Influence of stressors on breast cancer incidence in the Women's Health Initiative

Mechanisms of stress-attributed breast cancer incidence and progression

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths in women, with psychosocial stress commonly cited by patients as one of its causes. While there is conflicting epidemiological evidence investigating the association between psychosocial stress and breast cancer incidence and progression, there is reason to believe that interventions aimed at reducing stress pharmacologically or psychologically may improve breast cancer outcomes. The aim of this review is to discuss the molecular and biological mechanisms of stress-attributed breast cancer incidence and progression, including the induction of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), as well as decreased immune function and stress hormone-induced resistance to chemotherapy. Moreover, these mechanisms have been cited as potential therapeutic targets of pharmacologic and psychological interventions that may improve the care, well-being and survival of breast cancer patients. Further research is recommended to investigate whether interventions in the primary care setting for women with risk factors for breast cancer development may lead to a decreased incidence of invasive breast tumors.

Psychosocial stressors and breast cancer gene expression in the Black Women's Health Study

PURPOSE

Prior studies indicate that the physiologic response to stress can affect gene expression. We evaluated differential gene expression in breast cancers collected from Black women with high versus low exposure to psychosocial stressors.

METHODS

We analyzed tumor RNA sequencing data from 417 Black Women's Health Study breast cancer cases with data on early life trauma and neighborhood disadvantage. We conducted age-adjusted differential gene expression analyses and pathway analyses. We also evaluated Conserved Transcriptional Response to Adversity (CTRA) contrast scores, relative fractions of immune cell types, T cell exhaustion, and adrenergic signaling. Analyses were run separately for estrogen receptor positive (ER+; n = 299) and ER- (n = 118) cases.

RESULTS

Among ER+ cases, the top differentially expressed pathways by stress exposure were related to RNA and protein metabolism. Among ER- cases, they were related to developmental biology, signal transduction, metabolism, and the immune system. Targeted analyses indicated greater immune pathway enrichment with stress exposure for ER- cases, and possible relevance of adrenergic signaling for ER+ cases. CTRA contrast scores did not differ by stress exposure, but in analyses of the CTRA components, ER- breast cancer cases with high neighborhood disadvantage had higher pro-inflammatory gene expression (p = 0.039) and higher antibody gene expression (p = 0.006) compared to those with low neighborhood disadvantage.

CONCLUSION

There are multiple pathways through which psychosocial stress exposure may influence breast tumor biology. Given the present findings on inflammation and immune response in ER- tumors, further research to identify stress-induced changes in the etiology and progression of ER- breast cancer is warranted.

Stressful life events, social support, and epigenetic aging in the Women's Health Initiative

BACKGROUND

Elevated psychosocial stress has been linked with accelerated biological aging, including composite DNA methylation (DNAm) markers that predict aging-related outcomes ("epigenetic age"). However, no study has examined whether stressful life events (SLEs) are associated with epigenetic age acceleration in postmenopausal women, an aging population characterized by increased stress burden and disease risk.

METHODS

We leveraged the Women's Health Initiative, a large muti-ancestry cohort of postmenopausal women with available psychosocial stress measures over the past year and epigenomic data. SLEs and social support were ascertained via self-report questionnaires. Whole blood DNAm array (450 K) data were used to calculate five DNAm-based predictors of chronological age, health span and life span, and telomere length (HorvathAge, HannumAge, PhenoAge, GrimAge, DNAmTL).

RESULTS

After controlling for potential confounders, higher SLE burden was significantly associated with accelerated epigenetic aging, as measured by GrimAge (β: 0.34, 95% CI: 0.08, 0.59) and DNAmTL (β: -0.016, 95% CI: -0.028, -0.004). Exploratory analyses showed that SLEs-GrimAge associations were stronger in Black women as compared to other races/ethnicities and in those with lower social support levels. In women with lower social support, SLEs-DNAmTL associations showed opposite association in Hispanic women as compared to other race/ethnicity groups.

CONCLUSIONS

Our findings suggest that elevated stress burden is associated with accelerated epigenetic aging in postmenopausal women. Lower social support and/or self-reported race/ethnicity may modify the association of stress with epigenetic age acceleration. These findings advance understanding of how stress may contribute to aging-related outcomes and have important implications for disease prevention and treatment in aging women.

Life Events, Caregiving, and Risk of Autoimmune Rheumatic Diseases in the Women's Health Initiative Observational Study

OBJECTIVE

Growing evidence suggests psychosocial stressors may increase risk of developing autoimmune disease. We examined stressful life events and caregiving in relation to incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in the Women's Health Initiative Observational Study cohort.

METHODS

The sample of postmenopausal women included 211 incident RA or SLE cases reported within 3 years after enrollment, confirmed by use of disease-modifying antirheumatic drugs (i.e., probable RA/SLE), and 76,648 noncases. Baseline questionnaires asked about life events in the past year, caregiving, and social support. We used Cox regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs), adjusting for age, race/ethnicity, occupational class, education, pack-years of smoking and BMI.

RESULTS

Incident RA/SLE was associated with reporting 3 or more life events (e.g., age-adjusted HR 1.70 [95% CI 1.14, 2.53]; P for trend = 0.0026). Elevated HRs were noted for physical (HR 2.48 [95% CI 1.02, 6.04]) and verbal (HR 1.34 [0.89, 2.02]) abuse (P for trend = 0.0614), 2 or more interpersonal events (HR 1.23 [95% CI 0.87, 1.73]; P for trend = 0.2403), financial stress (HR 1.22 [95% CI 0.90, 1.64]), and caregiving 3 or more days per week (HR 1.25 [95% CI 0.87, 1.81]; P for trend = 0.2571). Results were similar, excluding women with baseline symptoms of depression or moderate-to-severe joint pain in the absence of diagnosed arthritis.

CONCLUSION

Our findings support the idea that diverse stressors may increase risk of developing probable RA or SLE in postmenopausal women, supporting the need for further studies in autoimmune rheumatic diseases, including childhood adverse events, life event trajectories, and modifying psychosocial and socioeconomic factors.

Stressful Life Events, Social Support, and Incident Breast Cancer by Estrogen Receptor Status

Chronic stress affects immune function and hormonal signaling and has been hypothesized to be associated with breast cancer, although results from the few prior studies are mixed and have not examined potential differences by estrogen receptor (ER) status. Using the Women's Health Initiative study, we included 76,951 postmenopausal women followed for events for a median of 16.7 years to investigate the association between baseline self-reported stressful life events and incident breast cancer by ER status and whether the association was modified by social support. We generated Cox proportional hazards models adjusting for demographic, clinical, lifestyle/behavioral, and social factors to estimate HRs and 95% confidence intervals (95%CI). The mean age was 63 (SD, 7.3), and majority of participants were White race (83.5%) and married or in a marriage-like relationship (63.0%). In analyses stratified by ER status, there was no relationship between stressful life events and ER-positive breast cancer. In contrast, compared with women in the lowest quartile, those in higher quartiles had an increased risk of ER-negative breast cancer, where those in quartile 4 had the highest risk (Quartile 4 vs. Quartile 1; HR = 1.30; 95%CI, 1.01-1.68; Ptrend = 0.050). Moreover, associations were stronger for the highest versus lowest quartile of stressful life events among widowed women (HR = 2.39; 95%CI, 1.29-4.44; Pinteraction<0.001). Association between stressful life events and ER-negative breast cancer was not modified by social support. In this cohort of postmenopausal women, higher experiences of prediagnostic stressful life events were associated with increased risk of ER-negative breast cancer.

