Racial Disparities in Oral Health Linked to Pancreatic Cancer Risk.
African Americans are more likely to get pancreatic cancer than their white counterparts, and are also more likely to experience periodontal disease and adult tooth loss.
A new study co-authored by School of Public Health researchers is the first to suggest a link between these two disparities, finding that, among African American women, having adult tooth loss and/or periodontal disease may double the risk of pancreatic cancer.
The study, published in Cancer Epidemiology, Biomarkers & Prevention, only found this association among non-smokers, who typically have lower risk of pancreatic cancer than smokers.
“Apart from avoiding cigarette smoking, there is little an individual can do to reduce risk of pancreatic cancer, but oral health is a modifiable factor,” says senior study author Julie Palmer, professor of epidemiology and associate director of BU’s Slone Epidemiology Center. “Improving access to low-cost, high-quality dental care for all Americans may decrease racial disparities in this cancer.”
Previous research in predominantly-white populations has suggested a link between oral health issues and pancreatic cancer risk, but no previous study had examined the link in African Americans.
For this study, the researchers used data from the BU-based Black Women’s Health Study, a long-term, prospective study of 59,000 Black women across the United States followed since 1995.
Among the 39,000 women who had not had any kind of cancer in 1997, the researchers found 78 cases of pancreatic cancer between 2007 and 2016. In self-reports, 18,258 of the women had not had any periodontal disease and had not lost teeth as adults, while 20,728 of the women reported periodontal disease and/or tooth loss.
In their analysis of the data, the researchers adjusted for age, type 2 diabetes, body-mass index (BMI), alcohol intake, and smoking.
Compared to women who had neither lost teeth nor had periodontal disease, women who had lost teeth were 2.05 times more likely to have pancreatic cancer, women who had had periodontal disease were 1.77 times more likely to have pancreatic cancer, and women who had had both tooth loss and periodontal disease had 1.58 the risk. Women who had lost one to four teeth had 1.72 times the risk of pancreatic cancer compared to women who had lost no teeth, and women who had lost five or more teeth had 2.20 times the risk of pancreatic cancer.
When the researchers compared smokers and non-smokers, they found little evidence of an association between oral health and pancreatic cancer for smokers, but they did see evidence in the non-smokers. Women who were past smokers or had never smoked and had lost at least one tooth were 2.42 times more likely to have pancreatic cancer than past or never-smokers who had not lost any teeth.
The authors wrote that a link between oral disease and pancreatic cancer could be caused by oral bacteria such as P. gingivalis, which causes gingivitis and resulting periodontal disease. Some previous research has linked the presence of P. gingivalis to cancer risk, although much more is needed to understand pathways and causality, the authors wrote.
The study was co-authored by Yvette Cozier, associate professor of epidemiology; Hanna Gerlovin of BU’s Slone Epidemiology Center; and Dominique Michaud of Tufts University Medical School.