What is cancer?
Cancer is the name given to the group of diseases that occur when cells in the body grow in an abnormal, uncontrolled way. A group of these growing cells together is called a tumour. Unlike healthy body cells, cancer cells are immortal and can grow forever . Some cancer cells are able to adapt to the medicines used to treat them by becoming resistant to these medicines and this makes treating cancer difficult. In many cases, cancer cells can evolve over time to become more aggressive and are able to spread to other parts of the body (metastasise) where they form new growths.
Metastasis or spreading of cancer involves cells moving away from the growing tumour to other areas of the body. This often occurs by cancer cells entering the blood stream and travelling to other parts of the body like debris drifting on a river. Common areas of the body where cancer can metastasise include the brain and lungs [2,3]. The presence of cancer cells in these organs can stop them from being able to function properly. Because of this, cancer metastasis is the main cause of all cancer-related deaths .
Breast cancer is the most common form of cancer diagnosed in Australia; one in seven Australian women is diagnosed with breast cancer in their lifetime [5, 6]. There are 55 Australians newly diagnosed with breast cancer every day . This disease can affect any of the women in our lives – mothers, sisters, daughters, friends, colleagues. Current treatment strategies for breast cancer include surgery to remove the cancerous tissue, as well as chemotherapy to try and kill any dividing cancer cells that may have spread to other parts of the body. Despite improvements in treatment, breast cancer is still the second leading cause of cancer-related death in Australian women , so research to improve current treatments and develop new treatments is important.
Stress and cancer
When a cancer cell such as a breast cancer cell metastasises, it could lodge in a place such as the hip bone where there is very little oxygen and nutrients available for it to survive. This low oxygen and nutrient environment would normally kill a regular breast cell but a breast cancer cell has adaptations that allow it to survive . One of the factors that enable this remarkable ability of the cancer cell to survive inhospitable environments is a family of proteins called heat shock proteins (HSP’s). They were initially discovered as they are released when a cell undergoes heating (which is stressful for the cell) but can be released in a cell under many stress situations [8,9]. When a cell undergoes stress, it produces these proteins which essentially help it to repair any damage it has sustained and thus continue living.
treatment of breast cancer in australia
The treatment of breast cancer in Australia, and the fact that stress has the potential to influence cancer and its consequences, is a complex challenge to address with many interconnected components. Breast cancer comes with an inherent burden to a woman’s physical and mental health, a financial and social impact, as well as a risk of mortality, which all results in substantial stress [10-12]. Stress has associations to quality of life and patient outcome, and emerging evidence suggests stress, both at the systemic and the cellular level, can affect breast cancer metastasis and response to treatment [12-15].
opportunities for change
As you can see from the system map above illustrating the issues with treatment of breast cancer in Australia, there are many interlinking problems that need to be addressed. Because there are multiple sources of stress in this system, and since stress can affect cancer metastasis and response to treatment [12-15], there are multiple opportunities for intervention to effect positive change.
At the higher levels of this system, steps by government to
- regulate the costs of pharmaceuticals (reducing financial pressure),
- promote equitable access to treatment through subsidies and
- fund medical research for new and improved treatments
are all key areas where change could translate to significant benefit for someone with breast cancer. At the level of the individual,
- working to provide support,
- encouraging exercise and stress reducing strategies such as mindfulness meditation, as well as
- maintaining a person’s connections and sense of belonging in social, work and community settings
can act to alleviate stressors, improve quality of life and hopefully contribute to improving treatment outcomes.
Further research is needed to properly understand the mechanisms involved in the complex interactions of this problem. Understanding them more completely has the potential to improve the outcome for many cancer patients.
