Associação entre periodontite e câncer de mama: uma revisão sistemática e metanálise

Abstract

Breast cancer (BC) stands out as the most incident type of cancer in women worldwide. Periodontitis is a multifactorial chronic inflammatory disease that involves a complex interaction between pathogenic stimuli and host response, characterized by progressive destruction of the tooth support apparatus. Systemic dissemination of infectious agents and inflammatory mediators of periodontitis can lead to a chronic systemic inflammatory condition, which may be associated with the pathogenesis of distal inflammatory processes such as cancer. The aim of this study is to systematically review the literature to assess the association between periodontitis and BC. The research protocol was structured according to the recommendations of the Cochrane Collaboration. Studies were searched in MEDLINE (via PubMed), EMBASE, LILACS, Web of Science, Google Scholar, and Open Gray (DANS) electronic databases up to June 2022. Longitudinal and case-control studies were included. Meta-analyses determined risk estimates (relative risk; RR and 95% confidence interval; CI). Two independent reviewers carried out the selection, data extraction, risk of bias assessment (Newcastle-Ottawa Scale) and quality of evidence (GRADE). A total of seventeen studies were included. Of these, 9 studies are prospective cohorts, 3 retrospective cohorts and 5 case-controls. The meta-analysis showed that women with periodontitis have an 18% greater risk of BC occurrence than those without or with milder forms of periodontitis (RR 1.18; 95% CI 1.05 to 1.33). Subgroup analyzes and metaregression showed that estimates from studies conducted in middle/lower-middle income countries and with diagnosis of periodontitis based on clinical examination were significantly higher than those in high/upper-middle income countries and diagnosed by self-report (p<0.05). Our findings confirmed that periodontitis is associated with BC and that the origin of the sample and the diagnosis of periodontitis partly explain the heterogeneity found. A better understanding of this association may have important clinical and public health implications, given the possibility that prevention and treatment of periodontitis may minimize the onset or progression of BC.