This transcript has been edited for clarity.
Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I’m Dr. F. Perry Wilson from the Yale School of Medicine.
When we think about what causes cancer, lifestyle factors like smoking, alcohol intake, and being overweight often come to mind. Genetics also play a significant role. And then there’s the idea of bad luck—random chance and cosmic rays hitting the wrong segment of DNA. But one factor that doesn’t usually come up in these discussions is stress.
While I specialize in other areas of medicine, my wife, Dr. Niamey Wilson, is a renowned breast cancer surgeon. When I asked her about the causes of cancer, she immediately mentioned stress. She explained that she has observed this pattern repeatedly in her practice. Patients often present with breast cancer without any apparent risk factors—no family history, no genetic predisposition, and they are relatively young. The common thread, she noted, is stress. Recent divorces, the loss of a parent, or an incredibly stressful work life are often cited.
This week, a new study delves deeper into the relationship between stress and cancer, revealing how stress can alter the immune system in ways that create ideal conditions for cancer cells to grow.
The Study: Stress and Breast Cancer
The study, titled “Multilevel Stressors and Systemic and Tumor Immunity in Black and White Women With Breast Cancer,” was published in JAMA Network Open. Conducted by Stefan Ambs of the National Cancer Institute and colleagues, it examined 121 women with breast cancer, primarily in stages 1 and 2, with an average age of 56. The study included 65 White women and 56 Black women.
While this study is categorized as a cohort study, it can also be described as a “deep phenotyping” or “-omics” study. The researchers measured a wide array of biomarkers in the blood, within the tumor, and in the surrounding tissue. This included 92 immune-oncologic protein markers and thousands of DNA and RNA markers, making it a powerful yet computationally challenging approach.
The study focused on four types of stress: daily stress (work, family, etc.), racial discrimination, social isolation, and neighborhood deprivation. These stressors were linked to three main outcomes: overall immune function, immune function in the tumor microenvironment, and tumor biology.
How Stress Affects the Immune System
The study found that increased stress levels negatively impact the immune system in several ways. While stress can boost immune activity, this response is not beneficial in preventing cancer. Higher stress levels lead to increased production of angiopoietins, substances that promote blood vessel growth in tissues. Since tumors require blood vessels to grow, this is a significant concern.
The immune microenvironment around the tumor is also affected. The study revealed that while some immune cells, such as M1 macrophages, are increased, M2 macrophages, which suppress immune function, are also elevated. Additionally, natural killer cells and follicular helper T-cells, which are crucial for eradicating tumor cells, are reduced. This suggests that stress may weaken the body’s ability to fight cancer.
The Impact on Tumor Biology
Interestingly, higher stress levels were associated with an increased tumor mutational burden, meaning more genetic errors in the tumor. While this can indicate a more aggressive cancer, it also means that the cancer may be more susceptible to immune checkpoint inhibitor therapy, a type of anti-cancer drug.
The effects of stress were more pronounced in Black women compared to White women, which may help explain why breast cancer incidence and severity are higher in this population.
Implications and Future Directions
While this study provides valuable insights, it is complex and requires further research to fully understand the relationship between stress and cancer. Future studies may uncover new anti-tumor targets and therapies.
For now, it’s important to consider stress as a potential risk factor for cancer. Managing stress through activities like yoga, mindfulness meditation, or spending time with loved ones can be beneficial. These practices may help reduce the “perceived daily stress” that can have adverse effects on health.
Understanding the complex interplay between stress and cancer is crucial for developing more effective prevention and treatment strategies.
Stay informed and take steps to manage stress in your life. Your body and immune system will thank you.
For more insights and updates, follow me on @fperrywilson. Your comments and feedback are always welcome.
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