The question nobody asked 36 women with breast cancer

She sat across from me and told me how breast cancer changed everything. Her plans. Her body. How safe she felt in the world. Then she said something I still think about.

"I never thought in a million years this would happen to me."

She went quiet for a long moment.

"But that's life."

I let the silence sit. Then I asked her the question I ask everyone who comes to me.

"Did you find out about your cancer after a huge stress or trauma in your life? Or did it come out of nowhere?"

She looked at me. "Yes. After my dad passed away. I couldn't handle life without him. I couldn't believe he was gone. I isolated myself from everyone, even my family. Then slowly, step by step, I started to get back to normal. And that's when I found out about the cancer."

She wasn't the only one who told me this.

36 women. One answer.

For 8 years I ran my own pain management clinic. In those years I worked with a foundation that supports women with breast cancer. The women came to me after their treatment, when they were putting their lives back together. I did not know any of them before the cancer. Over time, 36 women came through my door, one at a time.

They came from different walks of life. Working women and stay-at-home mothers. Some went to a doctor only when the symptoms were quite unusual for them. Some found out by coincidence, at the yearly breast scan, with no symptoms at all.

I asked each one the same question. Each one said yes.

Their diagnosis came after a period of heavy stress or trauma. Not everyday stress. The kind that shakes the foundation of your life. Most of them had lived in a draining relationship for years, so many years that they adapted to it and called it a normal life. Some had lost a beloved parent or partner, and with that loss they lost the desire to live. Some had been betrayed by the person they trusted most. Some had spent years carrying an impossible burden alone, telling everyone they were fine while quietly falling apart inside. Some had carried trauma since childhood. They never said it. I could tell because I saw how they had lost their own inner voice, or could not listen to it anymore. In my opinion, they lost it in a way that disconnected them totally from themselves, from who they truly are.

Thirty-six women. Thirty-six different stories. One pattern.

Every one of them had carried chronic stress for so long that she could not tell me when it even started.

The years before the diagnosis

Together, these 36 women sat through hundreds of appointments. Scans, surgery, chemotherapy, follow-ups. Their doctors treated the cancer, and treated it well. These women are alive. But in all of those appointments, nobody asked them how their life was before the diagnosis. Nobody asked if it came after a huge stress or trauma, or even how their environment was.

That was the shock for me. The stress did not shock me. I had seen what chronic stress does to a body for years. The gap shocked me. Each of these women walked in with a whole life behind her, and nobody had time to ask about it.

I believe our illness starts years before we get the name. The diagnosis has a date. The illness never does.

Medicine knew this once. Then it stopped asking.

Around 1,800 years ago, the Greek doctor Galen taught that cancer came from an excess of black bile (one of four fluids the old doctors believed ran the body). In his system, black bile was the fluid that caused sadness and grief. For about 1,500 years, doctors believed that a cancer and a grieving heart grew from the same source.

Then the anatomists opened the body and looked. They cut into tumors and found no black bile anywhere. In 1793, Matthew Baillie published his drawings of tumors, and the theory of black bile was retired. Siddhartha Mukherjee tells this story in The Emperor of All Maladies, his book on the history of cancer.

Here is what I take from it. Galen's explanation was wrong, because no one ever found black bile in a tumor. But his question was right: what has this person been carrying? When his theory died, the question died with it. For 1,500 years doctors had asked what a person had been carrying. After 1793 they asked what the cells were doing. More than 200 years later, "what are the cells doing?" is still the question a cancer appointment is built around. My 36 women are the proof.

What years of carrying something can do to our body

I asked my 36 women that question because I already knew what chronic stress does to a body. I always like to validate what I see with what the research says. Here is what the data says about how our body works under years of stress, step by step. Every step below comes from studies in people.

1. The alarm never switches off. A stressful day sharpens you. Adrenaline and cortisol go up, and your immune system gets ready for a wound. When the stress has no end and no exit, that same system turns on your body. Researchers pooled 293 studies of nearly 19,000 people. The longer stress lasts, and the less control we have over it, the weaker our immune system gets.

