Last Spring, a routine mammogram revealed cancer in my left breast. Call me stunned. I was not prepared to hear the words “you have cancer” nor did I have the skills to handle the stress that a diagnosis of cancer would trigger. I felt overwhelmed and incredibly angry. I asked my surgeon “Why me? Why now?” We have absolutely no estrogen driven cancers in my family. She explained that only 15% of breast cancers are genetic. For the rest of us it’s likely the result of an environmental exposure but she also said that it’s not uncommon for cancer to begin to grow during periods of intense stress. I, of course, had just gone through the worst stress of my life with the loss of both of my parents last year. I was talking with a new IC patient who shared that her daughter was found to have the same breast cancer as I. They had no family history of breast cancer but she shared that her daughter had spent the previous year in an agonizingly stressful divorce. Could that have been her trigger too?

The US National Cancer Institute shared how stress can trigger cancer growth. Stress, of course, is a normal part of our lives, often the result of work, family or financial pressures. Our body responds by releasing stress hormones which activate the “fight or flight” response. This is meant to be short term, to help us run from a threat and/or fight for our lives. But when stress is long-term and chronic, it can have more devastating effects, such as: digestive problems, heart disease, a weakened immune system, difficult sleeping, depression and more.

A prospective study among more than 100,000 UK women reported no association between the risk of breast cancer and perceived stress levels or adverse life events in the preceding 5 years.(1) A 15-year prospective study of Australian women at increased risk of familial breast cancer found no association between acute and chronic stressors, social support, optimism and the risk of breast cancer.(1) Yet, other studies show a clear connection. Stress was associated with a higher incidence of lung cancer.(2) Work stress has been found to be associated with a higher risk of lung, colorectal, and esophageal cancers.(3)

Does stress cause cancer cells to grow? Yes, it does. Evidence from laboratory studies in animal models and human cancer cells suggests that chronic stress may cause cancer to progress and metastasize.(4-6) Some studies have shown that when mice bearing human tumors were kept confined or isolated from other mice – conditions that increase stress – their tumors were more likely to grow and metastasize.(5-7)

Chronic stress may cause cancer to progress and metastasize.

Lab studies have found that norepinephrine, released as part of the body’s fight-or-flight response, stimulates angiogenesis (the growth of blood vessels) and metastasis.(5) This hormone may also activate neutrophils, a type of immune cell, that can help tumors grow by shielding them from the body’s immune system; they may also “awaken” dormant cancer cells.(8) Chronic stress may also lead to the release of a class of steroid hormones called glucocorticoids which can inhibit a type of tumor cell death called apoptosis and increase metastasis and resistance to chemotherapy.(9) They may also prevent the body’s immune system from recognizing and fighting cancer cells.(10)

I do believe that the prolonged and intense stress of caring for my parents played a role in my breast cancer. It wasn’t until after they had passed that I saw the toll that their care had taken on my body, particularly during COVID. I loved them dearly and am proud of that I could keep them in their home until the very end but the stress of their constant care, particularly in their last few months, was enormous. I hadn’t had a night away in six years.

Stress and its role in the onset of IC/BPS & widespread pain.

Spend time in any IC support group and you will find patients who report that their symptoms began during periods of intense stress from work, divorce or during their childhood. My first symptoms developed when I was in Junior High school. My teachers complained because I always needed to use the restroom. I developed vulvodynia in high school, IBS and migraines in my 20’s and pelvic pain in my early 30’s. And as I watched my peers get married and have children, I was usually at home near a restroom struggling with pain. Why?

I have shared my story many times over the years. I was attacked as a child by a boy who later raped and murdered one of my neighbors. I didn’t leave my home without fear for more than decade. I was in “fight or flight” every school day, especially as I ran home from school before he could catch and hurt me. We now know that adverse childhood events are strong risk factors in the development of IC and chronic overlapping pain conditions. These patients, myself included, have a very sensitive, injured central nervous system (nervous system dysregulation) which, over time, begins to amplify pain throughout the body.

