Gum Disease Linked to Colorectal Cancer: COLDENT Study

Sharon Worcester

February 10, 2022

Periodontal disease (PD) may increase the risk of sporadic colorectal cancer (CRC), findings from the population-based case-control COLDENT study suggest.

The rate of new CRC diagnoses among individuals in the study who had a history of PD was nearly 50% higher than in those with no such history, after adjusting for a host of medical and demographic factors, say the investigators.

This isn't the first time PD has been linked with extra-oral health outcomes, including gastrointestinal cancers. It has been shown to be associated with several major systemic diseases, such as cardiovascular, respiratory, chronic kidney, and metabolic diseases. Evidence also suggests a link between PD and Alzheimer's disease, as reported recently by Medscape Medical News.

However, prior studies that looked at the connection between PD and CRC have relied on secondary analyses of data from other studies and are limited by other methodologic shortcomings, note the researchers, led by Amal Idrissi Janati, DDS, University of Montreal, Quebec, Canada.

To better assess the etiologic role of PD in the development of CRC, Janati and colleagues analyzed 348 histologically confirmed cases of colon or rectal cancer diagnosed from January 2013 to December 2019 and compared them to 310 matched controls.

The rate of new CRC diagnoses among individuals with a history of PD was 1.4 times higher than among those with no PD history after adjusting for age and gender. It increased to 1.45 times higher when also adjusting for body mass index, education, income, diabetes, family history of CRC, regular use of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs, and lifetime cumulative smoking, consumption of red and processed meats, alcohol consumption, and total physical activity score, they report.

The findings were published online January 26 in Cancer Causes and Control.

"Our results support the hypothesis of an association between PD and sporadic CRC risk," the researchers comment, adding that further epidemiologic studies are recommended.

They speculate that the "putative mechanism of PD and cancer association involves the spread of periodontal pathogens to extra-oral sites, dissemination of bacteria endotoxins, and release of inflammation products directly into the bloodstream."

The chronic inflammation associated with PD "promotes carcinogenesis by induction of gene mutations, inhibition of apoptosis, stimulation of angiogenesis, cell proliferation, and epigenetic alterations," they add.

The COLDENT study was supported by the Cancer Research Society. The authors have disclosed no relevant financial relationships.

Cancer Causes Control. Published online January 26, 2022. Full text

Sharon Worcester is an award-winning medical journalist at MDedge News, part of the Medscape Professional Network.

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