An analysis1 from the Nurses’ Health Study II found that posttraumatic stress disorder (PTSD) was associated with an increased risk for ovarian cancer. The association was strongest in premenopausal women.
“Stress, particularly through the activation of the sympathetic nervous system, has been identified in animal models of ovarian cancer as an accelerant of tumor growth,” wrote study authors led by Andrea L. Roberts, PhD, of the Harvard T.H. Chan School of Public Health in Boston. “PTSD is a particularly extreme form of distress occurring in response to trauma.”
The authors used prospectively collected and self-reported data from 49,443 women included in the longitudinal Nurses’ Health Study II; the participants were followed for up to 26 years. During a total of 1,158,732 person-years, there were 110 incident ovarian cancers. Results of the analysis of this cohort were published online ahead of print on September 5 in Cancer Research.
At the time of enrollment in the cohort, women with high PTSD symptoms were more likely to be current smokers (16.5% vs 9.4%), have had tubal ligation (17.8% vs 13.9%), and to have used oral contraceptives (86.8% vs 80.8%).
After adjustment only for age, women with high PTSD symptoms had a higher risk for ovarian cancer than those without such symptoms with a hazard ratio (HR) of 2.10 (95% CI, 1.12-3.95; P = 0.02). Those with moderate PTSD symptoms also had an elevated ovarian cancer risk, but this did not reach statistical significance. In a model where PTSD symptoms were coded as a continuous variable, each additional symptom was associated with an 11% increased risk for ovarian cancer.
The authors also adjusted for health- and ovarian cancer-related risk factors. This did attenuate the association somewhat, with an HR of 1.86 (95% CI, 0.98-3.51).
Among a subset of patients with only prospectively collected data, there were 50 incident ovarian cancer cases across 231,584 person-years. In this group, the association between PTSD symptoms and ovarian cancer risk appeared somewhat stronger, with an HR of 2.38 (95% CI, 0.98-5.76; P = 0.06). Though it did not reach significance, the authors attributed this to the small number of total cases.
In only premenopausal women, there were 44 ovarian cancer cases reported. The HR for high PTSD symptoms in those women was 3.42 (95% CI, 1.08-10.85). In postmenopausal women, meanwhile, the effect was largely diminished, with an HR of 1.36 (95% CI, 0.58-3.20).
“Our data suggest that PTSD symptoms following traumatic events may be associated with increased risk of ovarian cancer decades later,” the authors concluded. “Better understanding of biological pathways could lead to interventions to reduce risk of ovarian cancer in women with PTSD and, potentially, other distress-related disorders.”
Posttraumatic Stress Disorder Is Associated with Increased Risk of Ovarian Cancer: A Prospective and Retrospective Longitudinal Cohort Study. Andrea L. Roberts, Tianyi Huang, Karestan C. Koenen, Yongjoo Kim, Laura D. Kubzansky and Shelley S. Tworoger Cancer Res October 1 2019 (79) (19) 5113-5120; DOI: 10.1158/0008-5472.CAN-19-1222