Download Ana Valeria Mato Mourazos. Tutor: Prof. Dra. María Isabel Brusca

Influence of Anti estrogen therapy in
patients with breast cancer in the
bearing of Candida spp
Objective


To determine the influence of hormone
therapy in periodontal disease through the
intake assessment of antiestrogen tamoxifen
in women with breast cancer.
To determine the prevalence and the
different species of yeast in the evolution of
patients with breast cancer treated with antiestrogen therapy with Tamoxifen
Secondary objectives
Diagnose and classify gingival disease - periodontal patients based on
clinical parameters.
Determine whether more time with tamoxifen therapy improves
gingival periodontal status.
Quantify the presence of yeast in the different stages of cancer
treatment.

CANCER: When dealing with cell proliferation,
estrogen receptor (ER) and progesterone (PR)
are directly involved and their functional
integrity is essential for multiplication, normal
growth and differentiation of these hormoneresponsive cells. The malignant
transformation of cells may be due to various
causes not always identifiable. Estrogens
have been linked to the onset of cancer in
various tissues, such as prostate and
mammary gland.
 Tamoxifen: The main pharmacological
effect of tamoxifen (Tx) derives from its ability
to bind to the ER. Thus, moves and blocks the
receptor from its union with the hormone. Acts
as cytostatic and not cytotoxic.
Periodontal disease: The presence of estrogen
receptors in the gingival tissues has been
confirmed in numerous studies. Fluctuating
levels of estrogen / progesterone affects the
periodontium. Progesterone cause modulation of
interleukin 6 production in fibroblasts, thus
reducing resistance to inflammatory changes
produced by bacteria. Meanwhile, estrogen and
progesterone induce a physiological
phenomenon vascular redness of the gums and
bleeding. These hormones also induce
microbiological changes to alter the
microenvironment and act as nutrients.
 What
happen with patients receiving antiestrogen therapies?
Hypothesis:
 Tamoxifen
intake positively
affects the gingival periodontal
status.
 Tamoxifen
intake positively
affects the state of oral health
decreasing Candida albicans in
the oral cavity.





Materials and Methods
Sample (n = 66): peri-menopausal diagnosed breast cancer
patients for 2 to 5 years, average patient age 50 years.
A survey of patients and, after periodontal indices and
mucosal swabs will be taken.
Healthy patients were classified as 0 (zero) with no bleeding
on probing, probing depth <2 mm, insertion loss <2 mm,
without mobility, plaque index <or = 1, gingival <or = 1 index.
The others were considered with periodontal disease were
grouped into mild, moderate, severe or aggressive
according to the latest ranking
MATERIALES AND METHODS:

Cross-sectional study of cases for the variables
"Patient Cancer-Tamoxifen

Experimental group: Women with breast cancer
receiving tamoxifen therapy drug. (n = 46).

Control group: Women with breast cancer who did
not receive the drug tamoxifen therapy (sample =
20)
Exclusion criteria:





Men
Patients may receive antibiotics and / or
antifungal three weeks prior to the study.
Patients who received periodontal treatment
two months prior to the experience.
Patients suffering from autoimmune diseases,
HIV (AIDS).
Patients could receive long-term
corticosteroid.
 RESULTS
What s microbiological findings showed
that a greater variety of species of
Candida were isolated from patients who
used the drug during the first two years (C.
albicans, C. tropicalis, C.parapsilosis,
C.dubliniensis, C.glabrata) and were
accompanied by isolation of P. gingivalis
and P.intermedia.
 Only
2 species were isolated in those
patients who used the drug for more than
two years or those who have completed
treatment.
The length of the intake of Tamoxifen
influenced the periodontal status.
 Patients
who used the drug during the first
two years show a high incidence of mild
and severe periodontitis. Patients who
used the drug more than two years and
those who have completed treatment
show a decreasing trend of moderate
and severe periodontitis and a high
incidence of mild periodontitis and
gingival health.
Tiempo de consumo de Tamoxifeno:
menor a 1 año
60%
56%
50%
40%
30%
22%
22%
20%
10%
0%
Periodontitis Grave
Periodontitis
Moderada
Periodontitis Leve
0%
0%
Gingivitis
En Salud
Tiempo de consumo de Tamoxifeno:
de 1 a 2 años
30%
25%
25%
25%
25%
25%
20%
15%
10%
5%
0%
0%
Periodontitis Grave
Periodontitis
Moderada
Periodontitis Leve
Gingivitis
En Salud
Tiempo de consumo de Tamoxifeno:
de 2 a 5 años
60%
50%
50%
40%
30%
25%
25%
20%
10%
0%
0%
Periodontitis Grave
Periodontitis
Moderada
0%
Periodontitis Leve
Gingivitis
En Salud
DISCUSSION
This work tried to investigate the presence
of pathogenic microorganisms in the oral
cavity (the same is found in the mouth in
different ecological niches, periodontal
pockets, mucus and others) in patients
undergoing oncological therapy with
Tamoxifen .
Our study allowed us to observe the lower
prevalence of periodontopathogens
during the time of intake of Tamoxifen, as
well as lesser count of Candida species.
This work also showed that the longer time
of drug use there is a growing tendency
for periodontal health.

Conclusions
Estrogen and progesterone induce
changes microbiological acting as
nutrients for microorganisms and
generating altered homeostasis.
 It is important epidemiological
surveillance and monitoring of
pathogens in particular clinical
situations to demonstrate their
participation in
gingivoperiodontales diseases as
well as health.
 Seniority in the anti-estrogen
therapy in women with breast
cancer generates cumulative
benefits.

Thank you very much!