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History of periodontal disease diagnosis and lung cancer incidence in the Women’s Health Initiative Observational Study

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Abstract

Purpose

While some evidence suggests that periodontal disease (PD) might be positively associated with lung cancer, prospective studies in women are limited. Previous findings may reflect residual confounding by smoking. The study aims to determine whether history of PD diagnosis is associated with incident lung cancer in a large cohort of postmenopausal women.

Methods

Prospective analyses were conducted in a cohort of 77,485 postmenopausal women enrolled in the Women’s Health Initiative Observational Study. History of PD (prevalence of 26.1 %) was self-reported, and 754 incident lung cancer cases occurred during an average 6.8 (SD ± 2.6) years of follow-up. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).

Results

Overall, PD was positively associated with lung cancer risk after adjusting for detailed smoking history including smoking status and pack-years of smoking (HR 1.24, 95 % CI 1.07–1.45). There was a positive additive interaction between PD with pack-years of smoking (p = 0.02), suggesting a potential synergistic effect between PD and smoking intensity on lung cancer. The association between PD and lung cancer was stronger in former smokers. When restricted to never-smokers, PD was not associated with lung cancer (HR 1.02, 95 % CI 0.68–1.53).

Conclusions

Periodontal disease was not independently associated with lung cancer in non-smoking postmenopausal women. However, smoking and PD jointly increased lung cancer risk beyond that expected from the sum of the each effect separately. The potential synergism between PD and smoking on lung cancer warrants further examination.

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Acknowledgments

This work was supported by the WHI program which is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts N01WH22110, 24152, 32100–2, 32105–6, 32108–9, 32111–13, 32115, 32118–32119, 32122, 42107–26, 42129–32, 44221, HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C; R01DE013505 from the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md., to Dr. Wactawski-Wende, and US Army, Medical Research and Materiel Command, Fort Detrick, Md., Grant OS950077 to Dr. Wactawski-Wende. Xiaodan Mai is funded by Interdisciplinary Training in Cancer Epidemiology: R25CA113951.

Conflict of interest

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Authors and Affiliations

  1. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, 270 Farber Hall, Buffalo, NY, 14214, USA

    Xiaodan Mai, Michael J. LaMonte, Kathleen M. Hovey, Jo L. Freudenheim & Jean Wactawski-Wende

  2. Department of Cancer Pathology and Prevention, Roswell Park Cancer Institute, Buffalo, NY, USA

    Ngozi Nwizu

  3. Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Mine Tezal, Frank Scannapieco & Robert J. Genco

  4. Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA

    Andrew Hyland

  5. Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA

    Christopher A. Andrews

Authors
  1. Xiaodan Mai
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  2. Michael J. LaMonte
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  3. Kathleen M. Hovey
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  4. Ngozi Nwizu
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  5. Jo L. Freudenheim
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  6. Mine Tezal
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  7. Frank Scannapieco
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  8. Andrew Hyland
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  9. Christopher A. Andrews
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  10. Robert J. Genco
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  11. Jean Wactawski-Wende
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Corresponding author

Correspondence to Jean Wactawski-Wende.

Appendix: Short list of WHI investigators

Appendix: Short list of WHI investigators

Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam, Dale Burwen, Joan McGowan, Leslie Ford, and Nancy Geller

Clinical Coordinating Center: Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg

Investigators and Academic Centers: (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E. Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thomson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker

Women’s Health Initiative Memory Study: (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker

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Mai, X., LaMonte, M.J., Hovey, K.M. et al. History of periodontal disease diagnosis and lung cancer incidence in the Women’s Health Initiative Observational Study. Cancer Causes Control 25, 1045–1053 (2014). https://doi.org/10.1007/s10552-014-0405-3

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  • DOI: https://doi.org/10.1007/s10552-014-0405-3

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