PREVENTION RELEVANCE

Epidemiologic studies on the association between psychosocial stress and breast cancer risk remain inconsistent, while investigation of whether the association differs by ER status is limited. In this prospective cohort of postmenopausal women, high experiences of stressful life events were positively associated with ER-negative disease but not ER-positive.

Context-Dependent Role of Glucocorticoid Receptor Alpha and Beta in Breast Cancer Cell Behaviour

Background. The dual role of GCs has been observed in breast cancer; however, due to many concomitant factors, GR action in cancer biology is still ambiguous. In this study, we aimed to unravel the context-dependent action of GR in breast cancer. Methods. GR expression was characterized in multiple cohorts: (1) 24,256 breast cancer specimens on the RNA level, 220 samples on the protein level and correlated with clinicopathological data; (2) oestrogen receptor (ER)-positive and -negative cell lines were used to test for the presence of ER and ligand, and the effect of the GRβ isoform following GRα and GRβ overexpression on GR action, by in vitro functional assays. Results. We found that GR expression was higher in ER- breast cancer cells compared to ER+ ones, and GR-transactivated genes were implicated mainly in cell migration. Immunohistochemistry showed mostly cytoplasmic but heterogenous staining irrespective of ER status. GRα increased cell proliferation, viability, and the migration of ER- cells. GRβ had a similar effect on breast cancer cell viability, proliferation, and migration. However, the GRβ isoform had the opposite effect depending on the presence of ER: an increased dead cell ratio was found in ER+ breast cancer cells compared to ER- ones. Interestingly, GRα and GRβ action did not depend on the presence of the ligand, suggesting the role of the "intrinsic", ligand-independent action of GR in breast cancer. Conclusions. Staining differences using different GR antibodies may be the reason behind controversial findings in the literature regarding the expression of GR protein and clinicopathological data. Therefore, caution in the interpretation of immunohistochemistry should be applied. By dissecting the effects of GRα and GRβ, we found that the presence of the GR in the context of ER had a different effect on cancer cell behaviour, but independently of ligand availability. Additionally, GR-transactivated genes are mostly involved in cell migration, which raises GR's importance in disease progression.

Blaming in Women with Breast Cancer Subjected to Intimate Partner Violence: A Hermeneutic Phenomenological Study

Objective

The present study was conducted to determine the blaming experiences of women with breast cancer subjected to intimate partner violence (IPV).

Methods

This hermeneutic phenomenological study explored blaming experiences of women with breast cancer subjected to IPV. Nine women with a mean age of 47.5 years referred to oncology hospitals in Tabriz (Iran) were interviewed using semi-structured in-depth interviews. Data analysis was performed based on Van Manen's thematic analysis method.

Results

The main theme emerged from the data is "blaming as a shifting cognitive judgment" with three subthemes of patient blaming partner, partner blaming patient, and self-blame.

Conclusions

The findings of the present study revealed that cognitive judgment shifting could be emerged as different types of blaming in the patients with breast cancer exposed to IPV. It is suggested that oncology nurses heed the psychological needs of women with breast cancer through holistic nursing considering couple and family-centered care.

Social Support, social ties, and cognitive function of women with breast cancer: findings from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study

PURPOSE

This study examined associations between self-reported cognitive functioning and social support as well as social ties among women with breast cancer.

METHODS

The study included 3351 women from the Women's Health Initiative Life and Longevity After Cancer cohort who were diagnosed with breast cancer stages I-III. Social support was assessed using a modified Medical Outcomes Study (MOS) Social Support Survey, and marital status was obtained from the baseline questionnaire. We also assessed social ties (e.g., number of friends, relatives, living children) and cognitive function (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-COG]) on the year-1-follow up questionnaire. Multivariable quantile regression was used to estimate the changes in median cognitive scores. Kruskal-Wallis tests were used to assess the association of cognitive function with social ties.

RESULTS

The majority of participants were non-Hispanic White (93.3%), presently married (49%), with at least a 4-year college degree (53.2%), and had been diagnosed with localized breast cancer (79%). A 10-point higher social support score correlated to a 0.32 higher (better) median cognitive score (p < 0.001). Women who were presently married tended to have better cognition than women who were divorced/separated or widowed (p = 0.01). Significant associations were also present for having close relatives (p < 0.001) or friends (p < 0.001), with cognitive scores being higher in those with at least one close relative or friend compared to none.

CONCLUSION

Women reporting higher social support and greater numbers of friends or relatives have higher cognitive functioning. Compared to divorced or separated women, married women were likely to have higher cognitive functioning. These findings suggest that social support assessments have the potential to help identify women at higher risk of cognitive decline.

Latent Class Models of Early-life Trauma and Incident Breast Cancer

BACKGROUND

Psychosocial trauma has been hypothesized to influence breast cancer risk, but little is known about how co-occurring traumas-particularly during early life-may impact incidence. We examine the relationship between multiple measures of early-life trauma and incident breast cancer.

METHODS

The Sister Study is a prospective cohort study of US women (n = 50,884; enrollment 2003-2009; ages 35-74). Of 45,961 eligible participants, 3,070 developed invasive breast cancer or ductal carcinoma in situ through 2017. We assessed trauma before age 18 using previously studied measures (cumulative score, individual trauma type, and substantive domain) and a six-class latent variable to evaluate co-occurring traumas. We accounted for missing data using multiple imputation and estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazards models.

RESULTS

Approximately 49% of participants reported early-life trauma. Using the latent class variable approach, breast cancer hazard was higher among participants who had sexual trauma or household dysfunction (HR = 1.1; CI = 0.93, 1.3) or moderate (HR = 1.2; CI = 0.99, 1.4) but not high trauma (HR = 0.66; CI = 0.44, 0.99) compared to low trauma. Breast cancer HRs associated with sexual early-life trauma or household dysfunction were elevated for pre- and postmenopausal breast cancer and by estrogen receptor status. We found no effect modification by race-ethnicity. Estimated effects were attenuated with report of constant childhood social support.

CONCLUSIONS

Breast cancer incidence varied by latent patterns of co-occurring early-life trauma. Models capturing childhood social support and trauma patterning, rather than cumulative or discrete indicators, may be more meaningful in breast cancer risk assessment.

Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes

The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.

Mechanisms behind context-dependent role of glucocorticoids in breast cancer progression

Glucocorticoids (GCs), mostly dexamethasone (dex), are routinely administered as adjuvant therapy to manage side effects in breast cancer. However, recently, it has been revealed that dex triggers different effects and correlates with opposite outcomes depending on the breast cancer molecular subtype. This has raised new concerns regarding the generalized use of GC and suggested that the context-dependent effects of GCs can be taken into potential consideration during treatment design. Based on this, attention has recently been drawn to the role of the glucocorticoid receptor (GR) in development and progression of breast cancer. Therefore, in this comprehensive review, we aimed to summarize the different mechanisms behind different context-dependent GC actions in breast cancer by applying a multilevel examination, starting from the association of variants of the GR-encoding gene to expression at the mRNA and protein level of the receptor, and its interactions with other factors influencing GC action in breast cancer. The role of GCs in chemosensitivity and chemoresistance observed during breast cancer therapy is discussed. In addition, experiences using GC targeting therapeutic options (already used and investigated in preclinical and clinical trials), such as classic GC dexamethasone, selective glucocorticoid receptor agonists and modulators, the GC antagonist mifepristone, and GR coregulators, are also summarized. Evidence presented can aid a better understanding of the biology of context-dependent GC action that can lead to further advances in the personalized therapy of breast cancer by the evaluation of GR along with the conventional estrogen receptor (ER) and progesterone receptor (PR) in the routine diagnostic procedure.

