Healthy Gums May Prevent Pancreatic Cancer, New Drug Could Treat It

In 2006, the American Cancer Society estimated that there were 33,730 cases of pancreatic cancer diagnosed in the United States, and 32,300 deaths from this disease.

According to the most recent information from the National Cancer Institute, only about 5 percent of patients diagnosed with pancreatic cancer will survive five years.

Survival from this cancer is so poor because in almost all patients, the cancer is advanced at the time of diagnosis.

Except for a small number of people who have a strong family history of pancreatic cancer, there are no generally recommended screening tests or early signs or symptoms to alert patients and doctors that the cancer is present.

For years, doctors have tried to improve the treatment of pancreatic cancer so that more people could survive. The surgery for this illness is difficult and complex, and only a small number of medical centers in this country have a large experience in the surgical treatment of this disease. That is because few patients are actually able to undergo surgery to cure this disease.

Despite numerous studies, there is no generally accepted agreement on the best treatment either before surgery or after an operation to either improve the odds of a better surgical outcome, or prevent the cancer from recurring once the surgery is completed.

Drug May Increase Chances of Survival for Patients

Unlike other cancers, such as breast cancer or colorectal cancer, the number of effective drugs we have for treating pancreatic cancer is very limited.

Gemcitabine, a chemotherapy drug, is considered the most effective drug for the treatment of advanced cancer of the pancreas. More recently, a targeted therapy called erlotinib was approved for the treatment of pancreatic cancer, but its ability to improve the outlook for patients with advanced disease is modest at best.

In the current issue of the Journal of the American Medical Association, a large group of investigators from Germany and Austria did a clinical trial where it randomly assigned 368 patients whose pancreatic cancer could be surgically removed into a group that received postoperative (adjuvant) treatment with gemcitabine, and another group that received no further therapy.

Dr. Len Lichtenfeld is deputy chief medical officer for the American Cancer Society.

The researchers found they were able to almost double the median disease-free survival of the group treated with gemcitabine to 13.4 months, compared to 6.9 months for the group that received no additional therapy.

Disease-free survival means the time it takes for the disease to reappear after removal at surgery. Median means that half the group had its disease recur before the number of months noted, and the other half afterward.

In addition, the authors estimated that about one in six patients in the group treated with the chemotherapy would be alive at five years, compared to only about one in 20 of the patients who did not receive postoperative gemcitabine.

This is just an estimate, of course. As noted in an editorial that accompanied this article, there is still controversy over the best approach to the adjuvant treatment of pancreatic cancer.

Other chemotherapy regimens, with and without radiation therapy, have been tried. Finding a single approach that the experts can agree on as the best approach remains difficult.

There were also some limits to the study, as noted both by the authors and in the editorial.

Perhaps one of the major issues with the study is that many of the patients were treated in small community practices. While this lends a "real world" quality to the study, it raises questions about the consistency of the surgeries and the quality of the examinations the patients received.

That said, however, the results of the study suggest that gemcitabine, as a single drug, has value in the adjuvant therapy of this otherwise deadly disease.

Dental Care Could Spell Prevention for Pancreatic Cancer

Another study appearing in the Journal of the National Cancer Institute suggests a lifestyle intervention that may help reduce your risk of pancreatic cancer.

We know that risk factors for pancreatic cancer include cigarette smoking and possibly diabetes and obesity.

Encouraged by other information that suggests gum inflammation (periodontal disease) and tooth loss may also be associated in some way with an increased risk of pancreatic cancer, researchers from Harvard University and the University of Puerto Rico looked at a large database of information to find out whether there was any evidence of such a connection.

Dr. Len Lichtenfeld is deputy chief medical officer for the American Cancer Society.

The theory may appear farfetched, but there has also been recent interest in a possible link between gum disease and coronary artery disease, based on the theory that gum disease may lead to increased levels of inflammation throughout our bodies.

Why this would increase the risk of pancreatic cancer is unknown, although we know that chronic pancreatitis -- an inflammation of the pancreas that can at times be severe and life-threatening -- is associated with a significantly increased risk of developing cancer of the pancreas.

Could this same gum disease cause inflammation-related disease in our pancreas, and increase the risk of cancer?

The answer, according to this report, is a possible "yes."

In this study of 51,529 male health professionals, 216 men were diagnosed with pancreatic cancer.

All of these men had been followed through surveys for many years. One of the questions they were asked was whether they had any history of gum disease or tooth loss.

When the researchers compared the answers of the men who had developed pancreatic cancer to those who had not, they found that the risk of developing the disease was 64 percent greater in the men who had gum disease.

If a participant had tooth loss within the previous four years, their risk of developing pancreatic cancer was 2.7 times greater than another man who had not lost a tooth during that time period.

What this means in practical terms is uncertain.

If you are someone who is interested in doing something positive for your health, such as not smoking, remaining physically active, and maintaining a healthy body weight to reduce your risk of cancer and other chronic diseases, then taking care of your teeth may be one more part of that total package.

Dr. Len Lichtenfeld is deputy chief medical officer for the American Cancer Society.

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