Dana Voigt had just traveled to Italy and hiked up thousands of stairs. She had felt amazing and had no symptoms of illness.
But after returning home, a routine mammogram revealed she had invasive lobular carcinoma—a hard-to-detect cancer that starts in milk-producing glands that turned her life into a whirlwind of information, appointments, and decisions.
Dana Voigt in Italy. Dana Voigt
Worst of all, while she wanted time to understand and absorb each bit of news, Ms. Voigt felt like her cancer team put her in a game of “beat the clock” that left no time to get a second opinion.
“I can’t think of anyone I’ve met who wasn’t overwhelmed and thrown into a tizzy on how to make a decision on something you have little to no experience with and you don’t even know what to ask or who to believe. You pretty much base everything on what the doctor and cancer team is telling you,” she said. “I was lost. I didn’t know which way to go, or how to think. I was in panic mode.”
There was something different about her breast cancer anxiety; Ms. Voigt described it as something she just couldn’t contain despite how hard she tried. Runaway emotions are common with a cancer diagnosis and treatment decisions—a major factor that undermines patient outcomes.
Research indicates that this is a tragic result of doctors, cancer clinics, and other health care workers neglecting to help patients reduce stress.
The Microbe Dimension
Anxiety is particularly troublesome for newly diagnosed cancer patients because stress has been shown to damage the gut microbiome, which is intimately connected to the immune system and predicts the success of some cancer therapies—both tied to prognosis.
New research has recognized this dilemma in a study that examined the intersection of the gut microbiome—the community of trillions of mostly bacteria, viruses, and fungi living in the gastrointestinal tract—and stress in the newly diagnosed breast cancer patient. The verdict: Patients who reported feeling distressed had marked differences in their microbial community that have been linked with various cancers, inflammatory bowel disease, poor treatment responses, and other negative traits that can affect quality of life even beyond treatment.
Published on Oct. 20, 2023, in Scientific Reports, the study pinpointed treatment decisions as the most frequently cited source of stress. Decisional distress can involve uncertainty, anxiety, and regret.
In other words, stress arising from a cancer diagnosis can also directly contribute to cancer itself. This raises the question of what doctors and cancer clinics can do to reduce stress and thereby improve cancer outcomes.
An article written for clinicians in Patient Education and Counseling in 2021 emphasized that breast cancer is accompanied by a special kind of stress that physicians need to be aware of when evaluating treatment decisions and eliminating confusion. The authors of the new study argue that because female breast cancer has surpassed lung cancer as the most diagnosed cancer—and because survival rates have gone up—improving quality of life is a worthwhile focus in research.
Patients, then, can also use new understandings of stress and its connection to the microbiome to enhance their microbial community—and prognosis—through lifestyle changes.
Microbiome’s Role in Breast Cancer
The new study builds on breast cancer research linked to the gut microbiome. The microbial community drives many metabolic, neural, and endocrine processes. It also acts as a gatekeeper of sorts for the human immune system, mostly by keeping pathogenic bacterial populations in check.
The microbiome is of keen interest to cancer researchers who are looking for ways to rev up the immune system through bacterial composition and interplay. Improvements in the immune system could allow the body to deal directly with cancerous cells.
Some previous findings related to the microbiome and breast cancer include the following:
- Specific microbes and the diversity of the microbial community have been linked to chemotherapy response and prognosis in patients. For instance, some bugs indicate a poor response to chemotherapy, whereas others show a beneficial response. Microbiota can predict chemotherapy-associated toxicity.
- An imbalance of microbiota, called dysbiosis, may lead to the development of breast cancer.
- Manipulating commensal bacteria—including using prebiotics and probiotics—has proven cancer-fighting potential in some patients.
Christine Holcomb encouraged the growth of disease-fighting microbes when she opted to forego chemotherapy and instead boost
Christine Holcomb Christine Holcomb
her immune system with raw foods, supplementation, and detoxification. Though she didn’t realize she was nurturing her microbiome at the time of her 2011 breast cancer diagnosis, it’s a concept she’s now become more familiar with.
“Your microbiome changes and that might have allowed breast cancer to develop,” she told The Epoch Times. “But if you get out of your chronic stress, your microbiome may change back, and it helps your immune system fight everything.”
Ms. Holcombe had a double mastectomy, healed from her breast cancer, and went on to become a public speaker on how to survive cancer and prevent it from coming back.
A Tale of 2 Microbiomes
The new study took a detailed look at the microbiomes of 82 breast cancer patients and noted significant differences in bacterial families and genera that coincided with distress and quality of life.
Specifically, those with high levels of distress had more abundant Alcaligenaceae and Sutterella bacteria. Alcaligenaceae is a bacterial family that is associated with irritable bowel disease (IBD), chronic kidney disease, and several types of cancers. These bacteria—which are pro-inflammatory and typically higher in patients with depression without anxiety—are believed to play a role in the development or progression of disease, according to the study.
Sutterella has been linked to a variety of diseases including IBD, Crohn’s disease, and multiple sclerosis, among others, the research said. An abundance of sutterella seems to be associated with better cancer therapy outcomes, and a lower abundance has been linked to people with depression, as well as people who sleep less.
The family of Streptococcaceae was also more significantly abundant in those with lower distress scores in the study. Many of the bacteria in this family are health protective, help balance neurotransmitters, and have the ability to produce serotonin.