Advanced periodontitis may be associated with a 2.5-fold increased risk of smoking-related cancers among patients who never smoke, according to a study published in Annals of Oncology.1

Researchers led by Dominique Michaud, ScD, of the Tufts University School of Medicine in Boston, MA, looked at 19 933 men who reported being “never smokers” of cigarettes, pipes, or cigars in the Health Professionals’ Follow-up Study in order to examine any direct impact of periodontal disease on cancer.

Patients self-reported periodontal disease status and teeth number at baseline and during follow-up.

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At baseline, patients reporting periodontitis were found to have a 13% increased risk in total cancer, with a 45% increased risk among those with advanced periodontitis.

Periodontitis was not found to be associated with prostate cancer, colorectal cancer, or melanoma, which were the 3 most common cancers in the cohort of never smokers. However, they observed a 33% increased risk for smoking-related cancers (lung, bladder, oropharyngeal, esophageal, kidney, stomach, and liver).

Men with advanced periodontitis had a hazard ratio of 2.57 for smoking-related cancers, compared to those who did not have periodontitis and had 17 teeth or more. Advanced periodontitis was associated with an increased risk of esophageal and head and neck cancers.

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“Further studies need to examine the immune impact of advanced periodontitis on cancer, especially for cancers known to be caused by smoking,” the authors concluded.


  1. Michaud DS, Kelsey KT, Papathanasiou E, et al. Periodontal disease and risk of all cancers among male never smokers: an updated analysis of the Health Professionals Follow-up Study [published online ahead of print January 24, 2016]. Ann Oncol. doi: 10.1093/annonc/mdw028.