Stress, Depression May Speed Breast Ca Progression : Combination may dysregulate the hypothalamic-pituitary-adrenal axis and lead to more stress.

SAN JUAN, P.R. – Women who experience stressful life events, especially trauma, together with depression have a shorter time to breast cancer progression than women with no such history, Dr. David Spiegel said at the annual meeting of the American College of Psychiatrists.

Based on this study, which is under review, screening women with breast cancer for depression and stressful and/or traumatic life events might be worthwhile, said Dr. Spiegel, Willson Professor at Stanford (Calif.) University.

In a second study he conducted with Janine Giese-Davis, Ph.D., antidepressant treatment improved survival in this population. Improving depression might improve breast cancer prognosis independent of other risk factors that affect survival, such as metastatic spread of disease, he said.

So what is the connection? The combination of trauma and depression may dysregulate the hypothalamic-pituitary-adrenal (HPA) axis and lead to more stress among women with breast cancer. “Our breast cancer patients look more like depressed patients than healthy people, which means they may share some aspect of HPA dysregulation,” Dr. Spiegel said.

Stressful life events can diminish a person's ability to handle subsequent challenges, including cancer. Diminished physical capability, changes in social environment and family roles, difficult treatments, fear, pain, and facing mortality can all cause stress in women with breast cancer.

“Cancer is a chronic and severe stressor with constant reminders because of its effects on the body,” said Dr. Spiegel, who is also a member of the university's comprehensive cancer center.

Chronic stress causes changes to brain structures and the endocrine system, according to neuroimaging and other studies in humans and animals. Specifically, researchers have found that stress alters the size and/or activation of the hippocampus and amygdala.

“A smaller amygdala and hippocampus do not buffer a patient from the effects of stressful life situations as well,” he said.

Other researchers determined that serious life events increase risk of cancer (Am. J. Epidemiol. 2003;157:415–23).

This prospective study included 10,808 women in Finland surveyed in 1981 about adverse life events. A total of 180 incident cases of breast cancer occurred between 1982 and 1996. Participants who reported any single event had a slightly elevated risk of breast cancer compared with controls (hazard ratio, 1.07). The risk increased with a major event (1.35), death of close relative or friend (1.36), death of husband (2.00), and divorce or separation (2.26). “The findings suggest a role for life events in breast cancer etiology through hormonal or other mechanisms,” the researchers wrote.

“We looked at our own data, and those with an early stress, especially early trauma, have a shorter time to progression of breast cancer from diagnosis compared to women with no such history,” Dr. Spiegel said.

Stress is not the only culprit. “A shorter disease-free interval has also been shown with depression,” and the study he conducted with Dr. Giese-Davis showed that “if you treat depression, you can improve survival,” he said.

Stress can also adversely affect the endocrine system. People with posttraumatic stress disorder or depression tend to have constant levels of cortisol throughout the day. Normally, cortisol levels increase and decrease according to a circadian rhythm. “Waking up is stressful–think of getting up this morning,” Dr. Spiegel said, “and in healthy individuals, cortisol levels are five times higher in the morning compared to at bedtime.”

He and another group of investigators have published data showing that these abnormal cortisol patterns predict shorter survival with breast cancer (J. Natl. Cancer Inst. 2000;92:994–1000).

When a person attending the meeting asked about changes in catecholamine levels, Dr. Spiegel said, “We did not measure that–cortisol is easier to measure.”

Dr. Spiegel said that patients with relatively flat cortisol slopes have fewer natural killer cells. As breast cancer progresses, natural killer cell levels tend to decrease “so it's a salient finding, because this component of the immune system is linked to cancer progression.

“We are trying to construct a model that links a history of stress or trauma to progression of cancer,” he said.

'Our breast cancer patients look more like depressed patients than healthy people.' DR. SPIEGEL

SAN JUAN, P.R. – Women who experience stressful life events, especially trauma, together with depression have a shorter time to breast cancer progression than women with no such history, Dr. David Spiegel said at the annual meeting of the American College of Psychiatrists.

Based on this study, which is under review, screening women with breast cancer for depression and stressful and/or traumatic life events might be worthwhile, said Dr. Spiegel, Willson Professor at Stanford (Calif.) University.

In a second study he conducted with Janine Giese-Davis, Ph.D., antidepressant treatment improved survival in this population. Improving depression might improve breast cancer prognosis independent of other risk factors that affect survival, such as metastatic spread of disease, he said.

So what is the connection? The combination of trauma and depression may dysregulate the hypothalamic-pituitary-adrenal (HPA) axis and lead to more stress among women with breast cancer. “Our breast cancer patients look more like depressed patients than healthy people, which means they may share some aspect of HPA dysregulation,” Dr. Spiegel said.

Stressful life events can diminish a person's ability to handle subsequent challenges, including cancer. Diminished physical capability, changes in social environment and family roles, difficult treatments, fear, pain, and facing mortality can all cause stress in women with breast cancer.

“Cancer is a chronic and severe stressor with constant reminders because of its effects on the body,” said Dr. Spiegel, who is also a member of the university's comprehensive cancer center.

Chronic stress causes changes to brain structures and the endocrine system, according to neuroimaging and other studies in humans and animals. Specifically, researchers have found that stress alters the size and/or activation of the hippocampus and amygdala.

“A smaller amygdala and hippocampus do not buffer a patient from the effects of stressful life situations as well,” he said.

Other researchers determined that serious life events increase risk of cancer (Am. J. Epidemiol. 2003;157:415–23).

