How Childhood Trauma Can Contribute to Developing Cancer as an Adult
A landmark study from the 90s had identified the consequences of adverse childhood experiences on adult health. But today, it's still not used enough in clinical practice.
In 1998, Carol Redding's life was in a tailspin. She'd just gone through a breakup and was starting to lose control after what felt like a lifelong battle with nightmares, flashbacks, anxiety, depression, thyroid disease, and three bouts with cancer (leukemia, breast cancer, and lymphoma).
A friend, who recognized symptoms of trauma, referred Redding to see Vincent Felitti, then head of Preventive Medicine at Kaiser Permanente in San Diego and a co-principal investigator of the Adverse Childhood Experiences (ACEs) Study. Together with Rob Anda, an epidemiologist at the Centers for Disease Control (CDC) and Prevention, Felitti had published groundbreaking research that showed a strong correlation between childhood trauma and many of the leading causes of death, including cancer.
Felitti asked Redding to complete a survey, known as the ACE Questionnaire, which covered ten categories of child abuse, neglect, and household dysfunction. Redding received one "point" each time she marked that she had experienced one of these. Those with a score of four or more were twice as likely to develop heart disease, according to Felitti's findings; seven or more, and they were three times more likely to develop cancer.
Redding scored ten out of ten.
"As soon as Dr. Felitti told me about the ACE Study, it was as if all of the messy jigsaw pieces of my life snapped into place," Redding told VICE. "Had it not been for that breakup, I might never have realized how damaged I was. And I was profoundly damaged."
Today, the ACE research is recognized by the CDC and the World Health Organization. Several states have even passed legislation to encourage programs and research into adverse childhood experiences. But when Redding met Felitti, the study had just been published.
"The ACE Study happened totally by accident," Felitti told VICE. In 1984, Felitti was conducting an obesity study at Kaiser. One of the study's most successful participants was a 28-year-old woman who had dropped nearly 300 pounds. But a few weeks after achieving her lowest weight ever, she was sexually propositioned at work and gained back all of the weight she'd lost.
"She told us she was the incest victim of her grandfather from age 11 to 21 and that she ate to feel better," Felitti said. "Weighing 408 pounds was also her way of unconsciously reducing her sexual attractiveness."
As Felitti interviewed more patients, he found that half of the 300 participants in his obesity program had been sexually abused. Toxic stress in childhood appeared to be associated with obesity; Felitti wondered if early trauma could be linked to other adulthood diseases. Soon after, the ACE Study was born.
"Who would think that something that happens when you're three or four years old could cause cancer when you're 40?" — Carol Redding
Although today there are more than 80 published journal articles on ACEs, Felitti says most physicians haven't heard of ACEs and "almost never" ask about a patient's childhood in routine screenings.
Pradeep Gidwani, a San Diego–based pediatrician and director of projects at the American Academy of Pediatrics, told VICE the medical field has been slow to embrace ACE research. Part of the problem, he said, is that physicians don't have adequate training or resources to deal with patients who do show signs of childhood trauma.
Redding said no one before Felitti connected her health problems to toxic events from her childhood—but it was clear that she had suffered trauma.
When she was four, her mother died of a brain hemorrhage. Her father—a World War II vet with PTSD—crumbled after her death, becoming a violent alcoholic. During her childhood, she says her father regularly beat her and her siblings; money and food were scarce, and at one point, Redding's family was evicted and she was sent away to live with their aunt.
Meeting Felitti was a watershed moment for her. "Who would think that something that happens when you're three or four years old could cause cancer when you're 40?" she said.
Bruce D. Perry, a senior fellow at the Child Trauma Academy, told VICE the events in Redding's childhood didn't necessarily "cause" her cancer. The original ACE Study, while groundbreaking, examined correlations—associations between childhood experiences and adult health—not direct causes.
Perry added that because an ACE score doesn't consider the age at which a traumatic event happened, whether it happened once or chronically, and if there were "buffering" factors, like a strong family or community support system, the score "has been misunderstood and misinterpreted by people—including clinicians—all with good intentions."
Even still, Perry said there is clear evidence of what is sometimes called the "neurobiology of stress."
"Over time, a chronically activated 'freeze, flee, or flight' system wears down our heart, lung, gut, immune system, and even brain networks involved in attention, thinking, and mood regulation," Perry told VICE. "Hence, the increased risk in problems in mental- and physical-heath capacities."
According to Felitti, ACEs affect mental and physical health in adulthood in three ways: The first is through coping mechanisms like smoking, overeating, alcoholism, or using drugs, all of which have immediate benefits but long-term risks. The second is the effect of chronic, major, unrelieved stress on certain areas of the brain that control our immune systems and inflammatory responses. The third involves changes to epigenetic mechanisms that control gene expression.
Healing this past trauma can be challenging, but Perry says that relationships are key. "The better predictor of physical and mental health outcomes is the number, quality, and consistency of healthy relationships," he told VICE.
Working with Felitti, Redding began a series of therapies, including cognitive behavioral therapy and eye movement desensitization and reprocessing, both of which reduce the long-term effects of toxic memories and help develop adaptive coping mechanisms. She started exercising, engaging in community projects like mentoring college students, and spending more time with her siblings to strengthen family bonds. She also started journaling, mostly writing about childhood memories in five-year increments. The memories triggered flashbacks, but they lessened with time and she was ultimately able to forgive what had happened in her past.
It's been 16 years since Redding's crash. Today, she says life is easier—there's less struggle, more joy. "I understand who I really am," she told VICE. "I like who I am."
See more of Dustin Grinnell's work on his website.