly related to the rapidity of hormone withdrawal. Among women, this is most commonly a drop in internal estrogen levels; with men, it is a drop in testosterone. For women, this may be linked to stopping hormone replacement therapy (HRT) when hormone-dependent breast cancer is diagnosed, the start of anti-estrogen therapies for treatment, chemotherapy-induced disruption of ovarian function, or damage to the ovaries (for example removal or radiation). Younger women are less likely than midlife women to have menopause induced by chemotherapy. In men, hot flashes are most commonly associated with anti-testosterone treatments for prostate cancer.

Certain cancers can be due to secretion of hormones by the cancer itself. Examples include some carcinoid tumors, medullary thyroid cancer, pancreas cancer, and kidney cancer.

I’m Dr. Michael Hunter. In my next blog, I’ll look at the physiology of hot flashes: Why do they occur?

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Coming Soon for iPad  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Thank you.

Breast Invasive Lobular Carcinoma: Link to HRT

Patients often wonder why they got a particular cancer. While we  cannot know with certainty why a particular individual got a cancer, we know of risk factors that increase the odds of getting it. Today, we look at the association of hormone replacement therapy (HRT) and a particular type of breast cancer, lobular carcinoma.

The observation: Post-menopausal hormone replacement therapy can significantly increase the risk of the less-common lobular form of breast cancer.

What’s lobular carcinoma? This breast cancer subtype involves the lobules, grape-like structures in the breast that contain milk-producing glands. Lobular carcinoma accounts for only about 15 percent of all invasive breast cancers, and is typically hormonally sensitive. However, lobular breast tumors also present a clinical challenge because they can be more difficult to detect both by clinical examination and by mammography (as compared to the more common ductal cancer).

English: Lobular Breast Cancer. Single file ce...
Lobular Breast Cancer. Single file cells and cell nests. (Photo credit: Wikipedia)

The data: In a study published in 2008 in Cancer Epidemiology, Biomarkers and Prevention, of more than 1,500 postmenopausal, western Washington women, my friend and colleague Christopher Li, MD found that current users of combined HRT had a 2.7-fold and 3.3-fold elevated risk of lobular and ductal-lobular cancer, respectively, regardless of tumor stage, size or number of lymph nodes involved. Only women who used combined HRT for three or more years faced an increased risk of lobular cancer. Among mixed ductal-lobular cases, hormone therapy increased the risk of tumors that were predominantly lobular but not tumors that had predominantly ductal characteristics.

Bottom Line: Postmenopausal women who take combined estrogen/progestin hormone-replacement therapy for three years or more face a fourfold increased risk of developing various forms of lobular breast cancer. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. And have a great day!