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Investigating the Association Between Periodontal Disease and Risk of Pancreatic Cancer

Chang, Jeffrey S. MD, PhD, MPH*; Tsai, Chia-Rung MA*; Chen, Li-Tzong MD, PhD*†‡§; Shan, Yan-Shen MD, PhD∥¶

doi: 10.1097/MPA.0000000000000419
Original Articles

Objective Periodontal disease (PD) is increasingly recognized as an emerging risk factor for various systemic diseases, including diabetes, cardiovascular diseases, and cancer. The current study examined the association between PD (periodontitis, gingivitis, and others) and pancreatic cancer.

Methods A total of 139,805 subjects with PD and 75,085 subjects without PD were identified from the National Health Insurance Research Database of Taiwan. Cox proportional hazards regression was performed to compare the incidence of pancreatic cancer between the 2 groups.

Results Periodontal disease was positively associated with pancreatic cancer risk (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.02–2.33). This positive association occurred predominantly among those aged 65 years or older (HR, 2.17; 95% CI, 1.03–4.57) and was not observed among those aged younger than 65 years (HR, 0.83; 95% CI, 0.52–1.34). Further analysis showed that PD is a risk factor for pancreatic cancer independent of diabetes, hyperlipidemia, allergies, viral hepatitis, peptic ulcer, pancreatitis, chronic obstructive pulmonary disease (as a proxy for cigarette smoking), and alcoholic-related conditions (as a proxy for alcohol drinking).

Conclusions Our results indicated a significantly positive association between PD and risk of pancreatic cancer. The underlying biological mechanisms for the positive association between PD and pancreatic cancer require further investigation.

From the *National Institute of Cancer Research, National Health Research Institutes; †Department of Internal Medicine, National Cheng Kung University Hospital, Tainan; ‡Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung; §Institute of Molecular Medicine, National Cheng Kung University, Tainan; ∥Department of Surgery, National Cheng Kung University, College of Medicine; and ¶Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, Tainan, Taiwan.

Received for publication September 4, 2014; accepted February 24, 2015.

Reprints: Li-Tzong Chen, MD, PhD, National Institute of Cancer Research, National Health Research Institutes, 2F No 367, Sheng-Li Rd, Tainan 70456, Taiwan (e-mail: or Yan-Shen Shan, MD, PhD, Department of Surgery, National Cheng Kung University, College of Medicine 138, Sheng-Li Road, Tainan 70428, Taiwan (e-mail:

This study was supported by the Establishment of Cancer Research System Excellence Program funded by the Department of Health, Executive Yuan, Taiwan (CA-103-SP-01; DOH101-TD-C-111-003) and by grant from the Ministry of Science and Technology, Taiwan (103-2314-B-400-012-MY2).

The authors declare no conflict of interest.

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