Study explores relationship between traumatic early life events and gynecological cancer

An investigation that is published in the current issue of Psychotherapy and Psychosomatics explores the relationship between early life events and gynecological cancer. 

As far as gynaecological cancers are concerned, the relationship between breast cancer and recent life events has been well studied in the literature, whereas the role of childhood life events is still not clear and the few studies published on this topic show conflicting results. In the present study a range of stressful life events which occurred during the first 15 years of life has been assessed in 108 women suffering from 3 types of gynaecological cancer (29 with breast cancer, 49 with endometrial cancer and 30 with ovary cancer) as well as in 104 control healthy women matched for age, education and marital status. The clinical information (oncological diagnosis, age of onset, stage of cancer, current and past treatments, chemotherapy, radiotherapy, surgical operation, hormonal therapy, cancer support therapy, family history of cancer, psychotropic drug use) of the patient group was drawn from the hospital clinical records. The sociodemographic characteristics (e.g. education, marital status, number of children, working activity) were also collected. To avoid a possible recall bias, only objectively verifiable early events were assessed by means of a semi-structured interview. This takes into account the following early events (during the first 15 years of life), as well as the context in which they occurred and the subject's age at the time of occurrence: death of or separation from mother, death of or separation from father, death of any other cohabiting relative and severe illness in the subject's childhood sufficient to interfere with the development of normal social relationships. Physical and sexual abuses were also studied by administering the corresponding sections of the Childhood Experience of Care and Abuse Questionnaire. The events of abuse reported were too rare (6 among the patient group and 1 among controls) to be considered statistically. Therefore, the subsequent results are relative to loss events only. The women affected by cancer reported a greater mean number of early loss events than the control subjects (p<0.001) whereas no significant difference was found among the 3 cancer groups. Loss of mother and father, death of another cohabiting relative and having been affected by severe illness during childhood, all increased the risk of cancer in adulthood, irrespective of the type of cancer.

This study is of course preliminary and merely explorative. A larger sample and more detailed investigation are necessary to confirm the association between childhood traumata and adult gynaecological cancer. However, as far as we know, this is the first report of an association between early trauma and ovarian and endometrial cancer. It must be noted that the association between early loss and adult cancer is not necessarily causal; a common factor such as a cancer family history could explain both the excess of loss events and the increased risk of cancer. When planning a more articulated study, in addition to a greater number of cases, it would be useful to explore other factors that may modulate the response to traumatic events, e.g. parental style, temperament and attachment style. Even more important, it would be interesting to investigate whether or not the occurrence of early traumata may influence the outcome of cancer. In conclusion, although at the moment the sample size is limited, this study offers additional support to study the interaction between traumatic early life events and the development of cancer.