title: World War II-related post-traumatic stress disorder and breast cancer risk among Israeli women: a case-control study.
abstract: BACKGROUND
  Several studies have suggested that post-traumatic stress disorder (PTSD) is related to adverse health outcomes. There are limited data on PTSD and cancer, which has a long latency period. We investigated the association between World War II (WWII)-related PTSD and subsequent breast cancer (BC) risk among Jewish WWII survivors and examined whether this association was modified by exposure to hunger during WWII.
  
  
  METHODS
  We compared 65 BC patients diagnosed in 2005 through 2010 to 200 population-based controls who were members of various organizations for Jewish WWII survivors in Israel. All participants were born in Europe, lived at least six months under Nazi rule during WWII, and immigrated to Israel after the war. We estimated PTSD using the PTSD Inventory and applied logistic regression models to estimate the association between WWII-related PTSD and BC, adjusting for potential confounders.
  
  
  RESULTS
  We observed a linear association between WWII-related PTSD and BC risk. This association remained significant following adjustment for potential confounders, including obesity, alcohol consumption, smoking, age during WWII, hunger exposure during WWII, and total number of traumatic life events (OR = 2.89, 95% CI = 1.14-7.31). However, the level of hunger exposure during WWII modified this effect significantly.
  
  
  CONCLUSIONS
  These findings suggest an independent association between WWII-related PTSD and subsequent BC risk in Jewish WWII survivors that is modified by hunger, a novel finding. Future research is needed to further explore these findings.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Neomi
authors.initials: N
authors.lastname: Vin-Raviv
authors.affiliation: Louis and Gabi Weisfeld School of Social Work, Faculty of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dekel
authors.affiliation: School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel.
authors.forename: Micha
authors.initials: M
authors.lastname: Barchana
authors.affiliation: School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Linn
authors.affiliation: School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel.
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology* / Q000523:psychology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006815:Hunger; D007557:Israel; D007585:Jews / Q000706:statistics & numerical data*; D008016:Life Change Events; D008019:Life Style; D011594:Psychometrics; D018570:Risk Assessment; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D047789:World War II