More than 26,000 Americans will be diagnosed with gastric cancer in 2018, and 10,800 will die of the disease.1 Gastric cancer is the second most common malignancy worldwide, with 5-year survival rates in the United States of 31%, lagging far behind those for breast cancer, colorectal cancer, melanoma, and prostate cancer. Prevention is a key strategy for reducing mortality associated with this disease.

Recommended strategies for precancerous gastric lesions include regular endoscopic surveillance for early cancer detection and eradication of Helicobacter pylori. Patients at high risk for developing precancerous lesions should be monitored and assessed regularly.2 Risk factors for precancerous lesions and gastric cancer are being identified, one of which may be periodontal disease.

Yihong Li, DDS, MPH, DrPH, is a professor of basic science and craniofacial biology at New York University (NYU) College of Dentistry in New York, New York, and co-author of a recent article in the Journal of Periodontology that examined the role of periodontal disease in the development of precancerous gastric lesions.3 The authors found that bacterial infection in the oral cavity, chronic periodontal inflammation, and not flossing teeth regularly might increase an individual’s risk of gastric cancer. Cancer Therapy Advisor (CTA) interviewed Dr Li about this research and its implications for oncologists.

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CTA: What inspired you and your colleagues to evaluate the association between periodontal issues and gastric lesions?

Dr Li: The original project was led by Dr Yu Chen, an associate professor and epidemiologist in the department of population health at NYU’s School of Medicine.

Dr Chen was the principle investigator of a National Institutes of Health (NIH)-funded project to study the association between the periodontal disease with gastritis and intestinal metaplasia in the stomach. Although gastric cancer is the second most common malignancy worldwide, the lack of early diagnosis biomarkers has always been challenging.

Periodontal disease is one of the main causes of tooth loss for people over 40 years of age, and several population-based prospective cohort studies have suggested a positive association between the risk of gastric cancer and tooth loss.

The etiological connections are, however, not fully understood. As an epidemiologist, Dr Chen led a team of clinical investigators in conducting this hospital-based case-control study to determine if periodontal disease is associated with an increased risk of chronic atrophic gastritis and intestinal metaplasia, which are common precancerous lesions of gastric cancer.

Using an advanced molecular microbiology approach, our team at the NYU College of Dentistry designed and performed a series of experiments to measure key periodontal pathogens in the oral cavity. The identification of links between oral bacteria involved with inflammatory periodontitis and also with a gastric lesion that leads to cancer would provide new scientific evidence for more biological-mechanistic studies of the oral disease and systemic disease connections.