title: Periodontal disease, tooth loss and colorectal cancer risk: Results from the Nurses' Health Study.
abstract: Periodontal diseases including tooth loss might increase systemic inflammation, lead to immune dysregulation and alter gut microbiota, thereby possibly influencing colorectal carcinogenesis. Few epidemiological studies have examined the association between periodontal diseases and colorectal cancer (CRC) risk. We collected information on the periodontal disease (defined as history of periodontal bone loss) and number of natural teeth in the Nurses' Health Study. A total of 77,443 women were followed since 1992. We used Cox proportional hazard models to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) after adjustment for smoking and other known risk factors for CRC. We documented 1,165 incident CRC through 2010. Compared to women with 25-32 teeth, the multivariable HR (95% CI) for CRC for women with <17 teeth was 1.20 (1.04-1.39). With regard to tumor site, the HRs (95% CIs) for the same comparison were 1.23 (1.01-1.51) for proximal colon cancer, 1.03 (0.76-1.38) for distal colon cancer and 1.48 (1.07-2.05) for rectal cancer. In addition, compared to those without periodontal disease, HRs for CRC were 0.91 (95% CI 0.74-1.12) for periodontal disease, and 1.22 (95% CI 0.91-1.63) when limited to moderate to severe periodontal disease. The results were not modified by smoking status, body mass index or alcohol consumption. Women with fewer teeth, possibly moderate or severe periodontal disease, might be at a modest increased risk of developing CRC, suggesting a potential role of oral health in colorectal carcinogenesis.
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.|Division of Periodontics, Section of Oral and Diagnostic Sciences, Columbia University College of Dental Medicine, New York, NY.
authors: Fatemeh
authors: F
authors: Momen-Heravi
authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.|Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
authors: Ana
authors: A
authors: Babic
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Shelley S
authors: SS
authors: Tworoger
authors: Institute for Community Inclusion, University of Massachusetts, Boston, MA.
authors: Libin
authors: L
authors: Zhang
authors: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
authors: Kana
authors: K
authors: Wu
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
authors: Stephanie A
authors: SA
authors: Smith-Warner
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.|Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Shuji
authors: S
authors: Ogino
authors: Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.|Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.
authors: Andrew T
authors: AT
authors: Chan
authors: Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
authors: Jeffrey
authors: J
authors: Meyerhardt
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
authors: Edward
authors: E
authors: Giovannucci
authors: Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
authors: Charles
authors: C
authors: Fuchs
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI.|Department of Epidemiology, Brown University School of Public Health, Providence, RI.
authors: Eunyoung
authors: E
authors: Cho
authors: Department of Epidemiology, Brown University School of Public Health, Providence, RI.|Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA.
authors: Dominique S
authors: DS
authors: Michaud
authors: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
authors: Meir J
authors: MJ
authors: Stampfer
authors: Harvard School of Dental Medicine, Boston, MA.
authors: Yau-Hua
authors: YH
authors: Yu
authors: Harvard School of Dental Medicine, Boston, MA.
authors: David
authors: D
authors: Kim
authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Xuehong
authors: X
authors: Zhang
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000209:etiology*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016388:Tooth Loss / Q000150:complications*
keywords: colorectal cancer; microbiota; oral health; periodontal disease; tooth loss