The Role of Psychologic Stress in Cancer Initiation: Clinical Relevance and Potential Molecular Mechanisms

The hypothesis that the physiologic response to psychologic stress influences the initiation of cancer is highly controversial. The link between initiating stressors, the psychologic stress response, and disease is plausible, considering that the stress response is associated with defined physiologic outcomes and molecular mechanisms. In light of this, we review the clinical relevance of psychologic stress on the risk of cancer, and we propose potential molecular pathways that may link the stress response to early stages of malignant cell transformation.

Impact of cholesterol-pathways on breast cancer development, a metabolic landscape

ApoB-lipoproteins and their components modulate intracellular metabolism and have been associated with the development of neoplastic phenomena, such as proliferation, anchorage-independent growth, epithelial-mesenchymal transition, and cancer invasion. In cancer cells, the modulation of targets that regulate cholesterol metabolism, such as synthesis de novo, endocytosis, and oxidation, are contributing factors to cancer development. While mechanisms associated with sterol regulatory element-binding protein 2 (SREBP-2)/mevalonate, the low-density lipoprotein receptor (LDL-R) and liver X receptor (LXR) have been linked with tumor growth; metabolites derived from cholesterol-oxidation, such as oxysterols and epoxy-cholesterols, also have been described as tumor processes-inducers. From this notion, we perform an analysis of the role of lipoproteins, their association with intracellular cholesterol metabolism, and the impact of these conditions on breast cancer development, mechanisms that can be shared during atherogenesis promoted mainly by LDL. Pathways connecting plasma dyslipidemias in conjunction with the effect of cholesterol-derived metabolites on intracellular mechanisms and cellular plasticity phenomena could provide new approaches to elucidate the triggering factors of carcinogenesis, conditions that could be considered in the development of new therapeutic approaches.

Genetic Variation and Immunohistochemical Localization of the Glucocorticoid Receptor in Breast Cancer Cases from the Breast Cancer Care in Chicago Cohort

BACKGROUND

Glucocorticoid, one of the primary mediators of stress, acts via its receptor, the glucocorticoid receptor (GCR/NR3C1), to regulate a myriad of physiological processes. We measured the genetic variation and protein expression of GCR, and the genes that regulate GCR function or response and examined whether these alterations were associated with breast cancer clinicopathological characteristics.

METHOD

We used samples from a multiracial cohort of breast cancer patients to assess the association between breast cancer characteristics and the genetic variants of single nucleotide polymorphisms (SNPs) in GCR/NR3C1, FKBP5, Sgk1, IL-6, ADIPOQ, LEPR, SOD2, CAT, and BCL2.

RESULTS

Several SNPs were associated with breast cancer characteristics, but statistical significance was lost after adjustment for multiple comparisons. GCR was detected in all normal breast tissues and was predominantly located in the nuclei of the myoepithelial cell layer, whereas the luminal layer was negative for GCR. GCR expression was significantly decreased in all breast cancer tissue types, compared to nontumor tissue, but was not associated with breast cancer characteristics. We found that high nuclear GCR expression was associated with basal cell marker cytokeratin 5/6 positivity.

CONCLUSION

GCR expression is reduced in breast cancer tissue and correlates with the basal cell marker CK5/6.

Glucocorticoid Receptor: A Multifaceted Actor in Breast Cancer

Breast cancer (BC) is one of the most common cancers in women worldwide. Even though the role of estrogen receptor alpha (ERα) is extensively documented in the development of breast tumors, other members of the nuclear receptor family have emerged as important players. Synthetic glucocorticoids (GCs) such as dexamethasone (dex) are commonly used in BC for their antiemetic, anti-inflammatory, as well as energy and appetite stimulating properties, and to manage the side effects of chemotherapy. However, dex triggers different effects depending on the BC subtype. The glucocorticoid receptor (GR) is also an important marker in BC, as high GR expression is correlated with a poor and good prognosis in ERα-negative and ERα-positive BCs, respectively. Indeed, though it drives the expression of pro-tumorigenic genes in ERα-negative BCs and is involved in resistance to chemotherapy and metastasis formation, dex inhibits estrogen-mediated cell proliferation in ERα-positive BCs. Recently, a new natural ligand for GR called OCDO was identified. OCDO is a cholesterol metabolite with oncogenic properties, triggering mammary cell proliferation in vitro and in vivo. In this review, we summarize recent data on GR signaling and its involvement in tumoral breast tissue, via its different ligands.

Stress et cancer : mythes et réalités

Les théories profanes émises par les patients et certains ouvrages destinés au grand public alimentent l’idée que le stress psychologique peut influencer le risque de survenue de cancer. Les études consultées sur cette question semblent donner des résultats contradictoires. D’un côté, ces théories peuvent sembler étayées par les résultats d’études expérimentales portant sur les corrélats physiologiques du stress sur des voies neuro-immunoendocrinologiques (perturbations immunitaires, altération de l’axe hypothalamohypophyso- surrénalien), métaboliques et cellulaires (stress oxydatif, dégénérescence cellulaire) pouvant être impliquées dans la tumorigenèse. De l’autre, les études épidémiologiques prospectives fondées sur une méthodologie robuste ne trouvent généralement pas d’association entre exposition au stress et développement ultérieur d’un cancer. Par ailleurs, les méta-analyses suggèrent l’existence de biais de publication pouvant surestimer le poids des études « positives ». Quand bien même une association est retrouvée, le caractère observationnel des études épidémiologiques et donc la possibilité de facteurs de confusion empêchent d’établir un lien de causalité entre l’exposition au stress et un risque majoré de cancer. En ce qui concerne les mécanismes d’une éventuelle relation causale directe, il faut souligner la difficulté d’extrapoler à l’être humain des résultats obtenus chez d’autres animaux, et s’assurer de bien prendre en compte la présence de facteurs comportementaux confondants ou médiateurs comme une mauvaise hygiène de vie alimentaire, la consommation de tabac et d’alcool, les expositions professionnelles, etc. Selon les recommandations du National Cancer Institute (NCI, 2012), les connaissances actuellement disponibles ne permettent pas d’établir un lien de causalité entre stress et augmentation du risque de cancer. Si le professionnel de soin psychique ne doit donc pas cautionner ce lien hypothétique au risque de culpabiliser le patient, il gardera à l’esprit, d’une part, que le cancer peut en revanche générer un stress bien réel au quotidien chez les patients atteints par cette maladie et, d’autre part, que ces théories « profanes » peuvent parfois témoigner d’un mécanisme de défense contre ce stress.

Meaning in Life and Its Relationship With Physical, Mental, and Cognitive Functioning: A Study of 1,042 Community-Dwelling Adults Across the Lifespan

OBJECTIVE

To examine the relationship of presence and search for meaning in life with age, physical and mental well-being, and cognitive functioning across the adult lifespan.

METHODS

Cross-sectional data from 1,042 adults in the Successful AGing Evaluation (SAGE)-a multicohort study of adult community-dwelling residents of San Diego County, California-were analyzed. Presence of meaning ("Presence") and search for meaning in life ("Search") were assessed with the Meaning in Life Questionnaire. Physical and mental well-being were measured using the Short Form 36 Health Survey (SF-36). Telephone Interview for Cognitive Status-modified was employed to screen for overall cognitive function. Study data were collected from January 2013 to June 2014.

