Childhood stress reduces ability to fight skin cancer according to a new study carried out at Ohio State University in Columbus. The scientists looked at nearly a hundred patients with basal cell carcinoma and assessed their experiences of childhood maltreatment, along with any recent stressful events.
They then examined the patients’ immune system responses to their tumors and found that early stress and a recent severe life episode created a ‘perfect storm’ of stress affecting the ability to battle this common form of skin cancer. Whilst basal cell carcinoma is immunogenic, other forms of skin cancer, such as melanoma, are not.
How might this affect approaches to skin cancer treatment? Perhaps patients will be offered counselling in addition to basal cell carcinoma treatment, using stress reduction techniques to achieve naturally healthy skin.
Basal Cell Carcinoma and Stress
The ability of the immune system to fight basal cell carcinoma has a significant effect on the patient’s prognosis as any immunosuppressive activity increases the risk of recurrent skin cancer and progression of this, most common, cancer.
Christopher Fagundes, PhD, the lead author of this latest study, is a psychologist working at the Institute for Behavioral Medicine and he and his co-workers looked at ninety-one adults with BCC in order to investigate the impact that stress, both in childhood and close to the time of diagnosis, has on skin cancer prognosis.
Stress and Cancer – It Counts
It may seem fairly apparent that your ability to cope with any disease or skin condition is reduced when other life stressors are sapping your energy but this study goes further in establishing a link between early stress and health later in life.
How children are raised and how secure and happy they are in childhood appears to not only affect their subsequent emotional and mental well-being but also has an influence on their physiological health it seems.
Basal Cell Carcinoma Recurrence
The risk of basal cell carcinoma returning after the first tumour is significant, with additional skin lesions occurring in 44% of cases within three years. Basal cell carcinoma is the most common type of skin cancer and skin cancer is the most common kind of cancer in the United States, according to the study published in the Archives of General Psychiatry.
Major risk factors for this kind of skin cancer are sun exposure in childhood, having fair skin, and being male, and the influence of the immune system can now be added to the list of factors affecting the outcome for patients with basal cell carcinoma.
Stress and the Immune System
Dr. Fagundes and his colleagues are particularly interested in the effects of stress on the immune system and are also researching how stress impairs vaccine response, slows healing of wounds, and now how it affects the ability of the body to fight skin cancer.
Most types of cancer are not actively fought by the immune system as it does not recognise the cancerous cells as foreign targets. With basal cell carcinoma, and a small number of other types of cancer, the immune system does respond to the cancerous cells and the tumours are immunogenic, offering the opportunity for the body to fight the cancer itself. This recognition is what makes BCC such an interesting target for these researchers looking at the effects of stress.
Assessing Immune Responses Using mRNA
Patients in the study were between twenty-three and ninety-two years of age, with just over half (53%) male, all participants white, and all with at least one prior basal cell carcinoma tumour. Analysis of the tumour tissue was carried out for each patient, looking at four messenger RNA immune markers that are linked to the progression or regression of tumours. These markers were CD25, CD3ε, intercellular adhesion molecule 1 (ICAM-1), and CD68.
Assessing Depression, Stress, and Childhood Maltreatment
In order to assess current levels of stress and depression the researchers used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, IV Edition and the Center for Epidemiological Studies Depression Scale.
To assess early childhood trauma the Childhood Experience of Care and Abuse Questionnaire was used, and the Life Events and Difficulties Schedule determined the incidence of recent (in the previous year) adverse events such as bereavement, unemployment, or other non-medical occurrences.
Childhood Stress and Cancer
Both maternal and paternal maltreatment and recent severe life events were associated with a reduced immune response affecting the ability to fight skin cancer of this type. This effect was slightly larger for those experiencing maternal maltreatment during childhood but paternal maltreatment was also significant in predicting immune system response.
Those suffering childhood stress but no recent adverse life event did not, however, have any significant differences in immune system response to the skin cancer. Depression or a history of depression was not significantly associated with the response to the tumour either but the study does provide the first evidence that early stress affects skin cancer progression when coupled with recent stressors.
Changing Cancer Treatment
How clinicians will use this information remains unaddressed but it does emphasise the importance of positive early life experiences in shaping subsequent health in adulthood. It could be that those known to have suffered maltreatment in childhood are given specific counselling following a diagnosis of basal cell carcinoma or other immunogenic cancer in an attempt to ameliorate any potential for recent life stressors to impair their recovery.
More research would need carrying out to evaluate any interventions of this nature and their potential to improve outcomes in skin cancer patients. This research strongly suggests that early stress impairs cancer-fighting ability, and in the future we may discover that it even affects our ability to fight seemingly simple skin infections.
Fagundes, C.P., Glaser, R., Basal Cell Carcinoma, Stressful Life Events and the Tumor Environment, Arch Gen Psychiatry. 2012;69(6):618-626. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1171961
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