Earlier this year l accepted a faculty position with Duke University. While I continue to see and treat patients in the community, the position at Duke allows me the opportunity to explore my research interests. I now have access to the latest developments in cancer and can explore areas of interest such as Neuro-Oncology (brain and spine tumors), Nutrition, Cancer Prevention, and PyschoNeuroImmunonology (PNI), the mind-body connection.
I continue to be a proponent of a healthy lifestyle and believe in a whole-food diet for prevention of cancer. However, the longer the I spend in clinical practice, the more I’m convinced of the relationship between the mind and the body. Every patient’s cancer journey is unique, and yet there are common stories that start to emerge over the years. The number of women who present with advanced cancer because they were “caring for my _____” (insert mother, daughter, son, sister, friend, aunt…) and just couldn’t find the time to schedule an appointment with their doctor. There are men who pride themselves on providing for their families, and yet neglect their own health to the point that their cancer diagnosis is catastrophic for that same family.
We know the risk factors for cancer.
They include poor diet, being sedentary, environmental exposures to name a few… but we still cannot prevent many cancers. So what’s the tipping point? We know that cancer is uncontrolled cell growth. Scientific research has shown us the exact molecular pathway to how tumors grow and how they spread. But why does one person respond to treatment and another loses the fight? Why do I have patients in their 80 or 90’s who survived 3 cancers and yet the 35-year-old patient faces her demise within a few months of diagnosis?
Medical science continues to search for the answers to the above questions. Myself, I think our mental state, emotional state, and our outlook on life has to play a role. It turns out, I’m not the only one.
Researchers in Finland1, used a twin study, the Finnish Twin Cohort, which followed same-sex sets of twins from 1982 to 1996, and examined their risk of breast cancer. Their hypothesis was that the accumulation of life events, as well as major life events alone (i.e.,the death of a husband, divorce/separation, and the death of a close relative or friend), would increase breast cancer risk.
The reference to the study by Lillbert et al. is copied below if you are interested in the statistical analysis or specifics. I found this table compelling, which shows the Hazard Ratio identified for each life event. Specifically, each of the life events listed below portended an increased risk of breast cancer.
The researchers did consider other risk factors for breast cancer in their analysis, and yet the data still showed the increased risk with the life events above. They also considered psychosocial factors, as “it is generally agreed that it is an individual’s reaction to life events rather than the events per se that might be predictively important”.
If negative life events such as those listed above can also increase your risk factor for cancer, the question is how? What are the mechanisms? This is what the field of psychoneuroimmunology attempts to answer. And of course, how can we respond to these life events in such a way to minimize the risk of disease?
1. Lillberg K, Verkasalo PK, Kaprio J, et al. Stressful life events and risk of breast cancer in 10 808 women: a cohort study. Am J Epidemiol. 2003;157(5):415-423.
Patient-focused treatment, and an individualized approach to oncology means Dr. Norleena Gullett is not just treating cancer, she's treating the whole person.