RESULTS

Presence of meaning exhibited an inverted U-shaped relationship whereas Search showed a U-shaped relationship with age (with Presence peaking and Search reaching the lowest point around age 60). Statistical modeling using generalized estimating equations revealed that physical well-being (SF-36 physical composite score) correlated negatively with age (P < .001) and positively with Presence (P < .001), and there was an age group x Presence interaction (P = .018), such that the relationship was stronger in subjects over age 60. Mental well-being correlated positively with age (P < .001) and Presence (P < .001) and negatively with Search (P = .002). Cognitive function correlated inversely with age (P < .001) and with Search (P < .001). Significant covariates of Presence and Search had small effect sizes, except for a medium effect size for satisfaction with life and Presence in adults over age 60 (P < .001).

CONCLUSIONS

Presence and search for meaning in life are important for health and well-being, though the relationships differ in adults younger and older than 60 years. Better understanding of the longitudinal relationships of meaning of life with well-being is warranted to design interventions to increase meaning of life and improve health and functioning.

Wisdom and Hard Times: The Ameliorating Effect of Wisdom on the Negative Association Between Adverse Life Events and Well-Being

Objectives

Old age is characterized by many physical and social losses that adversely affect subjective well-being (SWB). Yet, past studies have shown that wisdom tends to be positively related to SWB in old age, particularly under adverse circumstances. We tested whether three-dimensional wisdom, measured as a combination of cognitive, reflective, and compassionate (affective) personality qualities, moderated the inverse association between adverse life events and well-being.

Method

A sample of 994 adults aged 51-99 years (M = 77) from the Successful AGing Evaluation (SAGE) study and structural equation models with well-being as a latent variable were used to test the hypothesis.

Results

Greater wisdom, in particular the reflective wisdom dimension, was positively associated with SWB and buffered the inverse relation between the experience of adverse life events during the previous year and current well-being.

Discussion

Wisdom appears to strengthen older adults' ability to cope with aging-related losses and, therefore, is a valuable psychological resource in old age.

Personality and fatal diseases: Revisiting a scientific scandal

During the 1980s and 1990s, Hans J Eysenck conducted a programme of research into the causes, prevention and treatment of fatal diseases in collaboration with one of his protégés, Ronald Grossarth-Maticek. This led to what must be the most astonishing series of findings ever published in the peer-reviewed scientific literature with effect sizes that have never otherwise been encounterered in biomedical research. This article outlines just some of these reported findings and signposts readers to extremely serious scientific and ethical criticisms that were published almost three decades ago. Confidential internal documents that have become available as a result of litigation against tobacco companies provide additional insights into this work. It is suggested that this research programme has led to one of the worst scientific scandals of all time. A call is made for a long overdue formal inquiry.

Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV

OBJECTIVE

The causes of neurocognitive and everyday functioning impairment among aging people living with HIV (PLWH) are multifactorial. Exposure to stress and trauma can result in neurocognitive deficits via activation of neurological and other biological mechanisms.

METHOD

PLWH (n = 122) and persons without HIV (n = 95), 35-65 years of age, completed four questionnaires that were used to generate a trauma, economic hardship (food insecurity and low socioeconomic status), and stress composite variable (TES). Participants also completed a comprehensive neuropsychological battery and standardized self-reports of activities of daily living (ADLs). We examined the independent and interactive effects of TES and HIV status on neurocognitive performance and ADL declines.

RESULTS

PLWH had more traumatic events, more food insecurity, lower socioeconomic status, and higher perceived stress compared with HIV- individuals (all ps < .0001). Among PLWH, a higher composite TES score was associated with worse executive functioning (p = .02), worse learning (p = .02), worse working memory (p = .02), and more ADL declines (p < .0001), even after controlling for relevant demographic, psychiatric, substance use, and HIV disease covariates. On their own, individual TES components did not predict these outcomes. Conversely, no significant relationships were observed between TES and cognitive domains nor ADL declines among HIV- individuals.

CONCLUSIONS

A composite score of trauma, economic hardship, and stress was significantly associated with worse neurocognitive performance and functional declines among PLWH. These adverse experiences may contribute to neurocognitive and daily functioning difficulties commonly observed among PLWH. Longitudinal studies are needed to elucidate the relationships between economic/psychosocial adversities and cognitive/functional outcomes over time, and examine potential mediators, such as inflammatory biomarkers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Perception matters: Stressful life events increase breast cancer risk

OBJECTIVE

The relationship between psychological stress and breast cancer risk is unclear. The present study sought to understand how stressfulness appraisal of salient Life Events (LEs) influences breast cancer risk.

METHODS

A case-control design was used and included 664 female cases identified through the Cancer Surveillance Program of Orange County, CA and 203 female population-based controls. A LE questionnaire determined if events occurred prior to breast cancer diagnosis and if these events were considered to be stressful or not. Multivariate unconditional logistic regression was used to calculate ORs while adjusting for known breast cancer covariates.

RESULTS

Cumulative adverse LEs perceived as stressful were associated with increased breast cancer risk in a dose response fashion (OR = 1.63, 95% CI = 1.00-2.66, P_trend = 0.045). Conversely, events perceived as non-stressful did not have a significant impact on breast cancer risk. Previous personal illness was directly related to increased breast cancer risk, whether perceived as stressful (OR = 2.84, 95% CI = 1.96-4.11) or non-stressful (OR = 3.47, 95% CI = 1.34-8.94). Abortion and relocation were observed to have a protective effect on breast cancer risk only when reported as stressful (OR = 0.54, 95% CI = 0.32-0.92; OR = 0.63, 95% CI = 0.43-0.93, respectively). Pre/Peri-menopausal women who were nulliparous or who had their first child at ≥30 years of age were especially prone to the effects of appraised stress on increased breast cancer risk.

CONCLUSIONS

This study underscores the importance of stressfulness appraisal when determining the effect of major LEs on breast cancer risk. Our results support incorporating assessments of perceived stressfulness in future epidemiological investigation of this topic.

Social relationships, inflammation markers, and breast cancer incidence in the Women's Health Initiative

OBJECTIVES

Previous research has reported associations between social relationships and carcinogenesis. Inflammation is a potential mediator of these associations. To clarify these links for one tumor site, we examined associations between social relationships, circulating inflammation markers, and breast cancer incidence.

MATERIALS AND METHODS

Among 132,262 participants from the prospective Women's Health Initiative, we used linear and logistic regression to evaluate associations between social relationship characteristics (social support, social strain, social network size) and inflammation markers of C-reactive protein (CRP) and white blood cell count (WBC). Cox regression was used to evaluate associations between inflammation markers and breast cancer incidence, as well as associations between social relationship characteristics and breast cancer incidence with and without adjustment for inflammation markers.

RESULTS

Larger social networks were associated with lower continuous CRP (beta = -0.22, 95% CI -0.36, -0.08) and WBC (beta = -0.23, 95% CI -0.31, -0.16). Greater social strain was associated with higher continuous CRP (beta = 0.24, 95% CI 0.14, 0.33) and WBC (beta = 0.09, 95% CI 0.04, 0.14). When WBC was dichotomized at 10,000 cells/uL, high WBC was associated with greater hazards of in situ breast cancer (HR = 1.65, 95% CI 1.17, 2.33) but not invasive breast cancer. Social relationship characteristics were not associated with incidence of invasive or in situ breast cancer.

CONCLUSION

Larger social networks were associated with lower inflammation and greater social strain was associated with higher inflammation. Higher inflammation might be associated with development of in situ breast cancer, but this appeared to be due to factors other than social relationships.

Fear of recurrence among older breast, ovarian, endometrial, and colorectal cancer survivors: Findings from the WHI LILAC study

OBJECTIVE

To examine the prevalence of and factors associated with fear of recurrence (FCR) following treatment for breast, ovarian, endometrial, and colorectal cancer among older women.

