Most people share a common list of everyday stressors: deadlines, kids, commutes, bills and more. But for women with a family history of breast cancer, the wait for a mammogram report or the fear of finding a lump ranks especially high on that list. Increased levels of stress can impact immune function and ironically, could stand in the way of helping women most in need of a hoped-for breast-cancer vaccine. A new Public Health Sciences Division study aims to reveal if stress-reduction techniques can improve immune response to vaccine among women at higher risk for breast cancer.
"I'm interested in how psychological stress affects the immune system," said Dr. Bonnie McGregor, principal investigator of the Stress Management And Relaxation Training for Health (Health SMART) study and a clinical psychologist in the PHS Cancer Prevention Program. "My goal is to use intervention studies to add to the growing body of evidence suggesting that mental health is associated with physical functioning. If psychological stress is associated with weaker immune function, we should be able to do an experiment — or intervention — where we reduce stress and see improved immune function."
Recruitment for Health SMART began in December and focuses on women with a family history of breast cancer who report high levels of stress. Participants complete a baseline questionnaire and then are randomized to either an immediate or delayed intervention. Those in the first group participate in a 10-week, small-group, stress-reduction program and then receive two hepatitis A vaccines six months apart. Antibody response is measured one month after each vaccination. Those in the delayed-intervention group receive the vaccine doses first and participate in the stress-reduction program afterward. The researchers hope to recruit about 225 participants over the next two to three years.
Participants learn stress-management techniques and relaxation exercises. The stress-management techniques are designed to raise awareness of the behavioral, emotional, physical and social effects of stress. Women are taught various coping strategies, including using social support, managing anger and becoming more assertive. The relaxation techniques range from progressive-muscle relaxation to mindfulness meditation and guided imagery.
The study is funded through McGregor's career-development award from the National Cancer Institute. One of her mentors, Dr. Olivera Finn, is an immunologist at the University of Pittsburgh who is working on a breast-cancer vaccine. McGregor hopes to test the intervention on healthy women receiving an experimental breast-cancer vaccine within five years.
'No down side to participating'
There is still a lot of work to be done before breast-cancer vaccines are ready to be used for prevention. Once the vaccines are available, researchers will want women to show a strong immune response to the vaccine. But psychological stress may thwart the body's response to the vaccine. "There's strong scientific literature showing that stress can impair one's ability to mount an antibody response to vaccine," McGregor said. "If you can't make a successful response to a vaccine, you're not going to get the protective effect."
McGregor previously used the stress-reduction program with women who had recently been treated for breast cancer. "We found that participants in the intervention had increases in immune function, and the control participants did not have any change in immune function. However, many breast-cancer patients have chemotherapy, which affects their immune systems, so I wanted to study this in people who were stressed but otherwise healthy," she said.
Kristin Buckley, one of the Hutchinson Center's Major Gifts officers, jumped at the chance to join Health SMART. She considers herself healthy, but admits worry as a daughter whose mother died young from breast cancer. "I think of my mother's death every day and what that might mean for me in the future," Buckley said. "Through my participation, I like that I will help further research that may impact a breast-cancer vaccine and may help others. I am also looking forward to learning tools for stress reduction and being vaccinated against hepatitis A. There really is no down side to participating."
Unique measurement tool
McGregor's study makes use of a novel tool called a wrist actigraph, part of a trend in psychological studies to objectively measure participant data at prescribed intervals. The wristwatch-like device measures sleep and reminds participants to collect saliva samples throughout the day during certain periods in the study. The samples are tested for cortisol (a stress hormone) levels. Reduced sleep and high cortisol levels indicate increased stress.
Health SMART participants receive a set of CDs with relaxation exercises, a tote bag and a workbook filled with the stress-management techniques taught in the classes.
McGregor says the classes are well received. "I've run the groups with cancer patients, and they all report they like the intervention and find it very helpful," she said. "I needed to change the intervention slightly for healthy women with a family history of breast cancer, and I wasn't sure how it would work with this population."
"I ran one pilot group with women at risk for breast cancer last summer, and they loved it. It's a good fit for this population, so I'm excited about that."
Join the study
Health SMART staff are recruiting participants ages 18 to 60 from the greater-Seattle area. The intervention classes are held in the late afternoons or evenings in the PHS Prevention Center. For more information about joining the study, e-mail firstname.lastname@example.org or call (206) 667-7267.