79 An Exploration of the Influence of Adverse Childhood Experiences (ACEs) upon Symptom Burden & Tolerance of Anti-Estrogen Therapy (AET) in Breast Cancer Patients

Background

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood throughout the first 18 years of life, often constituting a profound impact upon academic performance, emotional development and regulation, and mental health conditions that persists and progresses into future adulthood. These experiences include the following, among other things: physical, psychological, or sexual abuse; household dysfunction via domestic violence or substance misuse; and violence against mother. They are common throughout the United States, where approximately 63.9% of adults reported at least 1 and approximately 17.3% of adults reported 4 or more ACEs. In recent years, an extensive body of research on ACEs has provided insight about its dose-response relationship with poor health outcomes, most notably an increased risk for development of chronic disease, premature mortality, and self-directed violence and substance misuse. Furthermore, ACEs are directly related to an elevated cancer risk through a multifaceted mechanism that is theorized to include the following: biological pathways via epigenetic changes; reduction in health care engagement (eg, preventive cancer screenings); and risky behaviors. This association is similarly observed in vulnerability to breast cancer, the second leading cause of cancer-related death among women in the United States. This underscores the long-term effects of ACEs on oncological risk in adulthood—a notable finding due to its preventable nature, in contrast to other risk factors such as age, family history, and genetic predisposition.

Materials and Methods

This study aims to add to the existing literature on ACEs by examining their impact upon symptom burden and tolerance of antiestrogen therapy (AET) in breast cancer, a key treatment modality for estrogen receptor–positive breast cancer due to its ability to improve outcomes and prevent recurrence thereof. A multi-institution, retrospective study included patients 18 years and older with an anatomical stage I to IV breast cancer with diagnosis between October 2023 and November 2024; residence in the Appalachian region of Tennessee; and whose primary oncologic treatment includes surgical management of their breast, along with possible radiation and systemic therapy.

Results

This retrospective study demonstrates that an increased number of ACEs is significantly associated with an increased symptom burden upon AET in patients with anatomical stage I to IV breast cancer in the Appalachian region of Tennessee, independent of age at diagnosis and pathological stage of cancer.