title: Periodontal disease severity and cancer risk in postmenopausal women: the Buffalo OsteoPerio Study.
abstract: OBJECTIVE
  Few prospective studies have reported on relationships between objective periodontal disease (PD) measures and cancer risk. This association was examined in 1,337 postmenopausal women participating in the Buffalo OsteoPerio Study.
  
  
  METHODS
  Oral alveolar crestal height (ACH) was measured using oral radiographs. Incident cancers were adjudicated with medical records. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations between ACH and incident cancer outcomes were estimated using Cox proportional hazards models.
  
  
  RESULTS
  There were 203 confirmed total incident cancer cases during follow-up (12.2 ± 4.2 years). After adjusting for age and smoking, there were no statistically significant associations between ACH-defined PD categories and total cancer risk (mild/moderate vs. none: HR 1.33, 95 % CI 0.91-1.94; severe vs. none: HR 1.20, 95 % CI 0.77-1.86). ACH-defined PD categories were not associated with common site-specific cancers. Whole-mouth mean and worst-site ACH (per 1 mm loss) were significantly associated with increased risk of lung (adjusted HR 1.81, 95 % CI 1.30-2.54; adjusted HR 1.34, 95 % CI 1.08-1.66, respectively), but not total or other site-specific cancer. Smoking status modified the associations between continuous ACH variables and total cancer risk; measures of PD were associated with total cancer among smokers but not never smokers (interaction p = 0.02 and p < 0.01 for whole-mouth mean and worst-site ACH, respectively).
  
  
  CONCLUSIONS
  ACH-defined PD was associated with total cancer risk in ever but not never smoking postmenopausal women. Whole-mouth mean and worst-site ACH were associated with increased lung cancer risk. However, these results need to be interpreted cautiously given the small number of lung cancer cases (n = 18). Further research utilizing a larger sample is warranted to confirm the relationships among oral bone loss, site-specific cancers, and total cancer.
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Mai
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaMonte
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Hovey
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Jo L
authors.initials: JL
authors.lastname: Freudenheim
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Andrews
authors.affiliation: Department of Oral Biology, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Genco
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA. jww@buffalo.edu.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology; D055113:Chronic Periodontitis / Q000453:epidemiology*; D015179:Colorectal Neoplasms / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000453:epidemiology; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology; D008545:Melanoma / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009518:New York / Q000453:epidemiology; D010510:Periodontal Diseases / Q000453:epidemiology; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology
keywords: Alveolar bone loss; Cancer epidemiology; Inflammation; Periodontal disease; Postmenopausal women; Prospective studies