Living in a constant state of stress and “fight or flight” perpetuates chronic pain throughout the body thus we must learn and embrace new stress and anxiety management skills to “wind down” our nervous system.  We can do this with a wide variety of strategies, including: deep breathing, mindfulness, exercise (interval training, yoga, etc.) and positivity. Even cursing every now and then can help. In her book  When It Hurts Down There, Dr. Angie Stoehr wrote “If you’ve ever hit your thumb with a hammer or stubbed your toe on a table, you’ve probably sworn or at least wanted to. This kind of reactive vocalization starts in the lower brain gateways. It’s a spontaneous reaction to pain and it actually reduces the pain signal.”  Of course, if cursing isn’t your thing, that’s ok but I will confess that I’ve found this quite helpful, including the few words I loudly uttered during my breast biopsies.

Her book is a fabulous resource for patients struggling with pelvic pain. She explains how pain that comes from your bladder and other organs are likely to be coming from stretch, lack of blood flow (i.e. tight pelvic floor muscles restricting blood supply to the bladder) and inflammation. It is often described as tightness or a squeezing fullness. She said that it’s hard to sit still with this type of pain. In contrast, chronic organ pain is more of a dull ache that ebbs and flows.

Dr. Stoehr covers a wide variety of topics in  a very easy to read book. She explains how pain messages are processed by the low brain, mid brain and then upper brain and then provides many tips on how to stop pain at each level.

Here’s an interesting factoid. Did you know that pelvic pain often causes you to change your posture by tilting your pelvis backwards to reduce the pain?? This then puts the weight of your abdomen directly on to the pelvic floor muscles which then become fatigued and develop trigger points. How many times did we do this during the often painful cramping we experienced during menstruation?

Dr. Stoehr reviews the gut-brain connection and how it is affected by intense stress. Struggle with random diarrhea? That could be a response to stress. Altered gut microbiomes don’t just effect the stomach and bowel, it can have far reaching effects throughout the body. Stress makes it difficult for good bacteria to thrive. So, how can we alleviate some of this pain?? By changing your diet. Dr. Stoehr encourages you to support a healthy microbiome by:

  1. Avoiding foods that cause inflammation, such as: refined carbohydrates, gluten, fried foods, processed meat, red meat and margarines, shortening and lard.
  2. Adding anti-inflammatory foods into your diet, such as: probiotics, antioxidants and foods that stabilize blood sugar… i.e. good Omega fats, fruits, some seeds, veggies and beans.
  3. Avoiding common bladder & bowel irritants, such as: alcohol, sodas, coffee, tea, cranberry juice, citrus, high fructose corn syrup, lactose, gluten and artificial sweeteners
  4. Reducing foods high in oxalates, such as: spinach, raspberries, kiwi, beets, rhubarb, soy and others
  5. Modify the intake of foods associated with endometriosis, such as: red meat, canned fruit, high fat foods.
  6. Add and support good bacteria in your gut with probiotics.
  7. Avoid unnecessary antibiotics
  8. Start exercising

You’ll find many more tips and suggestions that are easy to apply and practical. Really! Learn more about the book here! 

A Daily Strategy

To improve our health, longevity and cancer risk, we must make an effort to reduce the tress in our lives. Here are some techniques that I am use daily. I hope that they help you too!

#1 – Express your feelings

People have found that when they express strong feelings like anger or sadness, they’re more able to let go of them. Some talk about their feelings by talking to friends or family, other patients, a support group, or a counselor. But even if you prefer not to discuss your health with others, you can still sort out your feelings by thinking about them or writing them down. Journaling is a fabulous way to release the anger and stress at the end of the day, making for a more peaceful night of sleep.

#2 – Don’t blame yourself

Some people believe that they became ill because of something they did or did not do. Remember that all of our bodies are different, as well as our histories. Illness and injury can happen to anyone.

#3 – Don’t try to be upbeat if you’re not 

Many people say they want to have the freedom to give in to their feelings sometimes. As one woman said, “When it gets really bad, I just tell my family I’m having a bad…day and go upstairs and crawl into bed.”

#4 – You choose when to talk about your health

It can be hard for people to know how to talk to you about your health struggles. Often loved ones mean well, but they don’t know what to say or how to act. If you want to talk, you can make them feel more at ease by asking them what they’re thinking or how they’re feeling. And if you don’t want to talk about it, it’s okay to say that too. You can let them know when you’re ready to talk.

