Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul;12(14):15404-15413.
doi: 10.1002/cam4.6125. Epub 2023 Jun 16.

Multiple types of distress are prospectively associated with increased risk of ovarian cancer

Andrea L Roberts  1 , Andrew Ratanatharathorn  1 , Lori Chibnik  1 , Laura D Kubzansky  1 , Shelley S Tworoger  2
Affiliations

Multiple types of distress are prospectively associated with increased risk of ovarian cancer

Andrea L Roberts et al. Cancer Med. 2023 Jul.

Abstract

Background: Few modifiable risk factors for epithelial ovarian cancer have been identified. We and other investigators have found that individual psychosocial factors related to distress are associated with higher risk of ovarian cancer. The present study examined whether co-occurring distress-related factors are associated with ovarian cancer risk.

Methods: Five distress-related factors were measured repeatedly over 21 years of follow-up: depression, anxiety, social isolation, widowhood, and, in a subset or women, posttraumatic stress disorder (PTSD). Cox proportional hazards models estimate relative risks (RR) and 95% confidence intervals (CI) of ovarian cancer for a time-updated count of distress-related factors, in age-adjusted models, then further adjusted for ovarian cancer risk factors and behavior-related health risk factors.

Results: Across 1,193,927 person-years of follow-up, 526 incident ovarian cancers occurred. Women with ≥3 versus no distress-related psychosocial factors demonstrated increased ovarian cancer risk (HRage-adjusted = 1.71; 95% CI = 1.16, 2.52). No significant difference in ovarian cancer risk was observed in women with one or two versus no distress-related psychosocial factors. In the subsample with PTSD assessed, ≥3 versus no distress-related psychosocial factors was associated with twofold greater ovarian cancer risk (HRage-adjusted = 2.08, 95% CI = 1.01, 4.29). Further analysis suggested that women at highest ovarian cancer risk had PTSD co-occurring with any other distress-related factor (HR = 2.19, 95% CI = 1.20, 4.01). Adjusting for cancer risk factors and health behaviors minimally impacted risk estimates.

Conclusions: Presence of multiple indicators of distress was associated with risk of ovarian cancer. When including PTSD as an indicator of distress, the association was strengthened.

Keywords: PTSD; anxiety; depression; distress; epidemiology; ovarian cancer; posttraumatic stress disorder; social isolation; widowhood.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflicts of interest.

Similar articles

See all similar articles

Cited by

References

    1. American Cancer Society . Cancer Facts & Figures. 2013.
    1. Thaker PH, Han LY, Kamat AA, et al. Chronic stress promotes tumor growth and angiogenesis in a mouse model of ovarian carcinoma. Nat Med. 2006;12(8):939‐944. - PubMed
    1. Shahzad MM, Arevalo JM, Armaiz‐Pena GN, et al. Stress effects on FosB‐and interleukin‐8 (IL8)‐driven ovarian cancer growth and metastasis. J Biol Chem. 2010;285(46):35462‐35470. - PMC - PubMed
    1. Sood AK, Bhatty R, Kamat AA, et al. Stress hormone‐mediated invasion of ovarian cancer cells. Clin Cancer Res. 2006;12(2):369‐375. doi:10.1158/1078-0432.CCR-05-1698 - DOI - PMC - PubMed
    1. Hara MR, Kovacs JJ, Whalen EJ, et al. A stress response pathway regulates DNA damage through β2‐adrenoreceptors and β‐arrestin‐1. Nature. 2011;477(7364):349‐353. doi:10.1038/nature10368 - DOI - PMC - PubMed

Publication types

MeSH terms