Oral health and risk of upper gastrointestinal cancers in a large prospective study from a high-risk region: Golestan cohort study

Tooth loss and periodontal disease have been associated with several cancers, and poor oral health may be an important risk factor for upper gastrointestinal (UGI, i.e., esophageal and gastric) cancers. We assessed the relationship between oral health and UGI cancers using a large prospective study of over 50,000 adults living in Golestan Province, Iran, a high-incidence area for these cancers. Hazard ratios (HRs) and 95 confidence intervals (CI) were estimated for the association between three different measures of oral health frequency of tooth brushing; number of missing teeth; and the sum of decayed, missing, and filled teeth (DMFT) and UGI cancers. During a median follow-up duration of 13 years, there were 794 incident UGI cancers (396 esophageal and 398 gastric cancers). Daily tooth brushing was associated with a decreased risk of developing both esophageal (HR ¼ 0.670; 95% CI: 0.486�0.924) and gastric (HR ¼ 0.741; 95% CI: 0.544�1.01) cancers (combined UGI cancer HR ¼ 0.697; 95% CI: 0.558�0.871) compared with never brushing. Tooth loss in excess of the loess smoothed, age- and sex-specific median number of teeth lost was significantly associated with esophageal (HR ¼ 1.64; 95% CI: 1.08�2.47) and gastric cancers (HR ¼ 1.58; 95% CI: 1.05�2.38). There were some adverse associations between DMFT and UGI cancers but most were not statistically significant. These results suggest increased risk of developing UGI cancers among individuals with poor oral health, and those who do not perform regular oral hygiene. Prevention Relevance: Poor oral health is associated with the risk of upper gastrointestinal cancers, and oral hygiene practices may help prevent these cancers. © 2021 American Association for Cancer Research