Gum disease may cause more than just bad breath, according to a new study presented at the 2016 American Association for Cancer Research meeting, which points to a connection between periodontal disease as a potential early marker for pancreatic cancer. This could pave the way for early detection of pancreatic cancer – one of the most deadly forms of the disease –because of the advanced stage at which it is often diagnosed.
It is estimated that in 2016, 53,070 new cases of pancreatic cancer will be diagnosed with only 7.7 percent of victims surviving 5 years.
Researchers from New York University (NYU) Langone Medical Center with a grant from the National Cancer Institute, found people with two types of periodontal disease-causing oral bacteria have a higher prevalence of pancreatic cancer than those who did not have the gum disease.
The two types of periodontal disease bacteria the research team found were Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Saliva samples came from 361 individuals who developed pancreatic cancer and samples from 371 matched healthy individuals in large-scale, long-term prospective cohort studies. The DNA extracted from the saliva was sequenced, and variances in age, race, sex, smoking status, alcohol use, body mass index and diabetes were controlled.
Participants with Porphyromonas gingivalis in the microbiome of their oral cavity had a 59 percent greater risk of pancreatic cancer than participants who did not have it. The association of participants with Aggregatibacter actinomycetemcomitans was not as statistically significant even though they had at least a 50 percent increased relative risk of developing pancreatic cancer.
These findings support the current study’s hypothesis and previous research showing that people who have developed pancreatic cancer tended to have poor oral health. The researchers reasoned that periodontitis, which is inflammation of the tissue around the teeth often causing shrinkage of the gums and loosening of the teeth, is due to oral bacteria dysbiosis. Dysbiosis is a term for an unhealthy change in the normal bacterial ecology of a part of the body, such as the mouth.
Many previous studies have shown a strong relationship between associated periodontal disease with pancreatic cancer..
Findings from a 2013 European prospective cohort study showed having high levels of P gingivalis antibodies in blood caused a 2-fold increase of developing pancreatic cancer. Another 2007 prospective cohort study looked at over 50,000 male health professionals with a history of periodontitis and found a 64 percent increased risk of pancreatic cancer. Both of these previous studies however, were unable to determine which came first, poor oral health or pancreatic cancer.
This new study from NYU is the first study to determine that periodontal dysbiosis does in fact precede the development of pancreatic cancer and does not develop after the diagnosis. This was determined by looking at the oral samples of saliva collected prior to the onset of pancreatic cancer confirming the positive association with P gingivalis.
Researchers pointed out that this finding does not confirm that the two periodontal disease-causing bacteria cause pancreatic cancer. Rather, they most likely correlate it with systemic inflammation occurring within the body, known to be a precursor for developing cancer. Having periodontal disease-causing bacteria in the mouth may increase the likelihood of inflammation.
Symptoms of pancreatic cancer
The pancreas is located deep within the abdomen sandwiched between the stomach and the spine, with a small portion of it nestled in the curve of the upper portion of the small intestine. It functions as a glandular organ having an essential role in converting the food we eat into fuel for the body’s cells. It has an exocrine function of secreting digestive enzymes into the small intestine helping with digestion, and an endocrine function of releasing the hormone insulin into the bloodstream, a critical controller of blood sugar levels.
Tumors of the pancreas are rarely palpable, which is why most symptoms of pancreatic cancer do not appear until the tumor has grown large enough to interfere with the functioning of the pancreas, or has spread to other nearby organs such as the stomach, liver, or gallbladder. Symptoms of pancreatic cancer may include:
- Upper abdominal pain spreading to the back
- Jaundice or yellowing of the skin and whites of the eyes
- Diminished appetite and unexplained weight loss
- Digestive difficulties
- New onset of Type 2 diabetes in people over 50
Risk factors which may increase the risk of pancreatic cancer include:
- Cigarette smoking
- Age – over 80 percent of pancreatic cancers develop between the ages of 60 and 80
- Race – more common in African Americans
- Gender – more common in men
- Religious background – more common in Ashkenazi Jews
- Chronic pancreatitis
- Diet – diets high in meats, cholesterol, fried foods and nitrosamines
- Family history
Future additional studies are planned to determine if periodontal disease is a cause of pancreatic cancer. Until then, good oral hygiene including regular brushing and flossing of the teeth and visits to a dentist are recommended. If a person does have periodontal disease, they should be seen regularly by a periodontist for regular cleanings and checkups to get the condition under control.
Anyone who has any of the potential symptoms of pancreatic cancer should make an appointment with their physician for an evaluation and testing as soon as possible.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team and the chief medical correspondent for am970 in New York City. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.