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DNA Repair Capacity in Healthy Medical Students During and After Exam Stress

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Abstract

There has been extensive research into the effects of stress on immune function but little on the effects of stress on DNA repair capacity (DRC), a process central to maintaining a normal cell cycle. Defective DRC is one of the factors responsible for carcinogenesis. In the present study we assessed DRC in healthy medical students during times of high and low stress. Sixteen medical students were evaluated during the third day of a 5-day exam period and then again 3 weeks later, after vacation. At both time points, participants underwent a brief physical examination, had venous blood drawn, and completed questionnaires to identify subjective stress levels. The DRC was assessed by the host-cell reaction assay, which measures nucleotide excision repair capacity. Participants reported significantly higher levels of subjective stress during the exam period than after vacation. DRC was also significantly higher during the exam period than after vacation, suggesting a positive association between subject stress levels and DRC. The results are discussed in relation to previous findings and implications for cancer research.

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REFERENCES

  • Adachi, S., Kawamura, K., and Takemoto, K. (1993). Oxidative damage of nuclearDNAin liver of rats exposed to psychological stress. Cancer Res. 53(18): 4153-4155.

    Google Scholar 

  • Adler, A., Stein, J. A., and Ben-Efraim, S. (1980). Immunocompetence, immunosuppression, and human breast cancer. III. Prognostic significance of initial level of immunocompetence in early and advanced disease. Cancer 45: 2074-2083.

    Google Scholar 

  • Andersen, B. L., Farrar, W. B., Golden-Kreutz, D., Kutz, L. A., MacCallum, R., Courtney, M. E., and Glaser, R. (1998). Stress and immune responses after surgical treatment for regional breast cancer. J. Natl. Cancer Inst. 90(1): 30-36.

    Google Scholar 

  • Athas, A. F., Hedayati, M., Matanoski, G. M., Framer, E. R., and Grossman, L. (1991). Development and field-test validation of an assay for DNA repair in circulating human lymphocytes. Cancer Res. 51: 5786-5793.

    Google Scholar 

  • Bishop, J. M. (1991). Molecular themes in oncogenesis. Cell 64: 235-248.

    Google Scholar 

  • Bovbjerg, D. H. (1991). Psychoneuroimmunology. Implications for oncology? Cancer 67: 828-832.

    Google Scholar 

  • Burke, M. A., and Goodkin, K. (1997). Stress and the development of breast cancer: A persistent and popular link despite contrary evidence. Cancer 79(5): 1055-1058.

    Google Scholar 

  • Cassileth, B. R. (1996). Stress and the development of breast cancer: A persistent and popular link despite contrary evidence. Cancer 77: 1015-1016.

    Google Scholar 

  • Chen, C. C., David, A. S., Nunnerley, H., Michell, M., Dawson, J. L., Berry, H., Dobbs, J., and Fahy, T. (1995). Adverse life events and breast cancer: Case-control study. Br. Med. J. 311: 1527-1530.

    Google Scholar 

  • Ciaranello, R. D., Dornbusch, J. N., and Barchas, J. D. (1972). Rapid increase of phenylethanolamine N-methyltransferase by environmental stress in an inbred mouse strains. Science 175(23): 789-790.

    Google Scholar 

  • Cleaver, J. E., and Kraemer, K. (1989). Xeroderma pigmentosum. In Scriver, C. R., Beaudet, A. L., Sly, W. S., and Vale, D. (eds.), The Metabolic Basis of Inherited Diseases II, McGraw-Hill, New York, pp. 2949-2971.

    Google Scholar 

  • Cohen, S. (1996). Psychological stress, immunity, and upper respiratory infections. Curr. Dir. Psychol. Sci. 5(3): 86-90.

    Google Scholar 

  • Cohen, S., and Herbert, T. B. (1996). Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annu. Rev. Psychol. 47: 113-142.

    Google Scholar 

  • Cohen, S., Kamarck, T., and Mermelstein, R. F. (1983). A global measure of perceived stress. J. Health Soc. Behav. 24: 385-396.

    Google Scholar 

  • Decker, D., Schondorf, M., Bidlingmaier, F., Hirner, A., and von Ruecker, A.A. (1996). Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-medicated and up-regulation of antibody-mediated immunity commensurate to the trauma. Surgery 119: 316-325.

