Mon | Aug 21, 2017

Michael Abrahams | Child abuse can cause cancer

Published:Monday | June 27, 2016 | 6:05 AM
Dr Michael Abrahams

The correlation between childhood trauma and psychological dysfunction in adulthood is well documented. What is less well known, and probably more ominous, is the link between a traumatic childhood environment and physical disease. The Adverse Childhood Experiences Study (ACE Study), published in the American Journal of Preventive Medicine in 1998, is one of the most groundbreaking studies ever performed in the field of medicine. Utilising questionnaires, the researchers investigated 10 categories of childhood abuse and exposure to household dysfunction:
Physical abuse
Sexual abuse
Emotional abuse
Physical neglect
Emotional neglect
Mother/stepmother treated violently
Household substance abuse
Household mental illness
Parental separation or divorce
Incarcerated household member.
The study included over 17,000 participants, and the data was used to assign patients an “ACE score,” giving them one point for each category of trauma they had experienced.
The researchers then looked at the relationships between the scores and risk factors that contribute to the leading causes of morbidity and mortality in the United States, including smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, drug abuse, a high lifetime number of sexual partners (≥50), and a history of having a sexually transmitted disease. The relationships between childhood exposures and disease conditions that are among the leading causes of mortality in that country, namely ischemic heart disease, cancer, stroke, chronic bronchitis or emphysema (COPD), diabetes, hepatitis or jaundice, and fractures, were also examined.
The findings of the study were fascinating, demonstrating powerful correlations between ACE scores and poor outcomes. Two-thirds of the patients had experienced at least one category, and one in six had an ACE score of four or higher. Compared with people who had no history of ACEs, those with scores of four or more were twice as likely to smoke, six times as likely to have had sex before the age of 15, seven times as likely to be alcoholics, and 12 times as likely to have attempted suicide. They were also twice as likely to have been diagnosed with cancer, twice as likely to have heart disease, and four times as likely to suffer from emphysema or chronic bronchitis.
An essential question is, “By what mechanisms are adverse childhood experiences linked to health risk behaviours and adult diseases?” It would be logical to deduce that following childhood trauma, many persons develop bad habits and lifestyles which increase the likelihood of poor health and early demise. Unfortunately, the situation is even grimmer. It was found that ACEs had a profound negative effect on adult health even in the absence of unhealthy behaviours. The researchers looked at patients with ACE scores of seven or higher who did not smoke or drink excessively and were not overweight, and found that their risk of ischemic heart disease (the most common cause of death in the United States) was 360 per cent higher than it was for patients with a score of 0. The traumatic experiences of their childhoods were clearly negatively affecting their later health, through a mechanism that had nothing to do with unhealthy behaviour.
Since the original study, there has been a multitude of research on the topic, and it has been discovered that trauma in childhood can actually cause physical and biochemical changes in the body, independent of high-risk behaviour, that can lead directly to disease. This is the concept of toxic stress. When faced with acute stress, the body switches into a “fight or flight” mode. For example, if you are walking alone and someone jumps out of the bushes to attack you, you will reflexly either fight to defend yourself or run away to escape the threat. During this process, the body releases stress hormones such as adrenaline and cortisol, in addition to neurotransmitters and inflammatory proteins. Short-term, these substances help to keep us alive.
But when the body is overburdened by repeated, intense or chronic stress, the same chemicals that assist in our short-term survival can lead to changes in the structure and function of our developing brains and bodies. For example, chronic stress causes a build-up of inflammatory proteins such as high-sensitivity C-reactive protein, a leading marker for cardiovascular disease, and substances produced in the body in response to prolonged adversity weaken the immune system, making it less competent in fighting malignant cells, facilitating the development of cancer. 
Chronic stress can also affect our DNA by altering structures known as telomeres. These are protective casings at the ends of DNA strands. Each time a cell divides, it loses a small amount of the structures, but they are usually replenished by an enzyme called telomerase. However, chronic stress decreases the supply of the enzyme, affecting telomere length, causing cell death or inflammatory changes, predisposing to ageing, as well as diseases including cancer. So, child abuse can literally cause cancer.
It is therefore incumbent upon us to protect our children. These factors will not only affect them, but also persons they interact with and their own children, as persons with high ACE scores, not surprisingly, create environments conducive to the development of high scores in their children, perpetuating the cycle of dysfunction and illness. Screening for ACEs should be encouraged among physicians, and protocols for intervention discussed and disseminated, if we are to achieve a healthy society.

-Michael Abrahams is an obstetrician and gynaecologist, comedian and poet. Email feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or tweet @mikeyabrahams.