Periodontal disease and cancer risk: A nationwide population-based cohort study

Eun Hwa Kim; Sunghyun Nam; Chung Hyun Park; Yitak Kim; Myeongjee Lee; Joong Bae Ahn; Sang Joon Shin; Yu Rang Park; Hoi In Jung; Baek-Il Kim; Inkyung Jung; Han Sang Kim

doi:10.3389/fonc.2022.901098

Periodontal disease and cancer risk: A nationwide population-based cohort study

Front Oncol. 2022 Aug 23:12:901098. doi: 10.3389/fonc.2022.901098. eCollection 2022.

Authors

Eun Hwa Kim¹, Sunghyun Nam², Chung Hyun Park³, Yitak Kim², Myeongjee Lee¹, Joong Bae Ahn⁴, Sang Joon Shin⁴, Yu Rang Park², Hoi In Jung⁵, Baek-Il Kim⁵, Inkyung Jung⁶, Han Sang Kim^{4

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Affiliations

¹ Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
² College of Medicine, Yonsei University, Seoul, South Korea.
³ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
⁵ Department of Preventive Dentistry and Public Oral Health, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea.
⁶ Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Graduate School of Medical Science, Brain Korea 21 Project, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
⁸ Institute for Innovation in Digital Healthcare (IIDH), Severance Hospital, Seoul, South Korea.

Abstract

Background: Although emerging evidence suggests that periodontitis might increase the risk of cancer, comorbidity and lifestyle behaviors, such as smoking and body mass index (BMI), may have confounded this reported association. This study aimed to investigate whether chronic periodontitis is associated with cancer risk using a large, nationwide database.

Methods: We conducted a population-based, retrospective cohort study using data from the Korean National Health Insurance Cohort Database obtained between January 2003 and December 2015. We included 713,201 individuals without a history of cancer who were followed up to 10 years. Confounding factors included demographic factors (age, sex, income, and residential area), lifestyle behaviors (smoking history and BMI), and comorbidities, such as hypertension, diabetes, heart failure, and pulmonary disease, using the Charlson Comorbidity Index. Multivariable Cox regression analysis was applied to estimate the adjusted hazard ratio (aHR) for cancer risk.

Results: Of the 713,201 participants, 53,075 had periodontitis and were placed in the periodontitis group; the remaining 660,126 individuals were included as the control group. Overall, the cumulative incidence of cancer in the periodontitis group was 2.2 times higher than that in the control group. The periodontitis group had an increased risk of total cancer compared to the control group after adjusting for age, sex, comorbidities, BMI, and smoking history (aHR, 1.129; 95% confidence interval [CI], 1.089-1.171; P<0.0001). When examining specific cancer types, significant associations were also observed between periodontitis and stomach cancer (aHR, 1.136; 95% CI, 1.042-1.239; P=0.0037), colon cancer (aHR, 1.129; 95% CI, 1.029-1.239; P=0.0105), lung cancer (aHR, 1.127; 95% CI, 1.008-1.260; P=0.0353), bladder cancer (aHR, 1.307; 95% CI, 1.071-1.595; P=0.0085), thyroid cancer (aHR, 1.191; 95% CI, 1.085-1.308; P=0.0002), and leukemia (aHR, 1.394; 95% CI, 1.039-1.872; P=0.0270). There was no significant association between the development of secondary malignancy and periodontitis in cancer survivors who were alive 5 years after they were diagnosed with the primary malignancy.

Conclusions: Periodontal disease, including periodontitis, was associated with increased risk of cancer, which persisted after controlling for confounding factors. Further prospective research is warranted to establish a causal relationship.

Keywords: cancer risk; cohort study; oral inflammation; periodontal disease; periodontitis.