It happened again last month. On two different levels. I was working with a couple that I had been seeing for months, and I asked “Have we talked about BTF communication?” They shook their head ‘no’, and I felt a twinge of guilt. This is a crucial skill for couples to use, and they could have been benefiting from it for quite a while. ‘Okay,’ I blurted, ‘let’s talk about BTF communication. Also, pretty please promise me that you will not report me to the College of Psychologists of British Columbia for gross negligence.” They laughed, and I started the topic.
I had the same feeling while I was writing the previous post. There is crucial information that would be beneficial, even life-saving to so many of you and I have not unpacked the topic yet. It is a big one, so we will spend several posts painting a clear picture. I mentioned in the very first post that women diagnosed with breast cancer who are in a lousy marriage are 4 times more likely to have a recurrence of cancer, or to die, over a 10 year follow-up, than women in a good marriage. [i] Although I love statistics[ii] , this is more than a startling finding. It also took my mother’s life.
Sadly, my mother met both criteria. She was a survivor of breast cancer who had a single mastectomy to excise it. She also was in a lousy marriage. There was no violence or abuse, just two people who experienced friction over the same topics that all married couples do. Conflict over raising the kids. Arguments over holidays. My father was obsessed with working on the farm, and my mother had psychological injuries from her childhood that had never been healed and were manifesting decades later. There were occasional hugs, but sharp words and angry moods were more common. There was no cruelty between them, but there also was little connection and warmth.
The marriage limped along for years, and Mom started complaining of pain in her back. And then overnight, it changed. I went to bed one night in a house full of friction, and the next morning, there was much more peace and harmony. My parents started holding hands. They were more affectionate and cooperative with each other. I was startled at the shift. Later, Dad told me that they went to a meeting at church and asked for prayer. He said that there was an immediate change between them, and forgiveness. It was marvelous. It also was very brief. Only a couple of months later Dad said that Mom’s back pain actually was bone cancer. Half a year later, she died.
There are many things to unpack, but the first question is ‘how’? How do the sarcastic words between husband and wife not just resonate in the ears, but oscillate through their bodies? How do resentments permeate the body to energize the return of the cancer that had been treated years earlier? How does the relationship between spouses wire their biology?
Marital conflict that scrapes and scratches through the seasons is stressful. And when people are chronically stressed, the hormone that is released is cortisol. Nearly every cell in the body has receptors for cortisol, showing how the whole body is involved managing stress and danger. Cortisol is needed when the danger carries on and on. It mobilizes glucose into the bloodstream, giving the body energy for a longer period of time to either fight or flee. To keep the glucose in the blood so that it is available for your muscles, cortisol inhibits insulin from storing the glucose into cells. Cortisol also narrows the arteries, which increases blood pressure and forces the heart to pump faster. It reduces inflammation in the body as well. All these effects help your body in the short term to cope with danger. Thanks to cortisol, your muscles have more energy available to them, your heart speeds up (which brings more oxygen and glucose to your muscles), and you are more able to cope with injury.
But there is a dark side as well. As a result of biochemical reactions, cortisol eventually creates molecules that easily engage in chemical reactions, called reactive nitrogen species.[iii] Like their nasty cousins (reactive oxygen species), they can tear apart proteins and damage DNA. No wonder that people with high levels of cortisol show more breakage in their DNA.[iv] [v] And when people have high levels of cortisol in their blood for long periods of time, due to chronic stress, there is a cascade of negative effects. Cortisol suppresses the immune system, making people more susceptible to infections. Cortisol results in weight gain in three different pathways, including storing fat in the belly, overeating, and craving junk foods.
You do not need to be a keener to realize that DNA damage, suppression of the immune system, and weight gain all increase the risk of a relapse of cancer. And marital stress plays havoc with cortisol levels. When scientists studied newlyweds who were in excellent physical and mental health, they found that when couples had a conflict in the lab, the wife consistently had higher cortisol levels for hours.[vi] This is an interesting finding, but probably not that relevant to you, since you likely are not a newlywed in superb health. Looking at the other end of the age range is more relevant, such as when researchers looked at couples who had been together for over 40 years. If they used an unhealthy pattern of communication in resolving a conflict (wife demands/husband withdraws), then her cortisol level rose for hours.[vii] If the husband believed that his wife used an unhealthy pattern his cortisol level rose as well. In a similar vein, if the husband believed he had low levels of support from his wife, his cortisol levels rose for hours after discussing a conflict with his wife.[viii]
Pivoting away from newlyweds and the elderly, other researchers looked at couples in the middle age range. They wanted to see if stress levels affected cortisol levels during a conflict. And yes, I see the keener in the front row waving their hand in the air, quivering with excitement to tell me their guess that those couples who had a partner who was stressed, had higher cortisol levels. Very good. Oh, you also guess that if they used unhealthy communication during the discussion, that it spiked cortisol also? [ix] You are spot on, keener, you will get an A on the test.
