Abstract
Colorectal cancer remains the top leading cancer worldwide. Accumulating evidence suggests periodontal pathogens are involved in colorectal carcinogenesis, indicating the need for high-quality epidemiological evidence linking periodontal disease (PD) and colorectal cancer (CRC). Thus, we conducted the first population-based case–control study that was specifically designed to investigate the association between compromised oral health and sporadic CRC. A total of 348 incident cases of colon or rectal cancer, and 310 age and sex frequency-matched controls, from the Montreal island and Laval population participated in the study. Data were collected on PD and on several CRC risk factors using validated questionnaires. A life-course approach was used to document long-term history regarding lifestyle factors. Multivariable unconditional logistic regression analysis was used to estimate the rate ratio (RR) quantifying the association between CRC and PD. Results showed that the rate of new diagnosis of CRC in persons with a positive history of PD was 1.45 times higher than in those with a negative history of PD adjusting for age, sex, BMI, education, income, diabetes, family history of CRC, regular use of non-steroidal anti-inflammatory drugs, lifetime cumulative smoking, lifetime consumption of red meats, processed meats, and alcoholic drinks, and lifetime total physical activity score (adjusted RR = 1.45; 95% CI 1.04–2.01; p = 0.026). Our results support the hypothesis of an association between PD and sporadic CRC risk.
Highlights
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second cause of death from cancer worldwide, with over 1,900,000 new cases and over 900,000 deaths in 2020 (Global Cancer ObservatoryWorld Health Organization) [1]
1.4 (1.02–1.91); p = 0.037 1.45 (1.04–2.01); p = 0.026 a Age, sex, education attainment, annual personal income, body mass index (BMI), history of type II diabetes, history of CRC in first-degree relatives, history of regular use of aspirin and non-aspirin non-steroidal antiinflammatory drugs, lifetime measure of cigarette smoking, lifetime measure of consumption of red meats, lifetime measure of consumption of processed meats, lifetime measure of consumption of alcohol, and lifetime cumulative physical activity score. In this case–control study, we investigated the association between periodontal disease (PD) and CRC, and relied on multiple self-reported measurements to ascertain the PD status
Our findings suggest that the CRC rate is increased in persons with a positive history of PD compared with persons with a negative history of PD, even upon adjustment for a number of potential confounders
Summary
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second cause of death from cancer worldwide, with over 1,900,000 new cases and over 900,000 deaths in 2020 (Global Cancer ObservatoryWorld Health Organization) [1]. Several papers have been published on the association of CRC and PD [19,20,21,22,23,24,25,26,27], all of which relied on secondary analysis of data from studies that had been designed for other purposes. These papers suffer from various methodological limitations including, notably, misclassification of PD status and other relevant characteristics, residual confounding [28], and the low number of documented CRC cases. To better assess the possible etiologic role of PD in the occurrence of CRC, valid and reproducible epidemiological evidence is needed
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