METHODS

Participants were enrolled in the Women's Health Initiative Life and Longevity After Cancer study. Descriptive statistics and multivariate logistic regression models were used to assess the association of demographic, clinical, and quality of life variables with survivors' FCR, dichotomized as <14 (low) or ≥14 (high) using the Cancer Worry Scale.

RESULTS

Out of the 4259 participants, 3124 (73.3%) were diagnosed with breast cancer, 559 (13.1%) with colorectal cancer, 493 (11.6%) with endometrial cancer, and 83 (2%) with ovarian cancer. There were no significant differences in FCR by cancer type (P = .75), with a mean scale score of 10.8 ± 2.87 for all participants combined. Approximately 16% (n = 679) were in the high FCR group. Multivariable analyses indicated that being younger at diagnosis, reporting a symptom score of ≥8, receipt of chemotherapy, and lower self-rated health were significantly associated with high FCR. Women who were widowed or never married were less likely to report high FCR.

CONCLUSIONS

Fear of recurrence was experienced by a small but important proportion of older, long-term cancer survivors and is associated with multiple demographic and clinical variables. These results will better inform researchers and clinicians regarding the individuals who are at risk of FCR.

Possible role of stress, coping strategies, and life style in the development of breast cancer

Objective The aim of the present study was to investigate the possibility of the effect of life long stressful events, along with coping method used, perception of social support, and life style on the development of breast cancer. Methods In this hospital-based case control study, the study group comprised 250 women with breast cancer who were followed by Florence Nightingale Breast Study Group. Control group included 250 women, who had similar sociodemographic characteristics to the study group. Data were collected with semi-structured interview form, Healthy Life Style Behavior Scale, Coping Strategy Indicator, and Stress Evaluation Form developed by us. Results In multivariate analysis, family history of cancer (OR: 1.55, 95% CI: 2.29-1.05), inadequate social support (OR: 1.83, 95% CI: 1.23-2.73), and loss of father during childhood (OR: 2.68, 95% CI: 5.52-1.30) and serious stressor within the last five years (OR: 4.72, 95% CI: 7.03-3.18) were found to be risk factors increasing the risk of breast cancer. When family history of cancer was excluded from the model, the presence of psychiatric disorder history (OR: 1.95, 95% CI: 3.26-1.17) and major life events (OR: 2.24, 95% CI: 4.07-1.24) were added to the model as risk factors. Conclusion The present study indicates that especially the stressful events experienced within the last five years plays an undeniable role in the risk of breast cancer. Social support may be as important in the period before the diagnosis as in the period after diagnosis.

Causal Attribution of Breast Cancer by Survivors in French West Indies

Patients frequently ask about the cause of their breast cancer. To answer, physicians refer to breast cancer risk factors based on medical reports. We aim to assess these risk factors for the point of view of survivors, a point of view which seems to differ from that of medical references. We ran a survey with open- and closed-ended questionnaires on patients' opinions about risks factors both for women in general and for their own case. We also collected data on their sources of information on this subject. Most patients had no opinion. The most frequently cited risk factors were stress, then genetic causes, and poor diet. Internet was the leading source of information for patients, followed by physicians and magazines. Our study highlights the mismatch between breast cancer risk factors as perceived by scientists and by survivors. Survivors tend to focus on non-controllable risk factors. Taking into account attribution theories of life events, an awareness of patient opinion may be valuable for psychological support of survivors, and it may be informative to record the way in which patients attribute causality for life events such as breast cancer and, more generally, all type of cancer.

Psychological stress and breast cancer incidence: a systematic review

Objective

Breast cancer is the world’s leading cause of cancer mortality in women. Stress is an imminent risk factor with a documented negative impact on neuro-endocrine and immune system. Numerous epidemiological studies have investigated the link between stress and cancer, reporting contradictory results from no association to a close causal link. The impact of the topic and the lack of conclusion compelled this systematic review.

Methods

A systematic review was carried out, including all literature studies from 1966 to 2016, investigating the relationship between stress and the occurrence of breast cancer. Of the 1813 articles identified in the PubMed/Medline database, 52 were eligible and included in the analysis.

Results

A number of 17 retrospective, 20 limited prospective and 15 prospective studies were analyzed. The number of patients exceeded 29,000, for a total number of more than 700.000 women recruited from hospital, screening cohorts or population registers. We identified 26 positive articles linking personal traits, stressful events and breast cancer, 18 negative articles that did not confirm their hypothesis and 8 articles that could not be classified. Facing heterogeneity, all possible misguiding factors such as: study design, information gathering, stress type, moment of exposure, individual susceptibility and personality, were discussed independently.

Conclusions

Qualitative analysis of articles has revealed a possible association between stress and cancer, especially regarding stressful life events. In the absence of a meta-analysis and taking into account the methodological heterogeneity of the studies, the results are difficult to interpret and the role of chance is difficult to exclude.

Negative Valence Life Events Promote Breast Cancer Development

BACKGROUND

The influence of stress on breast cancer risk remains unknown. The goal of the present study was to determine the effect of stress in the form of salient positive and negative valence life events (LEs) on primary invasive breast cancer risk. We hypothesized that salient negative LEs would increase breast cancer risk and salient positive LEs would attenuate this increased risk.

PATIENTS AND METHODS

We used a case-control design with 664 cases identified through the Cancer Surveillance Program of Orange County and 203 population-based controls. Participants completed a risk factor questionnaire, which included a LE section. Fourteen salient LEs of positive or negative valence were used to quantify stress exposure. A baseline model was constructed, and odds ratios (ORs) were calculated using multivariate unconditional logistic regression.

RESULTS

Negative LEs were associated with increased breast cancer risk. The OR for ≥ 4 negative LEs showed a 2.81-fold increase in breast cancer risk (OR, 2.81; 95% confidence interval [CI], 1.47-5.36). A significant dose-response relationship between lifetime negative valence LEs and breast cancer risk was found. Previous personal illness increased breast cancer risk by 3.6-fold (OR, 3.60; 95% CI, 2.50-5.20). In contrast, abortion was associated with a 45% decrease in breast cancer risk (OR, 0.55; 95% CI, 0.34-0.89). Salient positive LEs did not have a significant effect on breast cancer risk. However, they seemed to buffer the adverse effect of salient negative LEs on breast cancer risk.

CONCLUSION

The findings from the present study support the role of salient negative LEs in promoting breast cancer development, with a possible buffering effect of salient positive LEs.

Black-White Disparities in Breast Cancer Subtype: The Intersection of Socially Patterned Stress and Genetic Expression

Hormone receptor negative (HR-) breast cancer subtypes are etiologically distinct from the more common, less aggressive, and more treatable form of estrogen receptor positive (ER+) breast cancer. Numerous population-based studies have found that, in the United States, Black women are 2 to 3 times more likely to develop HR- breast cancer than White women. Much of the existing research on racial disparities in breast cancer subtype has focused on identifying predisposing genetic factors associated with African ancestry. This approach fails to acknowledge that racial stratification shapes a wide range of environmental and social exposures over the life course. Human stress genomics considers the role of individual stress perceptions on gene expression. Yet, the role of structurally rooted biopsychosocial processes that may be activated by the social patterning of stressors in an historically unequal society, whether perceived by individual black women or not, could also impact cellular physiology and gene expression patterns relevant to HR- breast cancer etiology. Using the weathering hypothesis as our conceptual framework, we develop a structural perspective for examining racial disparities in breast cancer subtypes, integrating important findings from the stress biology, breast cancer epidemiology, and health disparities literatures. After integrating key findings from these largely independent literatures, we develop a theoretically and empirically guided framework for assessing potential multilevel factors relevant to the development of HR- breast cancer disproportionately among Black women in the US. We hypothesize that a dynamic interplay among socially patterned psychosocial stressors, physiological & behavioral responses, and genomic pathways contribute to the increased risk of HR- breast cancer among Black women. This work provides a basis for exploring potential alternative pathways linking the lived experience of race to the risk of HR- breast cancer, and suggests new avenues for research and public health action.

