Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function

• Type of Material: Article
• Authors: Lauren C Brown, Emory University; Amy R Murphy, Emory University; Chloe S Lalonde, Emory University; Preeti Subhedar, Emory University; Andrew Miller, Emory University; Jennifer Stevens, Emory University
• Language: English
• Date: 2020-05-06
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.32934
• Title of Journal or Parent Work: CANCER
• Volume: 126
• Issue: 14
• Start Page: 3181
• End Page: 3191
• Grant/Funding Information: Supported by the National Institutes of Health (grants K12 HD085850 and R01 MH117009 to Jennifer S. Stevens). Support also was received from the National Center for Advancing Translational Sciences of the National Institutes of Health (grant UL1TR002378). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health.
• Keywords: Life Sciences & Biomedicine; QUALITY-OF-LIFE; fear; DIAGNOSIS; POSTMENOPAUSAL WOMEN; CHILDHOOD TRAUMA; PTSD; brain; Oncology; estradiol; TAMOXIFEN; posttraumatic stress disorder; ESTROGEN; AROMATASE INHIBITORS; breast cancer; MENTAL-DISORDERS; Science & Technology; inflammation; quality of life; SUICIDAL IDEATION

Abstract

A breast cancer diagnosis can be a life-changing and stressful experience that can lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). Greater than one-third of patients initially diagnosed with PTSD after a diagnosis of breast cancer continue to have persistent or worsening PTSD symptoms after 4 years. An emerging body of literature has indicated several key environmental and biological risk factors for PTSD among survivors of breast cancer. Well-recognized risk factors include having a history of childhood trauma, being nonwhite, obesity, younger age at the time of diagnosis, diagnosis with a higher stage of breast cancer, and short time since treatment. Of the emerging risk factors related to fear circuitry in the brain, 2 pathways of particular importance are the stress-driven activation of inflammatory pathways and the long-term effect of antiendocrine therapies. These central and peripheral responses during and after stress exposure are important because increased fear and anxiety can lead to the maintenance of PTSD and worse patient outcomes. Given the poor outcomes associated with PTSD and the high prevalence of breast cancer in women, more research to identify those women at heightened risk of PTSD after breast cancer is warranted to reduce the number of diagnoses and lessen the negative impact of this chronic mental health condition.