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It’s called the silent killer for a reason. Ovarian cancer is difficult to detect in its early stages. Most patients are diagnosed when the disease has significantly progressed, reducing their chance of survival.

But a new study from Moffitt Cancer Center and Harvard T.H. Chan School of Public Health may shed light on one possible factor that could increase a woman’s risk of developing ovarian cancer. Their research suggests women who experience six or more symptoms of post-traumatic stress disorder (PTSD) at some point in their life had a twofold greater risk of developing the disease compared to women who have never had PTSD symptoms. PTSD symptoms including being easily startled by ordinary noises or avoiding reminders of traumatic experiences.

For this study, the research team analyzed responses from the Nurses’ Health Study II, a database that tracked the health of thousands of women between 1989 and 2015 through regular questionnaires and medical records. The participants who identified as having an ovarian cancer diagnosis were provided a supplemental questionnaire that asked if they had suffered any type of traumatic event during their life and what symptoms they experienced with those events. The results showed that women who experienced six or more symptoms associated with PTSD had a significantly higher risk of developing the high-grade serous histotype of ovarian cancer, which is the most common and aggressive form of the disease.

“Ovarian cancer has relatively few known risk factors. PTSD and other forms of distress, like depression, may represent a novel direction in ovarian cancer research,” said Dr. Shelley Tworoger, associate center director of Population Science at Moffitt. “If confirmed in other populations, this could be one factor that doctors could consider when determining if a woman is at higher risk of ovarian cancer in the future.”

The researchers say it is too soon to know whether other types of stress are also risk factors for ovarian cancer. They also would like to investigate whether successful treatment of PTSD could lower ovarian cancer risk.