This prospective study included 10,808 women in Finland surveyed in 1981 about adverse life events. A total of 180 incident cases of breast cancer occurred between 1982 and 1996. Participants who reported any single event had a slightly elevated risk of breast cancer compared with controls (hazard ratio, 1.07). The risk increased with a major event (1.35), death of close relative or friend (1.36), death of husband (2.00), and divorce or separation (2.26). “The findings suggest a role for life events in breast cancer etiology through hormonal or other mechanisms,” the researchers wrote.

“We looked at our own data, and those with an early stress, especially early trauma, have a shorter time to progression of breast cancer from diagnosis compared to women with no such history,” Dr. Spiegel said.

Stress is not the only culprit. “A shorter disease-free interval has also been shown with depression,” and the study he conducted with Dr. Giese-Davis showed that “if you treat depression, you can improve survival,” he said.

Stress can also adversely affect the endocrine system. People with posttraumatic stress disorder or depression tend to have constant levels of cortisol throughout the day. Normally, cortisol levels increase and decrease according to a circadian rhythm. “Waking up is stressful–think of getting up this morning,” Dr. Spiegel said, “and in healthy individuals, cortisol levels are five times higher in the morning compared to at bedtime.”

He and another group of investigators have published data showing that these abnormal cortisol patterns predict shorter survival with breast cancer (J. Natl. Cancer Inst. 2000;92:994–1000).

When a person attending the meeting asked about changes in catecholamine levels, Dr. Spiegel said, “We did not measure that–cortisol is easier to measure.”

Dr. Spiegel said that patients with relatively flat cortisol slopes have fewer natural killer cells. As breast cancer progresses, natural killer cell levels tend to decrease “so it's a salient finding, because this component of the immune system is linked to cancer progression.

“We are trying to construct a model that links a history of stress or trauma to progression of cancer,” he said.

'Our breast cancer patients look more like depressed patients than healthy people.' DR. SPIEGEL

SAN JUAN, P.R. – Women who experience stressful life events, especially trauma, together with depression have a shorter time to breast cancer progression than women with no such history, Dr. David Spiegel said at the annual meeting of the American College of Psychiatrists.

Based on this study, which is under review, screening women with breast cancer for depression and stressful and/or traumatic life events might be worthwhile, said Dr. Spiegel, Willson Professor at Stanford (Calif.) University.

In a second study he conducted with Janine Giese-Davis, Ph.D., antidepressant treatment improved survival in this population. Improving depression might improve breast cancer prognosis independent of other risk factors that affect survival, such as metastatic spread of disease, he said.

So what is the connection? The combination of trauma and depression may dysregulate the hypothalamic-pituitary-adrenal (HPA) axis and lead to more stress among women with breast cancer. “Our breast cancer patients look more like depressed patients than healthy people, which means they may share some aspect of HPA dysregulation,” Dr. Spiegel said.

Stressful life events can diminish a person's ability to handle subsequent challenges, including cancer. Diminished physical capability, changes in social environment and family roles, difficult treatments, fear, pain, and facing mortality can all cause stress in women with breast cancer.

“Cancer is a chronic and severe stressor with constant reminders because of its effects on the body,” said Dr. Spiegel, who is also a member of the university's comprehensive cancer center.

Chronic stress causes changes to brain structures and the endocrine system, according to neuroimaging and other studies in humans and animals. Specifically, researchers have found that stress alters the size and/or activation of the hippocampus and amygdala.

“A smaller amygdala and hippocampus do not buffer a patient from the effects of stressful life situations as well,” he said.

Other researchers determined that serious life events increase risk of cancer (Am. J. Epidemiol. 2003;157:415–23).

This prospective study included 10,808 women in Finland surveyed in 1981 about adverse life events. A total of 180 incident cases of breast cancer occurred between 1982 and 1996. Participants who reported any single event had a slightly elevated risk of breast cancer compared with controls (hazard ratio, 1.07). The risk increased with a major event (1.35), death of close relative or friend (1.36), death of husband (2.00), and divorce or separation (2.26). “The findings suggest a role for life events in breast cancer etiology through hormonal or other mechanisms,” the researchers wrote.

“We looked at our own data, and those with an early stress, especially early trauma, have a shorter time to progression of breast cancer from diagnosis compared to women with no such history,” Dr. Spiegel said.

Stress is not the only culprit. “A shorter disease-free interval has also been shown with depression,” and the study he conducted with Dr. Giese-Davis showed that “if you treat depression, you can improve survival,” he said.

Stress can also adversely affect the endocrine system. People with posttraumatic stress disorder or depression tend to have constant levels of cortisol throughout the day. Normally, cortisol levels increase and decrease according to a circadian rhythm. “Waking up is stressful–think of getting up this morning,” Dr. Spiegel said, “and in healthy individuals, cortisol levels are five times higher in the morning compared to at bedtime.”

He and another group of investigators have published data showing that these abnormal cortisol patterns predict shorter survival with breast cancer (J. Natl. Cancer Inst. 2000;92:994–1000).

When a person attending the meeting asked about changes in catecholamine levels, Dr. Spiegel said, “We did not measure that–cortisol is easier to measure.”

Dr. Spiegel said that patients with relatively flat cortisol slopes have fewer natural killer cells. As breast cancer progresses, natural killer cell levels tend to decrease “so it's a salient finding, because this component of the immune system is linked to cancer progression.

“We are trying to construct a model that links a history of stress or trauma to progression of cancer,” he said.

'Our breast cancer patients look more like depressed patients than healthy people.' DR. SPIEGEL