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Den 3. stressforsknings konference 2006. Mind and cancer Christoffer Johansen, M.D., Ph.D., DrMedSci. Head, Department of Psychosocial Cancer Research Institute of Cancer Epidemiology Danish Cancer Society. Background.

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den 3 stressforsknings konference 2006
Den 3. stressforsknings konference 2006

Mind and cancer

Christoffer Johansen, M.D., Ph.D., DrMedSci.

Head, Department of Psychosocial Cancer Research

Institute of Cancer Epidemiology

Danish Cancer Society

background
Background
  • The Department of Psychosocial Cancer Research (2001) utilise the epidemiological approach and combine register-based research with clinical studies in an effort to study the association between psychological factors, social factors and cancer
  • The department combines various methodological approaches to the subject and employs a range of persons educated from anthropology to statistics
slide3

Cause

Personality

Depression

Mood

Schizophrenia

Major life events

Psychoactive drugs

Religious belief

Effect

Social life

Psychological well-being

Divorce

Income

Work

Psychiatric diseases

Depression

Psychoactive drugs

Screening for fam. BC

Prognosis

Home visit

Education

Rehabilitation

Internet groups

Current research activities

Prevention

Smoking in

adolescence

the epidemiological approach in psychosocial oncology focus on
The epidemiological approach in psychosocial oncology focus on:

Background

  • Risk factors
  • Psychosocial effects
  • Psychosocial factors as prognostic factors
  • Prevention
background6
Background
  • Mind is an independent risk factor as well as an independent prognostic factor in cancer
  • How is it possible to investigate this paradigm ??

The central paradigm

background7
Background

Risk factors

background8
Background
  • Numerous case-control studies, cross-sectional studies and retrospective follow-up studies have demonstrated the central paradigm – but only few acknowledge the limitations of these methods – especially when dealing with our mind
background9
Background
  • This retrospective tradition has some ’inborn’ methodological problems:
  • Recall bias among cases
  • Exposure assessment by interview
  • Exposure assessment after diagnosis
  • Limited adjustment for biological factors
background10
Background

Basic principles/problems

Exposure

by ’mind’ factor

Exposure

assessment

Cancer diagnosis

Time

risk factors
Risk factors
  • Major life events
  • Depression
  • Personality
slide12

Major life events

Johansen C. & Olsen JH. No effect of psychological stress on cancer incidence or mortality from nonmalignant diseases.

British Journal of Cancer 1997; 75: 144-148

slide13

Didier Bar - the Loreto Village with the Vesuvio in eruption, Rome, private collection

etiology considerations
Etiology considerations
  • Latency
  • Duration
  • Initiation
  • Promotion
  • Timing
latency
Latency
  • The exposure to the diagnosis of cancer in a child and risk for cancer in parents (Johansen & Olsen JH. No effect of psychological stress on cancer incidence or mortality from nonmalignant diseases. British Journal of Cancer 1997; 75(1): 144-148)
  • The death of a child and risk for cancer in parents (Li J et al. Cancer incidence in parents who lost a child: a nationwide study in Denmark. Cancer 2002; 95: 2237 – 2242)
  • The exposure to various stressful life-events (Bergelt C et al. Stressful life-events and risk for cancer. European Journal of Cancer, in press 2006)
latency17
Latency
  • The diagnosis of scizophrenia in a child and risk for cancer in parents. (Dalton SO et al. Cancer incidence in parents who experience a child with schizophrenia – a major life event study in Denmark. British Journal of Cancer 2004; 90: 1364 – 66)
  • Hospital admission for depression and subsequent risk for cancer (Dalton SO et al. Depression and risk for cancer: a register-based study of patients hospitalized with affective disorders, Denmark, 1969-93. American Journal of Epidemiology 2002; 155: 1088-95)
duration
Duration

Personality traits

  • Schapiro I et al. Personality and risk for cancer. American Journal of Epidemiology2001; 153: 757 – 763.
  • Schapiro I et al. Psychic vulnerability and the associated risk of cancer. Cancer 2002; 94: 3299 – 3306.
  • Hansen PE et al. Personality traits, health behavior and risk for cancer: A prospective study of a Swedish twins cohort. Cancer 2005; 103: 1082 – 1091.
  • Bergelt C et al. Vital exhaustion and risk for cancer: a prosepctive cohort study on the association between depressive feelings, fatigue and risk for cancer. Cancer 2005; 104: 1288 - 1295
duration19
Duration
  • A large prospective study of daily job strain among 26 936 women in the American Nurses Health study (Achat 2000)
  • Perceived stress of daily activities in a Finnish cohort of 10 519 women (Lillberg 2001)
  • No increased risk for breast cancer
initiation or promotion
Initiation or Promotion (?)

