Inflammatory and Immune Mechanisms Relating PTSD and Depression to Ovarian Cancer Risk
Abstract
Ovarian cancer is the fifth leading cause of cancer death for U.S. women, and most ovarian cancer cases are not diagnosed until late stage when treatment is less effective. The ability to identify women at high risk is limited, and while some risk factors are known, few are easily modifiable. Thus, identifying new risk factors and how to mitigate their effects is critical. In prior work, we demonstrated women with post-traumatic stress disorder (PTSD) and depression are at substantially higher risk of developing ovarian cancer. PTSD, a form of chronic psychological distress that specifically arises from trauma exposure, is common in women Veterans due to prolonged deployments with war zone exposure, combat-related injuries, military sexual trauma, as well as traumas experienced prior to enlistment. Other forms of chronic psychological distress (e.g., depression) characterized by having recurring and ongoing negative thoughts and feelings, including symptoms of anxiety and depression, can also occur and are common as well. For example, nearly one in four women Veterans deployed in Iraq or Afghanistan who used Veterans Administration services have been diagnosed with depression, and one in six have PTSD. In the original research project, we reported that healthy women who experienced PTSD or depression were more likely to go on to subsequently develop ovarian cancer. Women with high PTSD symptoms were especially susceptible to developing ovarian cancer – they had a more than twofold greater risk of developing ovarian cancer compared to women who never experienced trauma. Women with depression had a 30% higher risk of ovarian cancer compared to those who did not have depression. We and others have shown that women with PTSD or depression are less likely to eat a healthy diet and more likely to use hormone therapy (which can increase ovarian cancer risk), smoke cigarettes, be sedentary, and be overweight or obese. However, our studies also found these behavioral factors explained relatively little of the association between distress and ovarian cancer risk, suggesting that there may be important, as yet undetermined, biological mechanisms driving these relationships. In our recent work, we also looked at some biologic factors related to PTSD that we thought might help explain the apparent increased risk of ovarian cancer we have seen among women with PTSD. Notably, we found that women with PTSD tend to have high levels of inflammation in their bodies. In addition, we found that, among women with ovarian cancer, the immune systems of depressed women did not appear to respond as robustly with regard to attacking their tumor as those without depression. Since distress is common among women, including both civilian women as well as those who are in the military, it is critical to understand more about how PTSD and depression may influence ovarian cancer development. Effective treatments for PTSD and depression exist and can be disseminated in military, Veteran, and civilian populations. Greater understanding of whether and how psychological distress may affect risk of developing ovarian cancer will facilitate identifying treatable risk factors and could lead to new targets for prevention, which is crucial if we want to reduce morbidity and mortality due to ovarian cancer. The goal of this expansion award is to gain greater insight into how distress influences a woman’s body in such a way that it affects her chances of getting cancer and also whether there is a particular time period when distress may be most likely to enhance ovarian cancer development. By learning more, we hope to design ways to prevent ovarian cancer as well as to identify women at high risk for ovarian cancer who would be most likely to benefit from prevention measures. We are specifically interested in several biological pathways that might help account for the increased risk of ovarian cancer we have observed among women with high level
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110326
Entities
People
- Laura Kubzansky
Organizations
- President and Fellows of Harvard College
- United States Army