Extreme population-level events: Do they have an impact on cancer?

The report by Sadetzki and colleagues in this issue showcases the impact of a horrendous event—the Holocaust—on subsequent health decades after the occurrence. Two additional calamities—country‐wide famines and population‐level discrimination—are provided as examples of this phenomenon to add evidence to the causal pathway identified by Sadetzki et al.

See also pages 3335‐45.

Perceived Stress and Colorectal Cancer Incidence: The Japan Collaborative Cohort Study

Colorectal cancer is the third most common cancer worldwide, and many risk factors for colorectal cancer have been established. However, it remains uncertain whether psychological stress contributes to the onset of colorectal cancer. Therefore, we conducted a large-scale prospective cohort study to confirm the association between perceived stress and colorectal cancer incidence. We identified 680 cases of colon cancer and 330 cases of rectal cancer during a maximum of 21-year follow-up of 61,563 Japanese men and women. Cox regression analysis adjusted for potential confounders revealed a significant association of perceived stress with rectal cancer incidence but not with colon cancer incidence. This finding is partly consistent with that from only one previous study that addressed an association between perceived stress and the risk of colorectal cancer. However, studies on this topic are sparse and warrant further exploration.

Impact of lifestyle and psychological stress on the development of early onset breast cancer

The present study aimed to investigate risk factors for early onset breast cancer that are related to lifestyle and psychological stress. A comparative case-control study was performed among patients from the Department of Breast Surgery in Shanghai Cancer Center of Fudan University. The information regarding risk factors associated with the development of early onset breast cancer was collected using a questionnaire in a face-to-face interview. The distribution of the risk factors associated with the development of early onset breast cancer between the patient group and the control group was analyzed with logistic regression. A total of 582 cases of young patients (≤40 years old) with breast cancer and 540 controls of young patients (≤40 years old) with benign breast disease were included in this study. The risk factors for breast cancer in young women include age at first birth (odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.88-0.98), history of breast cancer in an immediate family member (OR = 2.36, 95% CI: 1.14-4.89), history of genital surgery (OR = 2.11, 95% CI: 1.16-3.82), active and passive smoking in daily life or the environment (OR = 1.64, 95% CI: 1.19-2.25), weekly intake of soy products (OR = 1.24, 95% CI: 1.02-1.49), use of household cooking oil (OR = 2.04, 95% CI: 1.04-4.00), disharmonious marital status (OR = 1.16, 95% CI: 1.06-1.26), frequent depression (OR = 1.32, 95% CI: 1.00-1.75), and negative emotional experiences (OR = 1.15, 95% CI: 1.03-1.29). Our study could provide the basis for risk assessment and preventive interventions for early onset breast cancer.

The influence of personality and perceived stress on the development of breast cancer: 20-year follow-up of 29,098 Japanese women

Breast cancer is the most common cancer in women. However, it remains unproven whether psychological factors have an influence on breast cancer incidence. In our earlier study, subjects possessing two personality traits, decisiveness and "ikigai" (a Japanese word meaning something that makes one's life worth living), showed a significantly lower risk of developing breast cancer, although no psychological factors have been convincingly demonstrated to have an influence on breast cancer development in other studies. Therefore, we conducted this follow-up analysis to confirm the association between breast cancer incidence and psychological traits, using the final dataset of a large-scale prospective cohort study in Japan. We identified 209 cases of incident breast cancer out of a maximum 21-year follow-up of 29,098 Japanese women. Cox proportional hazard regression analysis, adjusted for the same potential confounders used in our previous study, did not reveal any significant relationships between breast cancer incidence and four psychological traits: having "ikigai", decisiveness, ease of anger arousal, and perceived stress. Our finding is consistent with previous studies, and suggests that the psychological traits are unlikely to be an important risk factor for breast cancer.

Expression of the glucocorticoid receptor in breast cancer-associated fibroblasts

Cancer- associated fibroblasts (CAFs) are actively involved in breast carcinoma. Our previous study demonstrated that the majority of these CAFs were smooth muscle actin (SMA) positive and were therefore termed peritumoral myofibroblast (PMY). Glucocorticoid, linked or not with its receptor (GR), has been postulated to serve a major role in normal breast and breast carcinoma; however, their role in CAFs remains poorly understood. The aim of the present study was to assess the presence of GR in breast CAFs and particularly in PMY in 56 cases of invasive breast carcinoma in correlation with clinicopathological parameters, by immunohistochemistry. GR was observed in CAFs in 51 cases (91%) and were more frequent in luminal A subtype (19/19 cases; 100%). The stromal expression was statistically correlated with the tumor grade (P=0.03), the Ki-67 index (P=0.003) and the presence of GR in the epithelial component (P=0.01). The demonstration of a frequent expression of GR in breast CAFs may serve as an interesting target for future therapeutics for the regulation of the tumoral breast microenvironment.

Psychological stress, adverse life events and breast cancer incidence: a cohort investigation in 106,000 women in the United Kingdom

Background

Women diagnosed with breast cancer frequently attribute their cancer to psychological stress, but scientific evidence is inconclusive. We investigated whether experienced frequency of stress and adverse life events affect subsequent breast cancer risk.

Methods

Breast cancer incidence was analysed with respect to stress variables collected at enrolment in a prospective cohort study of 106,000 women in the United Kingdom, with 1783 incident breast cancer cases. Relative risks (RR) were obtained as hazard ratios using Cox proportional hazards models.

Results

There was no association of breast cancer risk overall with experienced frequency of stress. Risk was reduced for death of a close relative during the 5 years preceding study entry (RR = 0.87, 95 % confidence interval (CI): 0.78–0.97), but not for death of a spouse/partner or close friend, personal illness/injury, or divorce/separation. There was a positive association of divorce with oestrogen-receptor-negative (RR = 1.54, 95 % CI: 1.01–2.34), but not with oestrogen-receptor-positive breast cancer. Risk was raised in women who were under age 20 at the death of their mother (RR = 1.31, 95 % CI: 1.02–1.67), but not of their father, and the effect was attenuated after excluding mothers with breast or ovarian cancer (RR = 1.17, 95 % CI: 0.85–1.61).

Conclusions

This large prospective study did not show consistent evidence for an association of breast cancer risk with perceived stress levels or adverse life events in the preceding 5 years, or loss of parents during childhood and adolescence.

Electronic supplementary material

The online version of this article (doi:10.1186/s13058-016-0733-1) contains supplementary material, which is available to authorized users.

Life stress, glucocorticoid signaling, and the aging epigenome: Implications for aging-related diseases

Life stress has been associated with accelerated cellular aging and increased risk for developing aging-related diseases; however, the underlying molecular mechanisms remain elusive. A highly relevant process that may underlie this association is epigenetic regulation. In this review, we build upon existing evidence to propose a model whereby exposure to life stress, in part via its effects on the hypothalamic-pituitary axis and the glucocorticoid signaling system, may alter the epigenetic landscape across the lifespan and, consequently, influence genomic regulation and function in ways that are conducive to the development of aging-related diseases. This model is supported by recent studies showing that life stressors and stress-related phenotypes can accelerate epigenetic aging, a measure that is based on DNA methylation prediction of chronological age and has been associated with several aging-related disease phenotypes. We discuss the implications of this model for the prevention and treatment of aging-related diseases, as well as the challenges and limitations of this line of research.

