Cancer Prevention: What You Need To Know

Stress, Emotions, and Cancer

What Is Known About This Topic?
One large scale study among approximately 2,000 middle aged male employees of the Western Electric Company reported that those individuals who were more depressed were 2.3 times as likely to die of cancer during the following 17 years than their non-depressed counterparts. Since that time, another large scale study, looking at almost 7,000 men and women between the ages of 25 and 75 has found no reliable associations between depressive symptoms and the development of cancer, and several other studies have been unable to reproduce the original Western Electric findings as well. A number of studies have found relationships between a helpless/hopeless attitude, psychological distress, and suppression of negative emotions with faster progression of breast cancer and other cancers. However, not all studies have reproduced these findings. It has been suggested that early in the development of cancer, psychological factors may play a larger role in disease progression than in advanced cancers, when biological factors may be much more important factors in disease progression.

It has been found that laboratory animals exposed to high levels of stress show irregularities in the enzymes that are responsible for repairing damaged DNA and genes. This may indicate a relationship between stress and development of changes in cells which could ultimately be cancerous or cancer-causing. In addition, laboratory animals experiencing uncontrollable stressors have shown less resistance to tumors than animals in control of their stressors.

Humans may face a variety of stressful life events, such as marital separation, a new job, or taking care of a parent with Alzheimer’s disease. Stressful events such as these have been linked with a decrease in several aspects of immune function, including the natural killer cell, which is responsible for the surveillance and destruction of tumor cells. In patients with breast cancer, stress has been associated with lower levels of natural killer cell activity, which in turn has been linked to poorer disease outcome. In addition, there are now clearly documented pathways between the central nervous system and the immune system. Although such results do not imply a link between chronic stress and the development of cancer, they do suggest a pathway by which chronic stress could potentially make the body more susceptible to illness.

Additionally, a recent study has reported that emotional distress and lifestyle factors may have additive negative effects on immune function. Depressed smokers were found to have poorer natural killer cell activity than depressed non-smokers, or than non-depressed people, whether smokers or nonsmokers. These findings may have implications for tumor surveillance and tumor progression among smokers who are also depressed.

In contrast, positive emotional states and relaxation have been related to improved signs of immune function in some studies. In addition, expression of emotions following distressing events has also been related to improved measures of immune functioning, at least over short periods of time. For example, one well publicized study has shown that metastatic breast cancer patients participating in supportive-expressive group psychotherapy had three times longer survival than patients with standard care. These provocative findings are currently being further investigated in a ten-year multi-site trial supported by the National Institutes of Health. Although all biological pathways are not clear, there is substantial evidence at this point that at least at some stages of cancer progression, emotional factors may make a contribution to physiological factors relevant to cancer progression. However, the extent to which emotional factors may actually influence disease progression is still unclear.

What Can I Do to Prevent the Problem?
Anything which helps you feel more in control, such as finding ways to decrease stress, increase relaxation, and increase your ability to cope in daily situations can be useful for decreasing distress. Finding opportunities to express your emotions in a context of support, whether in a support group, through counseling, or with understanding family and friends may also be helpful. We cannot say definitely that these factors are related to cancer prevention or slowed cancer progression, but they may provide improvement in other important health-related factors and in quality of life.

Where Can I Get More Information?

University of Iowa Resources

• University of Iowa Health Care, Department of Family Medicine Stress Clinic
• Cancer Information Service (1-800-237-1225)

Other Resources

• National Cancer Institute
  http://www.cancer.gov/cancer_information/
• American Cancer Society
  http://www.cancer.org
• Local mental health centers
• Private psychologists, counselors, social workers
• Relaxation training classes offered through local hospitals, colleges, or universities

If you would like more information about stress and cancer or to obtain phone numbers to be the above organizations, please contact the Cancer Information Service at 1-800-237-1225 or e-mail: cancer-information@uiowa.edu.

Title Page