Most physicians are content to note the condition of their patients’ oral hygiene and then leave its management to the dentist. But poor oral hygiene is a state of chronic inflammation with all the attendant ill effects that follow in its wake. It’s a very accurate forecast of serious health problems in the near future. Simply put, people with persistently impaired oral health don’t live very long.
Blood vessels are susceptible to damage secondary to chronic inflammation. Thus, it’s easy to understand the heart and kidney disease which are prominent in subjects with poor oral hygiene. The report summarized below, from JAMA Oncology, strongly suggests that common pathogens found in patients with periodontal disease are associated with the subsequent development of pancreatic cancer. This report adds to the list of undesirable outcomes that afflict those with bad oral hygiene.
The report is suggestive rather than definitive, but there are already plenty of data to support the salutary effects of maintaining oral health. Brushing, flossing, and regular visits to a dentist are already documented to convey major health benefits that go beyond the oral cavity. The physician who is either a generalist or a specialist treating a condition that is either generated or worsened by periodontal disease should reinforce the essential need to treat the disorder because of its harmful effects on general health.
Oral Bacterial and Fungal Microbiome and Subsequent Risk for Pancreatic Cancer
Key Points
Question Is the prediagnostic oral bacterial and fungal microbiome associated with the subsequent development of pancreatic cancer?
Findings In this cohort study including 122 000 individuals, 3 oral bacterial periodontal pathogens, an additional 20 bacteria, and 4 fungi were identified, which together conferred a more than 3-fold increase in the risk for pancreatic cancer.
Meaning The oral fungal and bacterial microbiotas may serve as readily accessible, noninvasive biomarkers for subsequent pancreatic cancer risk to identify individuals at high risk of pancreatic cancer.
Abstract
Importance The oral microbiota may be involved in the development of pancreatic cancer, yet current evidence is largely limited to bacterial 16S amplicon sequencing and small retrospective case-control studies.
Objective To test whether the oral bacterial and fungal microbiome is associated with the subsequent development of pancreatic cancer.
Design, Setting, and Participants This cohort study used data from 2 epidemiological cohorts: the American Cancer Society Cancer Prevention Study-II Nutrition Cohort and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Among cohort participants who provided oral samples, those who prospectively developed pancreatic cancer were identified during follow-up. Control participants who remained free of cancer were selected by 1:1 frequency matching on cohort, 5-year age band, sex, race and ethnicity, and time since oral sample collection. Data were collected from August 2023 to September 2024, and data were analyzed from August 2023 to January 2025.
Exposures The oral bacterial and fungal microbiome were characterized via whole-genome shotgun sequencing and internal transcribed spacer (ITS) sequencing, respectively. The association of periodontal pathogens of the red complex (Treponema denticola, Porphyromonas gingivalis, and Tannerella forsythia) and orange complex (Fusobacterium nucleatum, F periodonticum, Prevotella intermedia, P nigrescens, Parvimonas micra, Eubacterium nodatum, Campylobacter shower, and C gracilis) with pancreatic cancer was tested via logistic regression. The association of the microbiome-wide bacterial and fungal taxa with pancreatic cancer was assessed by Analysis of Compositions of Microbiomes With Bias Correction 2 (ANCOM-BC2). Microbial risk scores (MRS) for pancreatic cancer were calculated from the risk-associated bacterial and fungal species.
Main Outcomes and Measures Pancreatic cancer incidence.
Results Of 122 000 cohort participants who provided samples, 445 developed pancreatic cancer over a median (IQR) follow-up of 8.8 (4.9-13.4) years and were matched with 445 controls. Of these 890 participants, 474 (53.3%) were male, and the mean (SD) age was 67.2 (7.5) years. Three oral bacterial periodontal pathogens—P gingivalis, E nodatum, and P micra—were associated with increased risk of pancreatic cancer. A bacteriome-wide scan revealed 8 oral bacteria associated with decreased and 13 oral bacteria associated with increased risk of pancreatic cancer (false discovery rate–adjusted Q statistic less than .05). Of the fungi, genus Candida was associated with increased risk of pancreatic cancer. The MRS, based on 27 oral species, was associated with an increase in pancreatic cancer risk (multivariate odds ratio per 1-SD increase in MRS, 3.44; 95% CI, 2.63-4.51).
Conclusions and Relevance In this cohort study, oral bacteria and fungi were significant risk factors for pancreatic cancer development. Oral microbiota hold promise as biomarkers to identify individuals at high risk of pancreatic cancer, potentially contributing to personalized prevention.
