By Dorothy Gibbons
Who wants to remember Hurricane Harvey and all the devastation it caused to our city and in our lives, much less consider that it could be a contributing factor to an increase in cancer cases?
But after seeing a 34% increase in the number of women we have diagnosed over the past twelve months, I have to wonder.
Chronic stress as it relates to all diseases, including cancer, has been well researched, and the connection is clearly documented. Whenever we are under stress due to a life-changing event or trauma, our body’s immune system is compromised — the more chronic or intense stress, the more severe the results. A natural disaster creates its own kind of stress, no less lethal.
In 2018, our longtime volunteer, Fariya Sahadat, asked if she could complete her preceptorship for her Master’s degree at UT’s School of Public Health. Her research was to see whether 2017’s Hurricane Harvey decreased the likelihood of patients keeping their mammogram or diagnostic test appointments.
As she described in her summary: Since we have established a relationship between natural disasters and stress as well as stress and breast cancer severity, it is hypothesized that the same relationship will exist among The Rose patients. Additionally, other variables such as level of damage from the hurricane, household size, miles traveled to The Rose, and insurance status is hypothesized to be meaningful covariates in the stress/diagnosis relationship. Additionally, if patients canceled their appointments within this period of time, reasons for their cancellations will be paramount in understanding this patient population and implementing policies that would better serve them.
Her research resulted in many unexpected findings, and it enabled us to formalize post-hurricane response policies to better serve our patients in future emergency situations and disasters.
While we expected to find a number of patients who had initially canceled their appointments, we were surprised to learn that 1,800 women had canceled or did not show for their appointment and never rescheduled that year. Those 1,800 women were divided equally between insured and uninsured women and lived in various parts of town.
There were a few that canceled and did reschedule, and conversations with them revealed that while all had not personally experienced loss of property but all experienced Harvey at some level. Many were helping family members or friends who had lost everything and were now living with them; others had not recovered from their own loss of income when their companies shut down, a few had new responsibilities following deaths in the family, the list was long.
I was fascinated to learn that research performed around the world following natural disasters had shown that women experienced more post-traumatic stress than men for the same amount of damage. Fariya shared a 2014 meta-analysis where they found that the range of depression varied among adults for natural disasters, but there were certain clear risk factors associated with more depressive symptoms. Females experienced the brunt of these symptoms by being 1.39-1.79 times more likely to be depressed than men.
She also presented a 2009 study that included bio-labeled breast cancer lines in mice and found that the more stress they experienced, the more likely it was for these cells to move to more distant areas of the body (metastasis). The researchers took this to mean that there is a link between stress-induced inflammation and the spread of cancer.
So here we are, nearly two years after Harvey and at The Rose and over the past eight months we have diagnosed over 100 more women than the same time last year. We are serving the same number of women as last year, the same amount of insured and uninsured.
The more I think about the 34% increase of women we are diagnosing with breast cancer, the more I have to wonder if Hurricane Harvey and the inherent stress resulting from it has contributed to this spike. Oddly enough, in some studies, a disease is often diagnosed 18 to 24 months after a traumatic life event.
I realize that we would need a lot more research before determining anything conclusive. And, I’ll grant that our increase could be a fluke.
Still, we all know what it felt like two years ago. We remember the mind-numbing events, the losses, the devastation, and most of all, the stress.
