Possible Link Between Inflammation, Cognitive Problems in Older Breast Cancer Survivors
Higher levels of C-reactive protein, a marker of inflammation, were associated with cognitive problems in older women who received breast cancer treatment, a study suggests.
The research was published online on Sept. 30, 2022, by the Journal of Clinical Oncology. Read the abstract of “Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study.”
Breast cancer treatment and cognitive problems
During and after breast cancer treatment — especially chemotherapy and hormonal therapy — many people find it difficult to think clearly and to remember and concentrate on things. Doctors refer to these issues as cognitive impairment or cognitive problems. People who’ve received chemotherapy commonly refer to them as chemo brain or chemo fog.
People with cognitive problems may have trouble:
learning new tasks
remembering names
paying attention and concentrating
finding the right words
multitasking
organizing thoughts
making decisions
remembering where they’ve left personal items
According to the National Cancer Institute, up to 75% of people diagnosed with breast cancer say they have cognitive problems during chemotherapy. In some cases, people can have cognitive problems several years after completing chemotherapy.
What is inflammation?
In the most general sense, inflammation is your body’s response to something irritating, such as a germ or splinter in your toe. When your body activates your immune system, inflammatory cells get sent throughout the body. These cells start what’s called an inflammatory response to trap and attack bacteria and other invaders, or to start healing damaged tissue. The results of an inflammatory response can be:
pain
swelling
redness
bruising
But inflammation also affects systems in your body that you can’t see, so you may not notice the inflammation.
There are two types of inflammation:
Acute inflammation (short-term) is your body’s response to injury or damage, such as cutting your finger or breaking a bone. To heal the injury, your body sends inflammatory cells to the injury to start the healing process.
Chronic inflammation (long-term) is when your body continues sending out inflammatory cells, even though there is no irritant. Autoimmune disorders are often linked to chronic inflammation. For example, in rheumatoid arthritis, inflammatory cells attack joint tissue, which leads to inflammation that can severely damage the joints.
C-reactive protein is a protein made by your liver. Your C-reactive protein levels are usually low, unless you have inflammation in your body. When you have inflammation, your liver releases more C-reactive protein into your bloodstream. Measuring C-reactive protein levels can tell you if and how much inflammation you have. But the test can’t tell you what’s causing the inflammation or which part of your body is inflamed.
Doctors routinely use C-reactive protein test results to determine a person’s risk of heart disease. In this study, the researchers wanted to see if C-reactive protein levels might be linked to cognitive problems in women who had received breast cancer treatment.
About the study
Called the Thinking and Living With Cancer study, the study is one of the first long-term trials looking at the possible link between chronic inflammation and cognition in breast cancer survivors age 60 and older.
The study included 400 women age 60 and older who had received treatment for early-stage breast cancer and 329 similar women age 60 and older who had never been diagnosed with breast cancer. The women ranged in age from 60 to 90.
Overall, women who had received breast cancer treatment were more likely to have more than two other health conditions and be obese than women with no history of breast cancer.
Among the women who received breast cancer treatment:
17.4% were diagnosed with DCIS, or stage 0 breast cancer
60.9% were diagnosed with stage I breast cancer
18.2% were diagnosed with stage II breast cancer
3.6% were diagnosed with stage III breast cancer
88.6% of the cancers were estrogen receptor-positive
12% of the cancers were HER2-positive
23.3% of the women received chemotherapy
47.5% of the women received hormonal therapy and radiation therapy
29.3% of the women received hormonal therapy without radiation therapy or had only surgery
The researchers interviewed the women and took blood samples from them up to six times in five years. The women also filled out standard questionnaires that assessed how they perceived their cognition, including their ability to remember names and to concentrate.
The researchers also measured the women’s cognitive performance — including memory function, problem-solving, and the ability to think and understand — using standard neuropsychological tests.
The results showed that higher C-reactive protein levels were linked to worse cognitive function as reported by women who had received breast cancer treatment.
There was no relationship between C-reactive protein levels and reported cognitive function in women who had no history of breast cancer.
The researchers also found no link between C-reactive protein levels and cognitive performance as measured by standard neuropsychological tests.
The researchers pointed out that this may mean women are more sensitive to differences in their everyday cognitive function and self-report subtle cognition changes that other tests miss.
“Cognitive issues affect women’s daily lives years after completing treatment, and their reports of their own ability to complete tasks and remember things was the strongest indicator of problems in this study,” co-senior study author Jeanne Mandelblatt, MD, MPH, professor of oncology at Georgetown University said.
The researchers said their study supports the need for research on whether strategies to reduce inflammation — including more physical activity, better sleep, and anti-inflammatory medicines — may prevent or reduce cognitive problems in older women who’ve received breast cancer treatment.
What this means for you
If you’re age 60 or older and have received treatments for early-stage breast cancer, the results of this study are concerning. But the results also suggest that reducing chronic inflammation could help ease any cognitive problems you may be having.
Although more research is needed to see if steps such as exercising more and sleeping better lead directly to better cognition, we do know that regular exercise and good sleep can boost your well-being and help you be as healthy as you can.
Other healthy habits that can help decrease chronic inflammation are:
maintaining a healthy weight
not smoking, or quitting if you do
limiting or avoiding alcohol
managing stress with meditation, yoga, or journaling
Learn more about thinking and memory problems.
— Last updated on November 16, 2022 at 7:17 PM