Pancreatic cancer is an extremely difficult disease to treat and little is known about what causes it. One established risk factor in pancreatic cancer is cigarette smoking; other links have been made to obesity, diabetes type 2 and insulin resistance.

In a new study, researchers at the Harvard School of Public Health ( HSPH ) and Dana-Farber Cancer Institute found that periodontal disease was associated with an increased risk of cancer of the pancreas.

The study is published in the Journal of the National Cancer Institute ( JNCI ).

Periodontal disease is caused by bacterial infection and inflammation of the gums that over time causes loss of bone that supports the teeth; tooth loss is a consequence of severe periodontal disease. Two previous studies had found a link between tooth loss or periodontitis and pancreatic cancer, but one consisted of all smokers and the other did not control for smoking in the analysis, and therefore no firm conclusions could be drawn from these studies.

Data for the new study came from the Health Professionals Follow-Up Study, which began in 1986 and includes 51,529 U.S. men working in the health professions. Participants respond to questionnaires about their health every two years. After analyzing the data, the researchers confirmed 216 cases of pancreatic cancer between 1986 and 2002; of those, 67 reported periodontal disease.

The results showed that, after adjusting for age, smoking, diabetes, body mass index and a number of other factors, men with periodontal disease had a 63% higher risk of developing pancreatic cancer compared to those reporting no periodontal disease.

One possible explanation for the results is that inflammation from periodontal disease may promote cancer of the pancreas.
Individuals with periodontal disease have elevated serum biomarkers of systemic inflammation, such as C-reactive protein, and these may somehow contribute to the promotion of cancer cells.

Another explanation is that periodontal disease could lead to increased pancreatic carcinogenesis because individuals with periodontal disease have higher levels of oral bacteria and higher levels of nitrosamines, which are carcinogens, in their oral cavity. Prior studies have shown that nitrosamines and gastric acidity may play a role in pancreatic cancer.

Source: Harvard School of Public Health, 2007

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