Initiator establish gene defect

Promotor increase

rate of malignant

cell division

Cancer diagnosis

Time

timing
Timing

When is the vulnerable exposure window (?)

Birth

Cancer diagnosis

Time

timing22
Timing
  • We currently study the risk of cervical dysplasia among young women exposed the death of one or two parents during childhood and adolescence (Magtengaard 2006)
  • We also study the risk for cancer after the death of spouse, divorce or separation (Ross 2007)
etiology considerations23
Etiology considerations
  • Latency
  • Duration
  • Initiation
  • Promotion
  • Timing
depression

Depression

S Oksbjerg Dalton, L Mellemkjær,

JH Olsen and C Johansen, ,PB Mortensen. Depression and cancer risk: A register-based study of patients hospitalized with affective disorders, Denmark, 1969-93

American Journal of Epidemiology2002; 155: 1088-95

conclusions
Conclusions

This study gives no further support to the hypotheses that depression increases the risk for cancer

The increased risk observed in this study can

probably be ascribed to increased smoking

personality

Personality

Schapiro I, Falgaard Nielsen L, Jørgensen T, Boesen E, Johansen C. Psychic vulnerability and the associated risk of cancer.

Cancer 2002; 94: 3299-3306

slide30

A number of studies have reported that personality influence the risk of cancer

Hagnell 1966, Huggan 1968, Abse et al. 1974, Dattore et al.1980, Kirkcaldy & Kobylinska 1987, Scherg 1987, Grossarth-Maticek et al. 1988, Quander-Blaznik 1991

the cohort
The Cohort

Invited

7734

Excluded

676

(12%)

Participants

5812

(75%)

Study population

5136

(88%)

psychic vulnerability
Psychic vulnerability

A reaction readiness defined by a low threshold of being influenced and a risk of inexpedient reactions in social interaction or in a psychosomatic direction

cox proportional hazard analyses included information of
Cox proportional hazard analyses included information of:

Analyses

  • Age
  • Sex
  • Personality measurement
  • Marital status
  • Social class
  • Alcohol consumption
  • Tobacco smoking
  • Body mass index
discussion
Discussion
  • Exposure information (mind factor) from administrative sources versus based on personal interviews or questionnaires
  • Lack of confounder information (biology)
  • Recall bias in case control studies – a serious problem
discussion36
Discussion
  • The association between the mind factor and behaviour
  • Smoking, alcohol and diet are self-medications in order to cope with major life events, depression and personality
  • Policies to prevent smoking and alcohol consumption may focus more on well defined groups at risk for developing these behaviours
discussion37
Discussion
  • Do stress prevent cancer ?
  • Nielsen et al. BMJ 2005: High endogenous concentrations of oestrogen are a known risk factor for breast cancer, and impairment of oestrogen synthesis induced by chronic stress may explain a lower incidence of breast cancer in women with high stress.
  • Impairment of normal body function should not, however, be considered a healthy response, and the cumulative health consequences of stress may be disadvantageous.
discussion38
Discussion

Biological mechanism

Immunefunction

Cancer

Mind

discussion39
Discussion
  • Contrary to the ‘mind – cancer’ hypothesis we did not identify an increased risk for immune system related cancers such as leukemia, lymphoma and liver cancer in any of the studies published so far.
  • In addition we did not observe an increased risk for hormone related cancers such as breast cancer or ovary cancer.
conclusion i

Impaired immune

system

Conclusion I

A.

The cancer-prone mind model

Pathophysiological

processes

Cancer

Mind

B.

The mind-health behaviour model

Pathophysiological

processes

Cancer

Mind

Healthbehaviour

conclusion i41
Conclusion I

Stress does not cause cancer

IARC 4:

The agent (mixture) is probably not carcinogenic to humans

conclusion ii
Conclusion II

Policies to prevent smoking and alcohol consumption may focus more on well defined groups at risk for developing these behaviours

conclusion iii
Conclusion III
  • Social inequality is probably the ‘new’ risk factor for risk behaviour and thus increased risk for certain lifestyle associated cancer types will be more prevalent in lower social classes compared to higher social classes
  • Social class determines survival
information and contact
Information and contact

christof@cancer.dk

www.cancer.dk