#5 – Find ways to help yourself relax

Whatever activity helps you unwind, you should take some time to do it. Meditation, guided imagery, and relaxation exercises are just a few ways that have been shown to help others; these may help you relax when you feel worried. I have fallen in love with doing advanced paint by numbers paintings which I work on while listening to music or watching a movie almost every night. I’ve finished ten so far this year and have three more in my queue. The best part is that I now have them up around my house where their bright colors make me very happy. When I look at the paintings I’ve finished during what was a very scary time for me, I’m reminded that I can still do beautiful things. I may not have my breasts but I do still have my hands and heart.

#6 – Be as active as you can

Getting out of the house, exercising and doing something can help you focus on other things besides your health and the worries it brings. Get into the routine of walking everyday, stretching, perhaps some gentle yoga and going to the gym will help. Interval training, for example, requires your brain to focus on the workout rather than the pain, according to Dr. Stoehr.

#7 – Look at what you can control

Being involved in your health care, asking questions, keeping your appointments, and making changes in your lifestyle are among the things you can control. Even setting a daily schedule can give you a sense of control. And while no one can control every thought, some say that they try not to dwell on the fearful ones, but instead do what they can to enjoy the positive parts of life. If you can, try to use your energy to focus on what makes you feel better and what you can do now to stay as healthy as possible.

I would like to say Thank You to everyone who has followed my story the past six months. Your support has been critical for my mental health. I’ve also been filming a Breast Cancer Vlog to help others who might be walking this same path with me. You can find that at: youtube.com/icnjill.

#8 – Utilize the simple “stop sign, deep breath, minimize the thought” technique whenever negative thoughts intrude. Remember, each negative thought reinforces “fight or flight” which then releases a  jolt of adrenaline into your blood stream. The problem is that constant negative thoughts, as most patients with anxiety disorder struggle with, become a vicious cycle of fear, catastrophizing and massive amounts of adrenaline which keeps your nervous system dysregulated. Learn more about the Phobease technique here

References

  1. SoButow P, Price M, Coll J, et al. Does stress increase risk of breast cancer? A 15 year prospective study. Psychooncology 2018; 27(8):1908–1914. [PubMed Abstract]
  2. Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors con- tribute to cancer incidence and survival? Nature Clinical Practice Oncology 2008; 5(8):466–475. [PubMed Abstract]
  3. Yang T, Qiao Y, Xiang S, et al. Work stress and the risk of cancer: A meta-analysis of observational studies. International Journal of Cancer 2019; 144(10):2390– 2400. [PubMed Abstract]
  4. Heikkilä K, Nyberg ST, Theorell T, et al. Work stress and risk of cancer: Meta-analysis of 5700 incident cancer events in 116,000 European men and women. BMJ 2013; 346:f165. [PubMed Abstract]
  5. McDonald PG, Antoni MH, Lutgendorf SK, et al. A biobehavioral perspective of tumor biology. Discovery Medicine 2005; 5(30):520–526. [PubMed Abstract]
  6. Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncology 2010; 6(12):1863–1881. [PubMed Abstract]
  7. Eckerling A, Ricon-Becker I, Sorski L, Sandbank E, Ben-Eliyahu S. Stress and cancer: Mechanisms, significance and future directions. Nature Reviews Cancer 2021; 21(12):767–785. [PubMed Abstract]
  8. Sloan EK, Priceman SJ, Cox BF, et al. The sympathetic nervous system induces a metastatic switch in primary breast cancer. Cancer Research 2010; 70(18):7042–7052. [PubMed Abstract]
  9. Perego M, Tyurin VA, Tyurina YY, et al. Reactivation of dormant tumor cells by mod- ified lipids derived from stress-activated neutrophils. Science Translational Medicine 2020; 12(572):eabb5817. [PubMed Abstract]
  10. 10. Volden PA, Conzen SD. The influence of glucocorticoid signaling on tumor progression. Brain, Behavior, and Immunity 2013; 30 Suppl(0):S26–31. [PubMed Abstract]