Resilience, stressful life events, and depressive symptomatology among older Chinese adults

OBJECTIVE

The association between exposure to stressful life events (SLEs) and late-life depression is well-documented. However, the role of resilience as a buffer against the adverse mental health effects of SLEs in late life has not been convincingly demonstrated. In this paper, the moderating effect of resilience in the relationship between SLEs and depressive symptomatology in older Chinese adults is investigated.

METHOD

A population sample of 385 community-dwelling older Chinese adults aged ≥60 years responded to questionnaires on resilience (Connor-Davidson resilience scale), depressive symptomatology (Geriatric Depression Scale, GDS-15) and SLEs.

RESULTS

Increased numbers of SLEs (β = 0.343, p < .001) and lower levels of resilience (β = -0.137, p < 0.001) were significantly associated with higher levels of depressive symptomatology. There was a significant interaction of resilience and number of SLEs on depressive symptomatology (p = 0.003). The sense of personal competence and optimism was the principal underlying resilience dimension moderating the relationship for both the young-old (aged 60-69) and the old-old (aged 70 and above).

CONCLUSION

The finding of significant interaction supported the role of resilience in moderating the adverse effect of SLEs in terms of depressive symptoms among older Chinese adults.

Occupational Complexity and Cognitive Reserve in a Middle-Aged Cohort at Risk for Alzheimer's Disease

Higher occupational attainment has previously been associated with increased Alzheimer's disease (AD) neuropathology when individuals are matched for cognitive function, indicating occupation could provide cognitive reserve. We examined whether occupational complexity (OCC) associates with decreased hippocampal volume and increased whole-brain atrophy given comparable cognitive function in middle-aged adults at risk for AD. Participants (n = 323) underwent structural MRI, cognitive evaluation, and work history assessment. Three complexity ratings (work with data, people, and things) were obtained, averaged across up to 3 reported jobs, weighted by years per job, and summed to create a composite OCC rating. Greater OCC was associated with decreased hippocampal volume and increased whole-brain atrophy when matched for cognitive function; results remained substantively unchanged after adjusting for several demographic, AD risk, vascular, mental health, and socioeconomic characteristics. These findings suggest that, in people at risk for AD, OCC may confer resilience to the adverse effects of neuropathology on cognition.

S100A4 participates in epithelial-mesenchymal transition in breast cancer via targeting MMP2

Numerous studies have shown that S100A4 acquires its metastasis-promoting effects via inducing epithelial-mesenchymal transition (EMT). However, its role and mechanism in EMT in breast cancer had not been clearly elucidated. Herein, we showed that the knockdown of S100A4 expression in breast cancer cell lines, MDA-MB-231 and MDA-MB-468, inhibited not only cell invasion ability greatly, but also the occurrence of EMT significantly. In addition, S100A4 knockdown could also decrease the expression of MMP2, a promoter and a mediator of the EMT processes in cancer. Above all, restoring the expression of MMP2 in MDA-MB-231 and MDA-MB-468 could not only rescue the invasion ability inhibited by knockdown of S100A4, but also reverse the EMT suppressed by knockdown of S100A4. In summary, our results indicated that S100A4 could promote the invasion ability of breast cancer cells via EMT, more importantly, it could participate in EMT via regulating MMP2 in breast cancer. Therefore, S100A4 could be a candidate biomarker for defining breast cancer metastasis and useful target for therapy.

Social defeat stress promotes tumor growth and angiogenesis by upregulating vascular endothelial growth factor/extracellular signal-regulated kinase/matrix metalloproteinase signaling in a mouse model of lung carcinoma

Numerous epidemiological and experimental animal studies have indicated that chronic psychological stress may promote tumor development. However, the underlying molecular mechanisms by which chronic stress promotes tumorigenesis remain to be fully elucidated and animal models have not yet been well established. In the present study, an established mouse model of repeated social defeat stress (RSDS), was generated and used to investigate the effect of stress on tumor growth and metastasis. C57BL/6 mice were exposed to RSDS for 10 days, followed by subcutaneousl inoculation with Lewis lung carcinoma cells for seven days. The tumor weight and volume as well as the number of the lung metastatic nodules were then determined. Vascular endothelial growth factor (VEGF) serum levels were measured using ELISAs. In addition, expression levels of VEGF receptor (VEGFR) and L1 cell adhesion molecule (L1CAM) messenger (m)RNA were confirmed using reverse transcription quantitative polymerase chain reaction. Furthermore, protein expression levels of phosphorlyated extracellular signal-regulated kinase (pERK), matrix metalloproteinase (MMP)-2 and MMP-9 were examined using western blot analysis. The results showed that RSDS significantly increased the weight and the volume of the primary tumor as well as the number of the lung metastatic nodules. Serum VEGF levels were significantly higher in the tumor-stress group compared with those of the unstressed tumor mice. In addition, tumors in stressed animals demonstrated markedly enhanced expression of VEGFR-2 and L1CAM mRNA as well as pERK, MMP-2 and MMP-9 protein expression. In conclusion, these results suggested that RSDS contributed to lung cancer progression, angiogenesis and metastasis, which was partially associated with increased VEGF secretion and therefore the activation of the ERK signaling pathway, resulting in the induction of MMP-2 and MMP-9 protein expression.

Clinical and biological significance of glucocorticoid receptor (GR) expression in breast cancer

The glucocorticoid receptor (GR) is a member of the nuclear receptor superfamily of transcription factors, which exerts anti-proliferative and anti-apoptotic activities. The GR is expressed in a large proportion of breast cancer (BC) although levels generally decrease during cancer progression. This study aimed to determine the clinical and biological significance of GR expression using a large series of early-stage BC with long-term follow-up and BC cell lines. Immunohistochemistry was used to assess the expression of GR in 999 cases of primary invasive BC prepared as tissue microarrays. Reverse phase protein microarray was used to assess the expression of GR in MCF7 and MDA-MB-231 cell lines. Nuclear expression of GR was observed in 61.6 % of breast tumours and was associated with features of good prognosis including smaller tumour size and lower grade with less pleomorphism and low mitotic count. GR expression was positively correlated with expression of oestrogen (ER) and progesterone receptors. In ER-positive tumours, GR was associated with other features of favourable outcome including FOXA1, GATA3 and BEX1 expression, while low GR expression was associated with high Ki67, p53 and CD71 expression. GR expression is associated with features of good outcome but does not provide prognostic information independent of size, stage and grade. Understanding the receptor and its effects on BC behaviour is essential for avoiding any unwanted effects from the use of glucocorticoids in routine oncology practice.

Development of a new multidimensional individual and interpersonal resilience measure for older adults

OBJECTIVES

Develop an empirically grounded measure that can be used to assess family and individual resilience in a population of older adults (aged 50-99).

METHODS

Cross-sectional, self-report data from 1006 older adults were analyzed in two steps. The total sample was split into two subsamples and the first step identified the underlying latent structure through principal component exploratory factor analysis (EFA). The second step utilized the second half of the sample to validate the derived latent structure through confirmatory factor analysis (CFA).

RESULTS

EFA produced an eight-factor structure that appeared clinically relevant for measuring the multidimensional nature of resilience. Factors included self-efficacy, access to social support network, optimism, perceived economic and social resources, spirituality and religiosity, relational accord, emotional expression and communication, and emotional regulation. CFA confirmed the eight-factor structure previously achieved with covariance between each of the factors. Based on these analyses we developed the multidimensional individual and interpersonal resilience measure, a broad assessment of resilience for older adults.

