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.

Available Today: Your Breast Cancer app on Android (in Search, type Michael Hunter Your Breast Cancer … and voila!)

Should doctors prescribe exercise?

young woman running city park

“Although the data vary by different cancer types, there is a consistent trend suggesting that moderate daily exercise has a beneficial effect on preventing certain cancers. If you are a reasonably healthy adult, your should exercise regularly.” 

Let’s look at the relationship of exercise and selected cancers. The American Society of Clinical Oncology (ASCO) has done a nice job of summarizing:

Breast Cancer

While the amount of risk reduction varies among studies (20-80%), most suggest that 30 to 60 minutes of moderate to high-intensity exercise per day lowers breast cancer risk. Women who are physically active throughout their life appear to benefit the most, but those who increase physical activity after menopause also fare better than inactive women.1

Colon Cancer

Research suggests that people who increase their physical activity can lower the chance of developing colon cancer by 30 to 40% relative to sedentary adults.1,2 A decrease in colon cancer risk can be achieved regardless of body mass index (BMI) and people who are most active benefit the most. There is insufficient evidence of a protective effect of physical activity on the risk of rectal cancer (a protective effect was seen in some case-control studies, but not in cohort studies).3

Endometrial, Lung and Ovarian Cancer

A handful of studies have suggested that women who are physically active have a 20-40% reduced risk of endometrial cancer compared to those who don’t exercise.1 Higher levels of physical activity seem to also protect against lung cancer (up to 20% reduction in risk), particularly among men.1Although less consistent, research suggests that physical activity possibly reduces the risk of ovarian and prostate cancer.

What about Other Cancers?

While observational data on the benefits of exercise for prevention of the types of cancers listed above are fairly consistent, evidence of the effects of exercise on prevention of any other type of cancer either is either insufficient or inconsistent.2,4

Prostate Cancer

Prostate cancer is one disease in which the data are not consistent, however prostate cancer is a heterogeneous disease and risk factor associations for total non-aggressive disease are different from aggressive / lethal disease. Most population based studies show similar findings, with little effect of exercise on overall incidence of prostate cancer but lower risk of aggressive prostate cancers for those with the highest levels of VIGOROUS activity (rather than any type of activity). In the Health Professionals Follow-up Study men 65 years or older who engaged in vigorous physical activity, such as running, jogging, biking, swimming or tennis at least three hours per week  had a 67% lower risk of advanced prostate cancer and 74% lower risk of fatal prostate cancer.5

Conflicting data for other malignancies

For example, one recent study found no association between physical activity and risk of developing gastric, rectal, pancreatic, bladder, testicular, kidney and hematological cancers.4 In contrast, a pooled analysis of data from prospective trials with 1.4 million participants found that physical activity was linked to lower risk of 13 cancers: esophageal, lung, kidney, gastric, endometrial, myeloid leukemia, myeloma, colon, head and neck, rectal, bladder, and breast.6Interestingly, leisure-time physical activity was associated with a higher risk of melanoma (presumably due to time spent outdoors) and prostate cancer, although it is not clear from these data whether that association was with nonaggressive or aggressive prostate cancer.

While we wait for confirmation and clarity on the role of exercise in preventing all the 200+ types of cancer – should doctors prescribe exercise? The answer is simple: yes, because evidence of the protective role of exercise is already strong for some of the most common cancers.

References

  1. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  2. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239–252.
  3. Pham NM, et al. Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2012 Jan;42(1):2-13.
  4. Friedenreich CM, Neilson HK, Lynch BM. Eur J Cancer. State of the epidemiological evidence on physical activity and cancer prevention. 2010 Sep;46(14):2593-604.
  5. Giovannucci E, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165(9):1005-1010.
  6. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25.
  7. http://www.asco.org/about-asco/press-center/asco-resources-media/cancer-perspectives/should-cancer-doctors-prescribe?et_cid=38723632&et_rid=463715101&linkid=Read+more

 

I’m Dr. Michael Hunter. Of course, the disclaimer: Do not begin an exercise program without input from an appropriate medical professional. Many can simply start with a brisk walk for 30 minutes daily, 5 days per week. Have a wonderful day!

Aspirin May Fight Cancer by Slowing DNA Damage

Endoscopic image of Barrett's esophagus
Endoscopic image of Barrett’s esophagus (Photo credit: Wikipedia)

Aspirin may lower the risk of some cancers. Now, researchers led by scientists from the University of California, San Francisco may have an explanation. Aspirin appears to slow the accumulation of DNA mutations (changes) in abnormal cells in at least one pre-cancerous condition. In the online journal PLOS Genetics, Carlo Maley, PhD and colleagues analyzed biopsy samples from 13 patients with a pre-cancerous condition known as Barrett’s esophagus that can occur in the lower esophagus (especially with heartburn/reflux) and occasionally lead to esophagus cancer. The study is an observational crossover one, meaning that patients start by taking daily aspirin for several years, then stopped. Others started taking the aspirin for the first time during the observation. The researchers aimed to track the rate of mutations in tissues sampled at different times.

Biopsies takin while the patients were on aspirin had on average accumulated new mutations about 10 times more slowly than in biopsies obtained during years when the patients were not taking aspirin.

My take: We know that cancers can accumulate mutations over time more rapidly than normal cells. Even within a single tumor, we may see different rates. This diversity can set a tumor up for resistance to treatment. I also wonder whether the aspirin effects are mediated through the lowering of inflammation. Less inflammation may reduce the production of DNA-damaging oxidants in pre-cancerous cells. Someday, we may better halt or slow growth and mutation rather than simply aiming to kill a cancer cell. For now, check with your doctor to see if there are other reasons you should consider something like a baby aspirin. Who knows? You may lower your risk of cancer a bit (but do ask about potential side effects)! I’m Dr. Michael Hunter.

Cutting Your Cancer Risk through Diet

English: nitrosylheme, nitrosyl-heme, heme-NO,...
Nnitrosylheme. (Pegg & Shaidi, 2000, “The color of meat” in “Food & Nutrition, Press Inc., Trumbull, Connecticut, USA), released from NO-myoglobin by cooking cured meat (Honikel K.O., 2008, Meat Science, 78, 68-76) (Photo credit: Wikipedia)

Today, I’d like to focus on a couple of things you can do to reduce your risk of cancer. We have long known that consumption of processed meat can increase the risk of cancer.

1. Processed meats: These agents are created by nitrites used to color and preserve processed meats such as bacon, sausage, and lunch meats. These compounds have been linked to cancer in lab animals. The N-nitroso compounds are not in the meat (the food companies must add chemicals to keep it from forming), but are created in the gut in a reaction probably facilitated by bacteria. This may explain why those of us who eat processed meatus have a higher risk of colorectal, esophagus, and stomach cancer.

2. Unprocessed meats: Unprocessed red meat can also increase N-nitroso compounds in your gut. For example, the risk of colorectal cancer is higher (at least according to some studies) among individuals who consume more heme iron, a substance found in all meats, but especially in red meat). On the other hand, white meat does not appear to do so. Could it be that iron attaches to hemoglobin in the blood? The studies are insufficient to say with any degree of certainty.

3. Meat mutagens: Cooking meats to well done at high temperatures causes cancer in animal studies. For humans, the data is more mixed. In the NIH-AARP Diet and Health Study, colorectal cancer risk increased by a factor of 1.2 among those who consumed the highest levels of two key heterocyclic amines (HCA). Chicke eaters may have a lower risk, even though the levels of HCA may be high in barbecued chicken.

In our next issue, we’ll look at specific things you can do to lower risk, including improving your grilling technique. 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!