Jesting aside, we understand more how the sharp words in a crummy marriage move deep inside to rewire the biology of both partners. When couples are in conflict, their cortisol levels rise and stay high, especially among wives. If one partner is stressed, or there are low levels of support in the marriage, or negative communication patterns, that can increase cortisol as well. And chronic levels of cortisol increase DNA breakage, suppress the immune system, and facilitate weight gain. These factors all elevate the risk of cancer recurring. Scientists in the early 1980’s had no idea that these dynamics existed. Nobody knew that they were corrupting my mother’s cells.
But we know now, and you can use this to improve your health, or your partner’s health. Instead of criticizing, sneering, swearing at, or shutting down on your partner, shift gears. Marriage takes work, not cheap shots. It takes effort to respect each other as you speak. It takes effort to consider the other person’s point of view. It takes effort to acknowledge the positive things your partner does, even if you are frustrated or angry with one of their behaviors now. But that effort pays off, in having healthier discussions. Those produce healthier bodies, with less cortisol. Naturally, some couples cannot find their way up, if they have been in sharp downward spirals for too long. Marriage therapy can help heal those wounds, reorient you as a couple, and facilitate connection again. Whether you and your partner can improve on your own, or need expert help for your relationship, improving it is a very powerful weapon in your struggle against cancer.
[i] Yuan L, Cai H, An W, Yuan W, Toloza EM, Song Y, An J. (2023). Associations between marital quality and the prognosis of breast cancer in young Chinese women: 10.3-year median follow-up. Chin Clin Oncol. Oct;12(5):51. doi: 10.21037/cco-23-63. PMID: 37872116
[ii] Let me know if I am giving you too many.
[iii] Flaherty RL, Owen M, Fagan-Murphy A, Intabli H, Healy D, Patel A, Allen MC, Patel BA, Flint MS. (2017) Glucocorticoids induce production of reactive oxygen species/reactive nitrogen species and DNA damage through an iNOS mediated pathway in breast cancer. Breast Cancer Res. Mar 24;19(1):35.
[iv] Joergensen A, Broedbaek K, Weimann A, Semba RD, Ferrucci L, Joergensen MB, Poulsen HE. (2011) Association between urinary excretion of cortisol and markers of oxidatively damaged DNA and RNA in humans. PLoS One. 6(6):e20795.
[v] Aschbacher K, O'Donovan A, Wolkowitz OM, Dhabhar FS, Su Y, Epel E. (2013) Good stress, bad stress and oxidative stress: insights from anticipatory cortisol reactivity. Psychoneuroendocrinology. Sep;38(9):1698-708.
[vi] Kiecolt-Glaser, J. K., Newton, T., Cacioppo, J. T., MacCallum, R. C., Glaser, R., and Malarkey, W. B. (1996). Marital conflict and endocrine function: Are men really more physiologically affected than women? J. Consult. Clin. Psychol. 64(2): 324–332.
[vii] Heffner KL, Loving TJ, Kiecolt-Glaser JK, Himawan LK, Glaser R, Malarkey WB. (2006). Older spouses' cortisol responses to marital conflict: Associations with demand/withdraw communication patterns. J Behav Med. Aug;29(4):317-25. doi: 10.1007/s10865-006-9058-3. PMID: 16786411
[viii] Heffner KL, Kiecolt-Glaser JK, Loving TJ, Glaser R, Malarkey WB. (2004). Spousal support satisfaction as a modifier of physiological responses to marital conflict in younger and older couples. J Behav Med. Jun;27(3):233-54. doi: 10.1023/b:jobm.0000028497.79129.ad. PMID: 15259454
[ix] Shrout MR, Renna ME, Madison AA, Jaremka LM, Fagundes CP, Malarkey WB, Kiecolt-Glaser JK. (2020). Cortisol slopes and conflict: A spouse's perceived stress matters. Psychoneuroendocrinology. Nov;121:104839. doi: 10.1016/j.psyneuen.2020.104839. PMID: 32853875
Much evidence on oxidative protocols for cancer though like CDS if done properly. Agree though unhappy marriages effect women's health and it seems to be breasts that are at risk. How sad 😔