Childhood sexual assault and women’s cancer risk: is there a link?
Up to 30% of girls in the United States experience sexual assault during childhood. Research has shown that this experience can affect survivors’ long-term health. In certain cases, the experience of sexual assault in childhood can even increase a woman’s lifetime risk of cancer.
Childhood sexual assault can cause lifelong changes to a survivor’s health. Survivors are more likely to experience early-onset puberty, menstruation, perimenopause, and endometriosis. They also have a higher chance of financial instability.
These and other potential effects of childhood sexual assault can ultimately increase survivors’ risk of cancer. Understanding the long-term health effects of an assault can help survivors and their loved ones take steps to protect their health. Let’s take a deeper look at this connection between childhood sexual assault and women’s cancer risk now.
Childhood sexual assault and the reproductive timeline
Childhood sexual assault can trigger permanent changes in the reproductive cycle. Numerous studies have shown that survivors are more likely to begin menstruation at a younger age. And they typically experience an earlier onset of puberty when compared with age-matched controls.
These and other changes to the reproductive timeline may increase a survivor’s risk of cancer later in life.
According to the National Cancer Institute, starting menstruation early is associated with an increased risk of breast cancer. In one study, researchers estimate that the risk of breast cancer increases by a factor of 1.05 for each year of decreased age at the onset of menstruation.
In another study, researchers examined 19 different types of cancer among middle-aged women. In addition to breast cancer, they found that women who experienced early-onset menstruation had an increased risk of:
Endometrial cancerLiver cancerMelanomaBladder cancerColon cancerLung cancer
Recent studies have further demonstrated that childhood sexual assault can increase the risk of perimenopause, or early menopause. According to one such study, women who experienced severe sexual assault as children experienced double the risk of perimenopause.
Starting menopause before the age of 40 increases an individual’s risk of breast and ovarian cancer by 2 and 4 times, respectively. Relatives of these individuals are also at an increased risk of prostate, colon, and breast cancer.
Women with perimenopause also have double the risk of developing cardiovascular disease (CVD) before 60 years of age. Cardiovascular disease increases the risk of a number of health conditions, including cancer. One recent study found that individuals with CVD are 13% more likely to have cancer than people without CVD.
Survivors of childhood sexual assault may experience early puberty, menstruation, and menopause. This can increase the risk of certain cancers and other health conditions. Survivors are also more likely to develop certain premenstrual conditions. Let’s examine this in further detail now.
Childhood sexual assault and endometriosis
Survivors of childhood sexual assault also have a higher risk of developing premenstrual disorders like premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and endometriosis.
In one study of women with diagnosed endometriosis, women who reported severe childhood sexual assault had a 79% increased risk of endometriosis. Participants who experienced more severe abuse later developed more severe cases of endometriosis.
Recent research has demonstrated that endometriosis can increase the risk of certain cancers. For instance, researchers have found that exposing breast tissue to elevated estrogen levels can cause breast cancer. Increased levels of estrogen caused by endometriosis may thus increase breast cancer risk.
In the United States, it takes an average of 7 years for individuals with endometriosis to receive a diagnosis following symptom onset. This diagnostic delay can lead to worsened symptoms and heightened healthcare costs.
This delay may also contribute to the heightened rate of cancer among people with endometriosis. These individuals are over 4 times more likely to develop ovarian cancer, for example.
Women who experience childhood sexual assault are at a higher risk of diseases like endometriosis. Likewise, individuals with this condition have a higher risk of certain cancers. Diagnostic delays and lack of treatment options can limit or restrict access to endometriosis care.
Survivors of childhood sexual assault should be educated about their risk of developing further health conditions. Providing survivors with actionable knowledge may help reduce the lifelong health effects of childhood assault.
Childhood sexual assault and the stress response
Childhood sexual assault is known to disrupt the hypothalamic-pituitary-adrenal (HPA) axis. The HPA helps regulate the body’s response to stress. Disrupting the HPA axis can affect levels of cortisol, the body’s stress hormone.
Irregular cortisol levels can cause a range of different health conditions, from anxiety to prenatal depression. Researchers have also found that HPA axis disruption can increase the risk of obesity among survivors of childhood sexual assault.
In the United States, obesity remains one of the leading causes of cancer – and this is particularly true among women. Nearly 10% of cancer cases among women in the United States are caused by obesity. On the other hand, obesity causes fewer than 5% of cancer cases among men.
Women with obesity are at an especially high risk of breast cancer following menopause. They are also at an increased risk of ovarian, colon, endometrial, gallbladder, and other cancers. Furthermore, obesity elevates the risk of death following a cancer diagnosis.
In addition to increased obesity risk, childhood sexual assault can have a number of other effects on the body’s stress response. For example, recent studies have found that sexual assault in early life can trigger chronic inflammation throughout the body. Ongoing exposure to stress can also weaken an individual’s immune response.
Elevated levels of inflammation, combined with a weakened immune system, can play a part in cancer development and progression. Individuals with elevated cortisol levels may also experience higher levels of discomfort during cancer treatment.
The stress caused by childhood sexual assault can have long-lasting effects on a survivor’s health. It can increase the risk of obesity and chronic inflammation, both of which contributed to increased cancer risk in turn.
Childhood sexual assault and financial instability
Survivors of childhood sexual assault have a higher chance of experiencing financial instability throughout their lives. Research has shown that these individuals are more likely to experience housing instability and unemployment. They are also less likely to achieve advanced academic success.
Financial instability is an established risk factor for a number of different cancers. For example, researchers have found that poverty can increase mortality rates in lung, colorectal, breast, liver, and other cancers.
These rates can vary widely among counties in the United States. Residents of counties with higher rates of poverty have a higher chance of dying from cancer. One study estimated that the rate of cancer death in these counties was about 12% higher than in counties unaffected by persistent poverty.
The relationship between financial instability and cancer risk is especially pronounced in breast cancer rates. Women who live in areas with high rates of persistent poverty have an approximately 10% greater chance of dying from breast cancer. These women are also more likely to:
Experience aggressive tumorsDevelop more advanced diseaseRequire a mastectomyUndergo lymph node dissection
According to the American Cancer Society, breast cancer makes up around 30% of cancers that affect women each year. The cost of treating breast cancer represents about 14% of the costs for total cancer treatment in the United States each year.
The cost of breast cancer disproportionally affects survivors of childhood sexual assault. These survivors are at a greater risk of developing and dying from breast cancer. They are also more likely to experience financial instability, which may limit their healthcare options.
Discussion
According to the Centers for Disease control, at least 1 in 4 girls in the United States experience childhood sexual abuse. The CDC likewise asserts that “little investment has been made in preventing child sexual abuse.”
One effort to reduce childhood sexual abuse is mandatory reporting, a process that requires certain authority figures to report child abuse. However, only 23 states require these individuals to undergo mandatory reporter training. Federal law does not apply in most cases of childhood sexual abuse, so reporting policies vary by state.
These policies are largely focused on the legal process following sexual assault of a minor. Many institutions also offer guidelines for STI treatment and mental health support for survivors of these assaults. Beyond STI counseling, few (if any) institutions provide further education or support on the potentially lifelong changes to a survivor’s health.
Providing education about these changes can help both survivors and their loved ones. Expanding awareness among healthcare practitioners could help shift the focus of treatment towards preventative care. Keeping insurance companies up to date on the health implications of childhood sexual assault could also help ensure that survivors can access (and afford) the care they need. For example, insurers could provide expanded cancer screening coverage for survivors of childhood sexual assault. Enhancing education and coverage would reduce healthcare costs for providers and subscribers alike. And, much more importantly, it could save lives.
