Can loss and grief activate latent neoplasia? A clinical case of possible interaction between genetic risk and stress in breast cancer.
BACKGROUND
Nineteenth-century physicians working with cancer patients frequently reported that severe emotional losses and grief occurred in some cases before cancer. Research on psychoneuroimmunology seems to reactivate this interest and could give a possible convincing background.


METHODS
We recently observed the case of a 45-year-old woman who developed symptoms of breast cancer (ductal infiltrating carcinoma, T1, N1, M0) 3 years after the loss of her only child. The affection for the child compensated inadequacies of her marriage, which became increasingly unstable. The child died in a dramatic accident at home, while his mother was near him but unable to help.


RESULTS
The patient had a moderate genetic-familial risk of mammary cancer. Animal studies strongly suggest that stress, through neuroimmunomodulatory mediatory mechanisms, can significantly affect appearance and progression of mammary cancer. The patient developed long-lasting intense grief, despair and hopelessness.


CONCLUSIONS
We discuss the case from three main standpoints: genetic and risk factors for breast cancer; findings which demonstrated a relationship between stress, neuroimmunomodulation and cancer in animals; data from autopsy studies which found foci of latent breast cancer in 20% of healthy women in the same age range. Stress does not create cancer. However we hypothesize that in this case it could have contributed by the activation of a latent neoplasia and/or by impairing immunosurveillance during a critical life phase.
Biondi
M
M
Clinica Psichiatrica, Università di Roma La Sapienza, Italia.
Costantini
A
A
Parisi
A
A
D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics* / Q000523:psychology*; D002886:Chromosomes, Human, Pair 17; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D007165:Immunosuppression Therapy; D008875:Middle Aged; D013315:Stress, Psychological / Q000523:psychology