CONCLUSION

This study highlights the multidimensional nature of resilience and introduces an individual and interpersonal resilience measure developed for older adults which is grounded in the individual and family resilience literature.

Breast Cancer Cause Beliefs: Chinese, Korean, and Mexican American Breast Cancer Survivors

This study examined causal attribution beliefs about breast cancer and the influence that these beliefs exert on health behavior change among breast cancer survivors (BCS). Focus groups with Chinese (n = 21), Korean (n = 11), and Mexican American (n = 9) BCS recruited through community- and hospital-based support groups were conducted. Interviews were audio-recorded, transcribed verbatim, and translated into English for thematic content analysis. Three themes concerning beliefs about breast cancer cause common to all three groups included (a) stress, (b) diet, and (c) fatalism. Causal beliefs corresponded to behavioral changes with women describing efforts to improve their diet and manage their stress. Ethnic minority BCS adhere to beliefs about what caused their cancer that influence their health behaviors. Providing quality health care to ethnically diverse cancer survivors requires cultural sensitivity to patients' beliefs about the causes of their cancer and awareness of how beliefs influence patients' health behaviors post diagnosis.

Perceived stress and eating behaviors by sex, obesity status, and stress vulnerability: findings from the vitamins and lifestyle (VITAL) study

Stress has been associated with eating patterns in human studies with differences due to the type and duration of stressor, type of food, and individual susceptibility factors. Laboratory and smaller epidemiological studies have reported stress-associated preferences for foods high in sugar and fat; associations have been found more consistently among women and people who are obese. Larger studies are needed to sufficiently test these relationships. The aim of this study was to evaluate associations between self-reported amount of stress and dietary nutrient intakes (percentage energy from fat, carbohydrates, added sugar) and dietary behaviors (number of eating occasions and servings of fruits and vegetables, high-fat snacks, fast-food items, and sweetened drinks) by sex, obesity status, and stress vulnerability. Linear regression was used to estimate associations of perceived stress with eating patterns among 65,235 older adults while adjusting for demographic factors, body mass index, physical activity, alcohol intake, number of comorbidities, and other relevant covariates. Higher perceived stress was associated with greater intake of energy from fat, high-fat snacks, and fast-food items as well as lower intake of energy from carbohydrates (all P for trend ≤0.002). Among those with high perceived stress vulnerability, perceived stress was associated with fewer eating occasions (P for interaction <0.0001). Although associations were small, significant relationships were found for perceived stress arising from everyday experiences among an older, mostly white population. These findings have public health implications and suggest that stress may be important to consider in programs promoting healthy eating.

Cancer incidence and mortality following exposures to distal and proximal major stressors

PURPOSE

Severe psychological trauma has been shown to leave psychological and biological sequelae, including compromise of the neuro-hormonal and immunological systems. Despite much research, the putative effect of such stressor on cancer remains ambiguous. This study maximized the exploration of cancer incidence and mortality by combining a proximal (parental bereavement) with a distal major stressor (Holocaust exposure) on both risks.

METHODS

Subjects were bereaved Holocaust survivors (n = 904) and comparison individuals (n = 933) selected from the total cohort of 6,284 Jewish-Israeli parents who lost an adult son in war or from non-self-inflicted external causes. Cox regression was used to examine the differential risk for cancer between the two bereaved samples, adjusting for potential confounders.

RESULTS

No difference in cancer incidence or mortality was observed between both groups of bereaved parents. However, prior to bereavement, Holocaust survivors had an increased cancer risk compared with their counterparts in the general population.

CONCLUSIONS

Individuals who faced both a proximal (bereavement) and distal (Holocaust) major stressors had no additive risk for cancer incidence and mortality.

Psychological reactivity to laboratory stress is associated with hormonal responses in postmenopausal women

OBJECTIVE

The present study examined associations between psychological reactivity and hormonal responses to a standardized laboratory stressor (Trier Social Stress Test, TSST) in postmenopausal women.

METHODS

Postmenopausal women aged 50-74 years undertook anxiety and mood assessments prior to and following the TSST. Blood samples were drawn at multiple timepoints for assessment of cortisol, adrenocorticotrophic hormone (ACTH) and dehydroepiandrosterone (DHEA).

RESULTS

Forty postmenopausal women completed the assessments. As expected, significant increases in anxiety and negative affect and decreases in positive affect were observed after the TSST; however, the magnitude of change in anxiety and mood varied considerably across individuals. Analyses indicated that greater increases in anxiety and negative affect after the TSST were associated with higher levels of cortisol, ACTH and DHEA after controlling for race, age, body mass index and smoking status. Changes in positive affect were not associated with cortisol, ACTH or DHEA.

CONCLUSIONS

These findings suggest that enhanced reactivity to stress is associated with higher hormone levels among postmenopausal women, which could have potential implications for health.

Loss of glucocorticoid receptor activation is a hallmark of BRCA1-mutated breast tissue

Glucocorticoids (GCs) regulate cell homeostasis and can affect carcinogenesis. An inherited germline mutation in the BRCA1 gene, a tumor suppressor gene, confers a predisposition to breast and ovarian cancers. BRCA1 participates in the maintenance of genome stability through DNA repair, in cellular homeostasis through gene transcription, and in signaling regulation. The interaction between BRCA1 and the glucocorticoid receptor (GR) signaling pathway was studied in normal breast tissues and triple-negative breast cancers from BRCA1 mutation carriers. A loss of the active Ser211 phosphorylated form of GR was found in the mutant as compared to the non-mutant. In in vitro studies, the BRCA1 status in breast cancer cell lines regulates GC-dependent proliferation/apoptosis and impacts GC-dependent gene expression. The lack of BRCA1 inhibited dexamethasone actions on its target genes' expression and the opposite effect was seen with BRCA1 overexpression. BRCA1 overexpression enhances MAPK p38 phosphorylation, resulting in an amplification of GR phosphorylation on Ser 211 and GR basal expression. Our results indicate that BRCA1 is essential to develop an efficient GC signalization. GR P-Ser211 levels may constitute an important diagnostic factor for screening BRCA1 loss of expression in tumors from BRCA1 mutation carriers as well as in sporadic BRCAness tumors. This marker may help to optimize therapeutic strategies.

Striking life events associated with primary breast cancer susceptibility in women: a meta-analysis study

Purpose

The association between striking life events, an important stress and acute anxiety disorder, and the occurrence of primary breast cancer is unclear. The current meta-analysis was designed to assess the relationship between striking life events and primary breast cancer incidence in women.

Methods

Systematic computerized searching of the PubMed, ScienceDirect, Embase, and BMJ databases with the combinations of controlled descriptors from Mesh, including breast cancer, breast tumor, cancer of breast, mammary carcinoma, life events, life change events, case–control studies, case-base studies, cohort study, and cohort analysis and identified a total of 307 papers published from January 1995 to April 2012. Following evaluation of methodological quality with the Downs & Black criteria, seven case–control or cohort studies were selected and the association between striking life events and primary breast cancer incidence in women was measured using random effect or fixed-effect odds ratios combined with 95% confidence interval.

Results

The seven studies included in the final meta-analysis included 99,807 women. A meta-analysis showed that the pooled OR for striking life events and breast cancer was 1.51 (95% CI 1.15 - 1.97, P = 0.003), indicating that women with striking life events were at 1.5-fold greater risk of developing breast cancer. The pooled OR for severe striking life events and breast cancer was 2.07 (95% CI 1.06 - 4.03), indicating that women with severe striking life events were at 2-fold greater risk of developing breast cancer.

Conclusions

The current meta-analysis showed significant evidence for a positive association between striking life events and primary breast cancer incidence in women.