Cancer Causes & Control

, Volume 25, Issue 8, pp 1045–1053 | Cite as

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

  • Xiaodan Mai
  • Michael J. LaMonte
  • Kathleen M. Hovey
  • Ngozi Nwizu
  • Jo L. Freudenheim
  • Mine Tezal
  • Frank Scannapieco
  • Andrew Hyland
  • Christopher A. Andrews
  • Robert J. Genco
  • Jean Wactawski-WendeEmail author
Original paper



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.


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).


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).


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.


Lung cancer Periodontal disease Post menopause Smoking Chronic inflammation Interaction 



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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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Xiaodan Mai
    • 1
  • Michael J. LaMonte
    • 1
  • Kathleen M. Hovey
    • 1
  • Ngozi Nwizu
    • 2
  • Jo L. Freudenheim
    • 1
  • Mine Tezal
    • 3
  • Frank Scannapieco
    • 3
  • Andrew Hyland
    • 4
  • Christopher A. Andrews
    • 5
  • Robert J. Genco
    • 3
  • Jean Wactawski-Wende
    • 1
    Email author
  1. 1.Department of Epidemiology and Environmental Health, School of Public Health and Health ProfessionsUniversity at Buffalo, The State University of New YorkBuffaloUSA
  2. 2.Department of Cancer Pathology and PreventionRoswell Park Cancer InstituteBuffaloUSA
  3. 3.Department of Oral Biology, School of Dental MedicineUniversity at Buffalo, The State University of New YorkBuffaloUSA
  4. 4.Department of Health BehaviorRoswell Park Cancer InstituteBuffaloUSA
  5. 5.Department of Ophthalmology and Visual SciencesUniversity of MichiganAnn ArborUSA

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