Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function

A breast cancer diagnosis can be a life‐changing and stressful experience that can lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). Greater than one‐third of patients initially diagnosed with PTSD after a diagnosis of breast cancer continue to have persistent or worsening PTSD symptoms after 4 years. An emerging body of literature has indicated several key environmental and biological risk factors for PTSD among survivors of breast cancer. Well‐recognized risk factors include having a history of childhood trauma, being nonwhite, obesity, younger age at the time of diagnosis, diagnosis with a higher stage of breast cancer, and short time since treatment. Of the emerging risk factors related to fear circuitry in the brain, 2 pathways of particular importance are the stress‐driven activation of inflammatory pathways and the long‐term effect of antiendocrine therapies. These central and peripheral responses during and after stress exposure are important because increased fear and anxiety can lead to the maintenance of PTSD and worse patient outcomes. Given the poor outcomes associated with PTSD and the high prevalence of breast cancer in women, more research to identify those women at heightened risk of PTSD after breast cancer is warranted to reduce the number of diagnoses and lessen the negative impact of this chronic mental health condition. Increasing evidence indicates that posttraumatic stress disorder (PTSD) occurs in a significant percentage of survivors of breast cancer, with approximately one‐third of patients with PTSD failing to remit even years after their cancer treatment. Herein, the authors outline 2 major stress‐linked biological pathways—the inflammatory response and the moderating role of ovarian steroid hormones—that are likely key intervention targets for improving mental health outcomes in the survivorship period.