We appreciate the data provided by Drs. Lehrer, Green, and Rosenzweig (1) regarding ecological associations of breast cancer death rates and reported tooth loss from decay or gum disease among adults over the age of 65 years. In our article (2), we examined breast cancer incidence; we did not examine prognosis or mortality. Furthermore, the exposure measure they used was different from our measure of reported diagnosis of periodontal disease; theirs focused on tooth loss including loss to decay.

As they note, their findings need to be cautiously interpreted given that it is not known whether individuals in that survey with tooth loss are the ones who are dying of breast cancer. Furthermore, confounding by other factors, which they were not able to control, might also impact the findings.

We concur that further research regarding the interplay between chronic disease of the oral cavity and incidence and mortality from other systemic diseases including breast cancer is warranted.

See the original Letter to the Editor, p. 863

No potential conflicts of interest were disclosed.

1.
Lehrer
S
,
Green
S
,
Rosenzweig
KE
: 
Periodontal disease and breast cancer—letter
.
Cancer Epidemiol Biomarkers Prev
2016
;
25
:
863
.
2.
Freudenheim
JL
,
Genco
RJ
,
LaMonte
MJ
,
Millen
AE
,
Hovey
KM
,
Mai
X
, et al
Periodontal disease and breast cancer: prospective cohort study of postmenopausal women
.
Cancer Epidemiol Biomarkers Prev
2016
;
25
:
43
50
.