Psychosocial influences on cancer progression: alternative cellular and molecular mechanisms

Considerable interest in the biobehavioural pathways linking stress and can cer as well as the identification of modifiable risk factors has increased research examining psychological adjustment, biological responses, and canc er outcomes. Although most of this work has focused on how stress affects p rocesses such as immune surveillance that govern survival of tumors, less a ttention has been directed at how stress contributes to somatic mutation an d genomic instability, Progress in this area may be facilitated by consider ing how stress affects events that modulate development and accumulation of somatic mutations in addition to those affecting survival of tumor cells. It is possible that a sharper focus on other relevant biological processes such as increases in DNA damage, alterations in DNA repair, and inhibition of apoptosis, may explain more of the variance in disease outcomes. Cur Opi n Psychiatry 13:639-645. (C) 2000 Lippincott Williams & Wilkins.