Early Life Events and Gynaecological Cancer: A Pilot Study

years, neurological or neurocognitive impairment. The clinical information (oncological diagnosis, age of onset, stage of cancer, current and past treatments, chemotherapy, radiotherapy, surgical operation, hormonal therapy, cancer support therapy, family history of cancer, psychotropic drug use) of the patient group was drawn from the hospital clinical records. The sociodemographic characteristics (e.g. education, marital status, number of children, working activity) were also collected. To avoid a possible recall bias, only objectively verifiable early events were assessed by means of a semi-structured interview [11] . This takes into account the following early events (during the first 15 years of life), as well as the context in which they occurred and the subject’s age at the time of occurrence: death of or separation from mother, death of or separation from father, death of any other cohabiting relative and severe illness in the subject’s childhood sufficient to interfere with the development of normal social relationships. Physical and sexual abuses were also studied by administering the corresponding sections of the Childhood Experience of Care and Abuse Questionnaire [12] . The records of the interviews were examined by specially trained assessors not involved in the interviews who decided whether or not each descriptive account had to be considered an event. The assessors did not know whether an interview record referred to a case or to a control subject. The events of abuse reported were too rare (6 among the patient group and 1 among controls) to be considered statistically. Therefore, the subsequent results are relative to loss events only. The women affected by cancer reported a greater mean number of early loss events than the control subjects (0.98 8 0.94 vs. 0.37 8 0.59, t = –5.56, d.f. = 210, p ! 0.001) whereas no significant difference was found among the 3 cancer groups. Loss of mother and father, death of another cohabiting relative and having been affected by severe illness during childhood, all increased the risk of cancer in adulthood, irrespective of the type of cancer ( table 1 ). This study is of course preliminary and merely explorative. A larger sample and more detailed investigation are necessary to confirm the association between childhood traumata and adult gynaecological cancer. However, as far as we know, this is the first report of an association between early trauma and ovarian and endometrial cancer. Moreover, it produces further information in the debated issue of breast cancer. It must be noted that the association between early loss and adult cancer is not necessarily causal; a common factor such as a cancer family history could explain both the excess of loss events and the increased risk of cancer. When planning a more articulated study, in addition to a greater number of cases, it would be The relationship between stressful events and cancer has been widely studied. Although the resulting findings are not univocal, a recent meta-analysis taking into account more than 300 studies indicated that stress-related psychosocial factors are associated with a higher cancer incidence, poorer survival and higher cancer mortality [1] . However, scant attention has been paid to the relationship between childhood traumatic events and cancer during adulthood. This in spite of the recent evidence by which adversities in early life and the quality of the early environment cause a permanent sensitization of the responses to stress with lasting effects on the hypothalamic-pituitary-adrenal axis, thus predisposing the individuals to disease in adulthood [2–5] . This condition may generate disturbances in the balance between proand antiinflammatory mechanisms, affecting immune activation and inflammation, and eventually promoting the development of cancer [3, 6] . As far as gynaecological cancers are concerned, the relationship between breast cancer and recent life events has been well studied in the literature [7, 8] , whereas the role of childhood life events is still not clear and the few studies published on this topic show conflicting results. Some authors found a relationship between loss events or lesser mother care and breast cancer [4, 9, 10] , whereas others [5] reported similar childhood experiences. To our knowledge, nothing has been published on the relationship between childhood traumatic events and other types of gynaecological cancers. In the present study a range of stressful life events which occurred during the first 15 years of life has been assessed in 108 women suffering from 3 types of gynaecological cancer (29 with breast cancer, 49 with endometrial cancer and 30 with ovary cancer) as well as in 104 control healthy women matched for age, education and marital status. Exclusion criteria were: age 1 75 Received: December 2, 2010 Accepted after revision: May 2, 2011 Published online: November 25, 2011