Response to Lehrer Free

We thank Dr Lehrer for his correspondence regarding our research.¹ Dr Lehrer’s findings provide further support of distress as a putative causal risk factor for ovarian cancer. In the Finnish population, using Finngen/Risteys data, Dr Lehrer found that both depression (hazard ratio = 1.38, 95% CI = 1.05 to 1.82) and any anxiety disorder (hazard ratio = 1.84, 95% CI = 1.27 to 2.67) were statistically significantly associated with incident ovarian cancer.¹

Consistent evidence across different populations supports distress as a putative risk factor for ovarian cancer.^1-7 Given its high prevalence in women, distress may be a meaningful risk factor for ovarian cancer at the population level.

Cancer interception, which is taking an active approach to combating or stopping cancer at earlier stages, may be an important strategy to reduce ovarian cancer risk in individuals experiencing distress. To develop appropriate recommendations to reduce cancer risk, future research should focus on

• the relationship between distress and ovarian cancer risk in underrepresented populations, because most studies have been conducted in non-Hispanic White individuals;

• the association between distress and risk among individuals who are at high risk of ovarian cancer either because of genetic variations or because they have multiple risk factors;

• the potential impact of including distress in risk-prediction models for ovarian cancer;

• mechanistic pathways, such as inflammation, immune suppression, and metabolic dysregulation, by which distress affects early carcinogenesis to identify targets for interception; and

• the potential of specific agents or interventions that can either reduce the severity of distress (eg, green space exposure, coping, meditation, individual counseling) or reduce related inflammation or increase immunity (eg, aspirin, statins, physical activity).

The growing body of work on this topic further demonstrates the importance of diagnosing and treating distress in women, particularly because distress-related disorders are a problem in their own right as well as associated with increased risk for several additional adverse health outcomes (eg, cancer, heart disease, dementia, mortality).

Author contributions

Andrea Roberts, PhD (Writing—review & editing), Laura Kubzansky, PhD (Writing—review & editing), Shelley Tworoger, PhD (Writing—original draft)

Funding

This research was funded by the US Department of Defense grant No. W81XWH2110326 (to S.T. and L.K.). The Nurses’ Health Studies are funded in part by National Institutes of Health grants UM1CA186107, P01CA87969, and U01CA176726. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Defense or the National Institutes of Health. The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication.

Conflict of interest

The authors declare no potential conflicts of interest.

Data availability

No data were generated or analyzed for this response.

References