Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study

Abstract

BackgroundStrong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood.MethodsBaseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index.ResultsThe ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000-1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000-1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs → smoking → lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs.ConclusionsAdverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.

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“…By using PCA, we were able to use the data to derive three components of ACEs. Brown et al (2010) found a positive association between ACEs and risk of lung cancer, which coincides with the findings in the current study. However, the current study considered prevalence of all cancers overall, in childhood and adulthood, in a cross-sectional study with a population-based sample while Brown et al (2010) looked at incident lung cancer using a prospective study design [15].…”

“…However, the increase in the risk of lung cancer could only be partially explained by the relationship between ACEs and smoking. Therefore, this finding suggests that the association between ACEs and cancer may be attributable to other mechanisms in which stressors and trauma during childhood negatively affect health [15]. In a prospective study, adverse events occurring between ages six and eight, and cumulative adversity from birth to age eight were found to be associated with inflammation at age ten [23].…”

“…Cancer was selected as previous research has suggested a link between ACEs and different types of cancer [15,16]. Cancer diagnosis was defined by: 1) ''Have you ever been told by a doctor, nurse, or other health professional that you had cancer?''…”

“…Men tend to have higher colorectal cancer incidence and mortality rates compared to women with Black men having higher colorectal cancer incidence and mortality rates compared to men of other racial/ethnic groups [35]. Income, educational level, and marital status have also been included in previous studies as a covariate examining the link between ACEs and adverse outcomes [15,20]. Socioeconomic status may partially explain the association of traumatic events during childhood with chronic illness [36].…”

“…ACEs have been linked to substance abuse [7][8][9][10][11], depression [7,8,12,13], cardiovascular disease [7,14], diabetes [7], cancer [7,15,16], risky sexual behaviors [17][18][19], sexually transmitted infections [7,8,19] suicidality [7,8,13,17,18], and premature mortality in adulthood [17]. Researchers have suggested examining multiple ACEs allowing for a potential assessment of a graded relationship between these exposures and health outcomes [6].…”