- Fouad, Y. A., & Aanei, C. (2017). Revisiting the hallmarks of cancer. American journal of cancer research, 7(5), 1016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446472/
- Rostami, R., Mittal, S., Rostami, P., Tavassoli, F., & Jabbari, B. (2016). Brain metastasis in breast cancer: a comprehensive literature review. Journal of neuro-oncology, 127(3), 407-414. https://link.springer.com/article/10.1007/s11060-016-2075-3
- Scully, O. J., Bay, B. H., Yip, G., & Yu, Y. (2012). Breast cancer metastasis. Cancer genomics & proteomics, 9(5), 311-320. https://cgp.iiarjournals.org/content/cgp/9/5/311.full.pdf
- Dillekås, H., Rogers, M. S., & Straume, O. (2019). Are 90% of deaths from cancer caused by metastases?. Cancer medicine, 8(12), 5574–5576. https://doi.org/10.1002/cam4.2474
- National Breast Cancer Foundation (2022) Breast Cancer Stats.
Available at: https://nbcf.org.au/about-breast-cancer/breast-cancer-stats/ Accessed: February 2022
- Cancer Australia (2022). Breast Cancer in Australia Statistics
Available at: https://www.canceraustralia.gov.au/cancer-types/breast-cancer/statistics Accessed: February 2022
- Australian Institute of Health and Welfare (2021). Cancer in Australia 2021. Cancer series no. 133. Cat. no. CAN 144. Canberra: AIHW. Available at: https://www.aihw.gov.au/getmedia/0ea708eb-dd6e-4499-9080-1cc7b5990e64/aihw-can-144.pdf.aspx?inline=true
- Lindquist, S. and E.A. Craig (1988). The heat-shock proteins. Annu Rev Genet, 22: p. 631-77 https://www.annualreviews.org/doi/10.1146/annurev.ge.22.120188.003215
- Richter, K., Haslbeck, M., & Buchner, J. (2010). The heat shock response: life on the verge of death. Molecular cell, 40(2), 253–266. https://doi.org/10.1016/j.molcel.2010.10.006
- Kornblith, A.B., Herndon, J.E., Zuckerman, E., Viscoli, C.M., Horwitz, R.I., Cooper, M.R., Harris, L., Tkaczuk, K.H., Perry, M.C., Budman, D. and Norton, L., 2001. Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer, 91(2), pp.443-454. https://doi.org/10.1002/1097-0142(20010115)91:2%3C443::AID-CNCR1020%3E3.0.CO;2-Z
- Bower, J.E., Crosswell, A.D., Stanton, A.L., Crespi, C.M., Winston, D., Arevalo, J., Ma, J., Cole, S.W. and Ganz, P.A., 2015. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer, 121(8), pp.1231-1240. https://doi.org/10.1002/cncr.29194
- Fairman, C.M., Focht, B.C., Lucas, A.R. and Lustberg, M.B., 2016. Effects of exercise interventions during different treatments in breast cancer. The Journal of community and supportive oncology, 14(5), p.200. https://dx.doi.org/10.12788%2Fjcso.0225
- Eckerling, A., Ricon-Becker, I., Sorski, L., Sandbank, E., & Ben-Eliyahu, S. (2021). Stress and cancer: mechanisms, significance and future directions. Nature Reviews Cancer, 21(12), 767-785. https://doi.org/10.1038/s41568-021-00395-5
- Falcinelli, M., Thaker, P. H., Lutgendorf, S. K., Conzen, S. D., Flaherty, R. L., & Flint, M. S. (2021). The Role of Psychologic Stress in Cancer Initiation: Clinical Relevance and Potential Molecular Mechanisms. Cancer research, 81(20), 5131-5140. https://aacrjournals.org/cancerres/article/81/20/5131/670702/The-Role-of-Psychologic-Stress-in-Cancer
- Robinson, D. R., Wu, Y. M., Lonigro, R. J., Vats, P., Cobain, E., Everett, J., … & Chinnaiyan, A. M. (2017). Integrative clinical genomics of metastatic cancer. Nature, 548(7667), 297-303. https://www.nature.com/articles/nature23306
- Lang, B. J., Guerrero-Giménez, M. E., Prince, T. L., Ackerman, A., Bonorino, C., & Calderwood, S. K. (2019). Heat shock proteins are essential components in transformation and tumor progression: Cancer cell intrinsic pathways and beyond. International journal of molecular sciences, 20(18), 4507. https://www.mdpi.com/1422-0067/20/18/4507/htm