Scientists are still trying to figure out why so many breast cancer patients experience severe cognitive problems years after treatment. Inflammation is one possible reason. A new long-term study of older breast cancer survivors led by UCLA researchers and published today in the Journal of Clinical Oncology adds important support to that possibility.
In the latest study, higher levels of an inflammatory marker known as C-reactive protein (CRP) were linked to older breast cancer survivors reporting cognitive impairments. “CRP blood tests are commonly used in clinic to identify risk of heart disease.”
According to study lead author Judith Carroll, an associate professor of psychiatry and biobehavioral sciences and faculty member of UCLA’s Cousins Center for Psychoneuroimmunology and the UCLA Jonsson Comprehensive Cancer Center, “this common test for inflammation may also be an indicator of risk for cognitive problems reported by breast cancer survivors.”
The Thinking and Living with Cancer (TLC) Study is one of the first long-term efforts to investigate the potential link between chronic inflammation and cognition in breast cancer survivors aged 60 and older, who account for the vast majority of the nearly 4 million breast cancer survivors in the United States.
Previous study has mostly focused on younger women and those soon following therapy, making conclusions regarding CRP’s significance in long-term cognitive difficulties among older breast cancer survivors challenging.
Over the course of five years, teams of researchers from throughout the country interviewed and collected blood samples from hundreds of breast cancer survivors and women without disease. The study was inspired by survivors and activists who expressed concern about cognitive difficulties.
“Cognitive issues affect women’s daily lives years after treatment, and their reports of their own ability to complete tasks and remember things was the strongest indicator of problems in this study,” said co-senior study author and TLC study leader Dr. Jeanne Mandelblatt, a professor of oncology at Georgetown University.
“Being able to test for levels of inflammation at the same time that cognition was being rigorously evaluated gave the TLC team a potential window into the biology underlying cognitive concerns,” said Elizabeth C. Breen, emerita professor of psychiatry and biobehavioral sciences at UCLA and co-senior study author.
Cognition was assessed from each woman’s perspective using a regularly used questionnaire that assessed how the women perceive their capacity to recall things like names and directions, ability to focus, and other areas of daily life. Higher CRP levels among survivors were shown to be indicative with worse reported cognitive function among breast cancer survivors, according to the study. In the women who did not have cancer, there was no correlation between CRP levels and reported cognition.
CRP did not appear to be related to cognitive performance, as determined by established neuropsychological testing. According to the authors, this might mean that women are more sensitive to variances in their daily cognitive performance, self-reporting changes that other tests overlook.
The authors believe that more research is needed to determine if therapies that reduce inflammation, such as greater physical activity, improved sleep, and anti-inflammatory drugs, might prevent or lessen cognitive issues in older breast cancer survivors.