Breast cancer risk linked to trauma resulting from hunger in Holocaust

Malignancy was twice as common among women with PTSD and even higher among those who endured severe hunger.

By JUDY SIEGEL-ITZKOVICH
A monitor shows the image of a woman infected with breast cancer. (photo credit: REUTERS)
A monitor shows the image of a woman infected with breast cancer.
(photo credit: REUTERS)
There is a higher risk of contracting breast cancer among women who suffered from post-traumatic stress disorder as a result of going through the Holocaust compared to women who were spared such psychological trauma, according to researchers at the University of Haifa.
The main factor in increasing the risk of the malignancy was hunger the survivors suffered during World War II, said the researchers, who have just published their findings in the journal International Psychogeriatrics.
Dr. Naomi Wein-Raviv of the School for Public Health said that the research identifies a new high-risk group who must be diagnosed and treated.
In her previous study, the Haifa researcher had found that the breast cancer rate among Holocaust survivors who moved to Israel was higher than those who came from Europe to Israel before World War II.
In the new study, conducted under the supervision of Dr. Lital Keinan Boker, Dr. Micha Barhana and Prof. Shei Lin of the University of Haifa and Prof. Rahel Dekel of Bar-Ilan University, the researchers wanted to see if there was a connection between the higher breast cancer rate and post-traumatic stress disorder (PTSD) – a psychological syndrome causing disturbing recurring flashbacks, avoidance or numbing of memories of the event and hyperarousal (high levels of anxiety) – resulting from hunger suffered many years before under the Nazis.
A total of 265 women who survived the Holocaust, lived in Europe between 1939 and 1945 and came on aliya until 1989, were studied. Of them, 65 were diagnosed with breast cancer and the rest were a control group who did not contract any cancer at all. All the participants responded to a questionnaire, and their answers determined whether they had suffered from emotional trauma connected to the Holocaust. A second questionnaire examined whether they had suffered from other traumatic events after the war, so the cause could be isolated.
The researchers also asked about the level of hunger they had been exposed to during the war – an objective measure of hunger according to where they were during the Holocaust; a subjective measure of hunger determined according to the memories of each survivor; and a measure of hunger symptoms determined by the survivors’ reports of physical symptoms they suffered during the war.
The findings pointed to a direct connection between the level of PTSD and the risk of contracting breast cancer. The number of women who got the malignancy was twice as high as women who did not suffer from such a syndrome.
But the researchers also found that exposure to hunger during the Holocaust influenced the connection between post-trauma and the risk of developing breast cancer. When multifactorial analysis was conducted on the objective measure of hunger, it was found that the connection with the risk for getting breast cancer was among women who suffered from severe hunger during the Holocaust but not among women who suffered relatively less from hunger.
“The findings showed that post-traumatic stress syndrome is a risk factor only when there is already an existing risk factor, such as serious hunger during the Holocaust. In this case, PTSD promotes breast cancer” in survivors, explained Wein-Raviv.
“I interviewed more than 300 incredible women from around the country,” wrote the main author. “As one who was raised in the home of Holocaust survivors, whose parents raised her on Zionism and love for the Jewish homeland, I suffered a great crisis when I discovered the state’s attitudes toward survivors – that they had to appear before committees of rehabilitation for the disabled in the Treasury and the fact that the state continues to withhold what they deserve. I hope that my research will help the survivors in general and to prove they are right opposite the bureaucratic apathy so they can grow old with honor,” said Wein-Raviv.
Meanwhile, phone lines providing emotional support for families of fallen soldiers and victims of terror and war will be boosted by the voluntary organization Natal in the coming days. Remembrance Day for the Fallen of Israel’s Wars will be held a week after Holocaust Remembrance Day. People may call 1-800-363-363 for help. Parents, orphans and spouses especially suffer at this time, said Natal, but calls are also accepted from siblings, grandparents and good friends, as well as from veterans who lost comrades on the battlefield.
“Don’t remain alone with the pain,” said Natal. “There is a need to create legitimacy for seeking emotional help among IDF veterans and reservists, it said, as well as among relatives and friends of the fallen who are not formally regarded as bereaved.
“Times have changed,” said Natal director Orly Gal. “In the past, it was less acceptable among soldiers, their families and friends to speak of pain and trauma. Today, it is a different generation which recognizes the invisible wounds of post-trauma.”
Since the Second Lebanon War, about 2,000 discharged soldiers have taken part in Natal’s activities, from phonein help to clinical care, nature workshops and support groups.
Just admitting the pain is the first step to recovery,” added Gal.
Remembrance Day for the Fallen and Terror Victims is painful but also gives the families a public day of recognition, said psychologist Dani Iger, a member of the organization’s professional steering committee.