WASHINGTON, DC—Psychosocial stress may play a role in the etiology of breast cancer aggressiveness, particularly among minority populations, according to study results. In a cross-sectional study, greater levels of fear, anxiety, or isolation were found to be associated with more aggressive breast cancer; however, no clear driver for the association is yet identified.
“We found that after diagnosis, black and Hispanic breast cancer patients reported higher levels of stress than whites, and that stress was associated with tumor aggressiveness,” said study investigator Garth Rauscher, PhD, associate professor of epidemiology in the division of epidemiology and biostatistics at the School of Public Health, Uni - versity of Illinois at Chicago.
Rauscher and his colleagues studied patient-reported perceptions of fear, anxiety, and isolation, together referred to as psychosocial stress, and associations with breast cancer aggressiveness. The pa tients’ stress levels were examined 2 to 3 months after diagnosis. The study included 989 breast cancer patients who were recently diagnosed (411 were non-Hispanic black, 397 were non- Hispanic white, and 181 were Hispanic).
Results showed that psychosocial stress scores were higher for both black and Hispanic patients compared with white patients. “Those who reported higher levels of stress tended to have more aggressive tumors. However, what we don’t know is if we had asked them the same question a year or 5 years before diagnosis, would we have seen the same association between stress and breast cancer aggressiveness?” said Rauscher. “It’s not clear what’s driving this association. It may be that the level of stress in these patients’ lives influenced tumor aggressiveness. It may be that being diagnosed with a more aggressive tumor, with a more worrisome diagnosis and more stressful treatments, influenced reports of stress. It may be that both of these are playing a role in the association. We don’t know the answer to that question.”
Patient-reported psychosocial stress was one third of a standard deviation higher for patients with receptor-negative versus -positive disease, and higher for patients with high- versus low- or intermediate-grade disease (difference = 0.17). Compared with whites, psychosocial stress scores were higher for black patients (difference = 0.22), and higher for Hispanic patients (difference = 0.44).
“There are reasons that the breast may be more vulnerable to effects of stress. Stress increases certain hormone levels in the body and hormones affect breast cancer risk,” Rauscher said in an interview with The Oncology Pharmacist. “Stress may be an important prognostic factor, but it is not clear what the process is. We need to figure out what we need to do to intervene. There are all kinds of reasons to help people lower their stress, and this study suggests there may be a benefit in terms of breast cancer.”