Prospective study of tooth loss and incident esophageal and gastric cancers in China
Objective: To determine the association between tooth loss and the risk of developing esophageal squamous cell carcinoma, gastric cardia adenocarcinoma, or gastric non-cardia adenocarcinoma in a prospective study.
Methods: Cox proportional hazards regression was used to examine these associations in a 28,868-person cohort followed prospectively for 5.25 years. The baseline questionnaire included questions regarding tooth loss, and individuals reporting lost teeth had their teeth counted by study personnel. The analytic cohort included 620 esophagus, 431 gastric cardia, and 102 gastric non-cardia cancer cases.
Results: Tooth loss was associated with a significantly elevated risk of developing all three cancers. When examined as median splits, tooth loss was associated with a relative risk (RR) (95% confidence interval, CI) of 1.3 (1.1–1.6) in the esophagus, 1.3 (1.0–1.6) in the gastric cardia, and 1.8 (1.1–3.0) in the gastric non-cardia. Further analysis demonstrated that this increased risk was most strongly associated with the loss of the first few teeth and was primarily confined to the younger members of our cohort.
Conclusions: In this cohort tooth loss increased the risk of developing upper gastrointestinal cancer. We hypothesize that this may be related to alterations in oral bacterial flora and subsequent increases in the in-vivo production of carcinogens such as nitrosamines.
esophageal cancer gastric cancer nitrosamines tooth loss
Zheng TZ, Boyle P, Hu HF, et al.
(1990) Dentition, oral hygiene, and risk of oral cancer: a case-control study in Beijing, People's Republic of China. Cancer Causes Control
: 235–241.PubMedGoogle Scholar
Bundgaard T, Wildt J, Frydenberg M, Elbrond O, Nielsen JE (1995) Case-control study of squamous cell cancer of the oral cavity in Denmark. Cancer Causes Control
: 57–67.PubMedGoogle Scholar
Zheng W, Blot WJ, Shu XO, et al.
(1992) Risk factors for oral and pharyngeal cancer in Shanghai, with emphasis on diet. Cancer Epidemiol Biomarkers Prev
: 441–448.PubMedGoogle Scholar
Wang YP, Han XY, Su W, et al.
(1992) Esophageal cancer in Shanxi Province, People's Republic of China: a case-control study in high and moderate risk areas. Cancer Causes Control
: 107–113.PubMedGoogle Scholar
Watabe K, Nishi M, Miyake H, Hirata K (1998) Lifestyle and gastric cancer: a case-control study. Oncol Rep
: 1191–1194.PubMedGoogle Scholar
Demirer T, Icli F, Uzunalimoglu O, Kucuk O (1990) Diet and stomach cancer incidence. A case-control study in Turkey. Cancer
: 2344–2348.PubMedGoogle Scholar
Wolff G, Lauter J (1976) On epidemiology of gastric cancer. Arch Geschwulstforsch
: 1–14.PubMedGoogle Scholar
Zhang ZX, Li BY, Jin SS (1990) Epidemiologic trends of esophageal cancer in Linxian. Research on esophageal cancer prevention and treatment (Shi Guan Ai Fang Zhi Yan Jiu-Linxian)
: 1–14.Google Scholar
Li B, Taylor PR, Li JY, et al.
(1993) Linxian nutrition intervention trials. Design, methods, participant characteristics, and compliance. Ann Epidemiol
: 577–585.PubMedGoogle Scholar
Blot WJ, Li JY, Taylor PR, et al.
(1993) Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst
: 1483–1492.PubMedGoogle Scholar
Limburg PJ, Qiao Y-L, Mark SD, et al.
(2001) Helicobacter pylori
seropositivity and subsite-specific cancer risks in Linxian, China. J Natl Cancer Inst
: 226–233.PubMedGoogle Scholar
Li JY, Ershow AG, Chen ZJ, et al.
(1989) A case control study of cancer of the esophagus and gastric cardia in Linxian. Int J Cancer
: 755–761.PubMedGoogle Scholar
Yu Y, Taylor PR, Li JY, et al.
(1993) Retrospective cohort study of risk-factors for esophageal cancer in Linxian, People's Republic of China. Cancer Causes Control
: 195–202.PubMedGoogle Scholar
Yang CS (1980) Research on esophageal cancer in China: a review. Cancer Res
: 2633–2644.PubMedGoogle Scholar
Muto M, Hitomi Y, Ohtsu A, et al.
(2000) Acetaldehyde production by non-pathogenic Neisseria
in human oral microflora: implications for carcinogenesis in upper aerodigestive tract. Int J Cancer
: 342–350.PubMedGoogle Scholar
Shapiro KB, Hotchkiss JH, Roe DA (1991) Quantitative relationship between oral nitrate-reducing activity and the endogenous formation of N-nitrosoamino acids in humans. Food Chem Toxicol
: 751–755.PubMedGoogle Scholar
Nair J, Ohshima H, Nair UJ, Bartsch H (1996) Endogenous formation of nitrosamines and oxidative DNA-damaging agents in tobacco users. Crit Rev Toxicol
: 149–161.PubMedGoogle Scholar
Tricker AR (1997) N-nitroso compounds and man: sources of exposure, endogenous formation and occurrence in body fluids. Eur J Cancer Prev
: 226–268.PubMedGoogle Scholar
Wu Y, Chen J, Ohshima H, et al.
(1993) Geographic association between urinary excretion of N-nitroso compounds and oesophageal cancer mortality in China. Int J Cancer
: 713–719.PubMedGoogle Scholar
© Kluwer Academic Publishers 2001