2. Loneliness changes how your immune cells work. In people who felt isolated, more than 200 genes in their white blood cells behaved differently from people who felt connected. The inflammation genes switched up. The genes that fight viruses and make antibodies switched down. Adrenaline carries the message. The same pattern shows up in people who are grieving, in long-term caregivers, in people carrying trauma. This is what "stress changes your DNA" really means. Your DNA stays the same. Stress changes which genes are switched on and which are switched off.

3. The brake stops working. Cortisol is the brake on inflammation. Under long stress, your immune cells stop listening to it. Researchers gave 276 healthy adults a cold virus. The ones living under long stress had cells that no longer answered cortisol. Inflammation ran free, and they got sicker. The body keeps pressing the brake, and the cells stop feeling it.

4. Fewer guards on duty. Your body has cells whose only job is to find damaged cells and destroy them. Every day, every cell in your body takes thousands of small hits to its DNA. Your cells repair most of them. Natural killer cells, the guards of your immune system, catch the rest. In 75 medical students, natural killer cell activity dropped at exam time, and it dropped most in the lonely students. Under long stress, fewer guards are on duty. How much do they matter? After an organ transplant, doctors switch the immune system down on purpose, with drugs. Among 175,732 transplant patients, the overall rate of cancer about doubled. That is what happens when the guards are off duty.

5. The minerals drain. Adrenaline pulls magnesium out of your blood within the hour, and your kidneys keep flushing it out for up to two days. In one study of stressed people, up to 45% were quietly low in magnesium. Low magnesium makes the stress response louder. A circle that feeds itself. Then the shortage does its own damage. A shortage of folate, B12, B6, iron, zinc or vitamin C damages DNA the same way radiation does. Low folate alone can put about four million wrong letters into the DNA of one cell. I believe many of my 36 women had been short of what their bodies needed for years, on top of the stress.

6. A normal cell becomes a cancer cell. A normal cell obeys three rules. It stops dividing when the body tells it to. It dies when the damage is too much to repair. And if it breaks the first two rules, the guards catch it. A cancer cell has lost all three, one change at a time, over years. It learned to hide from the immune system and to feed on inflammation. Look back at steps 2 to 5. Each one wears down one of those rules.

Why the biggest study found no single cause. Researchers pooled 22 groups of people from around the world. No single factor, stress included, predicted who would get cancer. I believe them. Cancer takes years and many hits from many directions. In the largest twin study ever done, genes explained about a third of cancer risk. The rest is the life around the genes. Years of carrying something wear down every defense your body has. And nobody asks.

Your heart knows before you do

The heart is the quickest witness. Researchers studied 1,985 people who had a heart attack. In the first 24 hours after losing someone they loved, the risk of a heart attack was 21 times higher than on an ordinary day. There is a diagnosis called broken heart syndrome. A surge of stress hormones stuns the heart muscle until it looks and feels like a heart attack. Nine in ten of the people it happens to are women after menopause. The triggers in the cardiology journals: a death, a divorce, a lost job.

Slower, and just as real. When researchers pooled the studies on loneliness, living alone raised a person's chance of dying in the years that followed by 32%. Feeling lonely raised it by 26%.

Your heart reports the other direction too. Researchers followed 1,739 healthy adults for ten years. Each step up in measured happiness meant 22% less heart disease. And in the longest study of human life ever run, started at Harvard in 1938, how satisfied people were with their relationships at 50 predicted their physical health at 80 better than their cholesterol did.

Bottom line

I believe the real guide to living healthy is to accept that we are human. We need love. We have to be kind. We need people around us who care about us and love us, and we have to be that for them. If we got that right, I think a lot of our problems, and a lot of our diseases, would not be there at all.

Nothing in your life is worth your health. Not the job. Not the resentment. Not the relationship you keep because leaving is harder. Not the "yes" you keep saying because you cannot say no.

I have asked this question for a long time. These 36 women confirmed it for me, and so did many other clients since, with different conditions. The cases were different. The root causes were almost the same.

Your body is always talking to you. It whispers for years before it has to shout.