Psychological measures of stress and associated biomarkers in breast cancer survivors on aromatase inhibitors

Abstract The use of aromatase inhibitors (AIs) is associated with higher rates of cardiovascular events and lower endothelial function in breast cancer survivors. Psychosocial stress is associated with higher levels of inflammatory and aging markers, and lower endothelial function in otherwise healthy subjects. Given these associations among breast cancers survivors on AIs are not well defined, a cross-sectional study of 31 breast cancer survivors on AIs was performed to assess the associations between scores of psychosocial stress (PHQ-9, PSS, and GAD-7 questionnaires) and markers of inflammation, aging, and endothelial function. Endothelial function was assessed using the EndoPAT2000 system. Breast cancer patients on AIs demonstrate a positive correlation between psychosocial stress scores and inflammatory markers C reactive protein, IL-6, and ICAM-1. There was no significant association between psychosocial stress cores and either endothelial function or gene expression of the aging biomarker p16INK4a. Psychosocial stress is associated with higher inflammatory markers in breast cancer survivors on AIs. The lack of association between psychosocial stress and either endothelial function or aging biomarkers may be due to the already low endothelial function and accelerated aging in our cohort of breast cancer survivors on AIs. Further work is needed to understand this association.