    Google Scholar 

  • Eichman, W. (1989). The Eighth Mental Measurements Yearbook, Gryphon Press, NJ.

    Google Scholar 

  • Fawzy, F. I., Fawzy, N. W., Hyun, C. S., Elashoff, R., Guthrie, D., Fahey, J. L., and Morton, D. L. (1993). Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch. Gen. Psychiatry 50: 681-689.

    Google Scholar 

  • Fife, A., Beasley, P. J., and Fertig, D. L. (1996). Psychoneuroimmunology and cancer: Historical perspectives and current research. Adv. Neuroimmunol. 6: 179-190.

    Google Scholar 

  • Fischman, H. K., Pero, R.W., and Kelly, D. D. (1996). Psychogenic stress induces chromosomal and DNA damage. Int. J. Neurosci. 84(1–4): 219-227.

    Google Scholar 

  • Foecking, M. K., and Hofstetter, H. (1986). Powerful and versatile enhancer-promoter unit for mammalian expression vectors. Gene 45: 101-105.

    Google Scholar 

  • Garzetti, G. G., Ciavattini, A., Goteri, G., Tranquilli, A. L., Muzzioli, M., Fabris, N., De Nictolis, M., and Romanini, C. (1994). Natural killer cell activity in stage I endometrial carcinoma: Correlation with nuclear grading, myometrial invasion, and immunoreactivity of proliferating cell nuclear antigen. Gynecol. Oncol. 55: 111-114.

    Google Scholar 

  • Gehde, E., and Balthrusch, H. J. F. (1990). Early experience and development of cancer in later life: Implications for psychoimmunologic research. Int. J. Neurosci. 51: 257-260.

    Google Scholar 

  • Glaser, R., Kiecolt-Glaser, J. K., Speicher, C. E., and Holliday, J. E. (1985a). Stress, loneliness, and changes in herpesvirus latency. J. Behav. Med. 8: 249-260.

    Google Scholar 

  • Glaser, R., Thorn, B. E., Tarr, K. L., Kiecolt-Glaser, J. K., and D'Ambrosio, S. M. (1985b). Effects of stress on methyltransferase synthesis: An importantDNArepair enzyme. Health Psychol. 4(5): 403-412.

    Google Scholar 

  • Greer, S., and Morris, T. (1975). Psychological attributes of women who develop breast cancer: A controlled study. J. Psychosom. Res. 19: 147-153.

    Google Scholar 

  • Greer, S., Morris, T., and Pettingale, K. W. (1979). Psychological response to breast cancer: Effect on outcome. Lancet 2: 1239-1248.

    Google Scholar 

  • Hartwell, L. H., and Weinert, T. A. (1989). Checkpoints: Controls that assure the order of cell cycle events. Science 246: 629-633.

    Google Scholar 

  • Head, J. F., Elliott, R. L., and McCoy, J. L. (1993). Evaluation of lymphocyte immunity in breast cancer patients. Breast Cancer Res. Treat. 26: 77-88.

    Google Scholar 

  • Heddle, J. A. (1991). Implications for genetic toxicology of the chromosomal breakage syndromes. Mutat. Res. 247(2): 221-229.

    Google Scholar 

  • Humphery, L. J., Humphery, M. A., Singla, O. M., and Volenec, J. (1981). Immunologic responsiveness of patients with cancer: Relationship to tumor type, stage and prognosis. Ann. Surg. 193: 574-578.

    Google Scholar 

  • Hurwitz, B. E., and Schneiderman, N. (1998). Cardiovascular reactivity and its relation to cardiovascular disease risk. In Krantz, D. S., and Baum, A. (eds.), Technology and Methods in Behavioral Medicine, Lawrence Erlbaum Associates, Mahwah, NJ, pp. 245-273.

    Google Scholar 

  • Irwin, M., Patterson, T., Smith, T. L., Caldwell, C., Brown, S. A., Gillin, J.C., and Grant, I. (1990). Reduction of immune function in life stress and depression. Biol. Psychiatry 27: 22-30.

    Google Scholar 

  • Kanner, A. D., Coyne, J. C., Schaefer, C., and Lazarus, R. S. (1981). Comparison of two modes of stress management: Daily hassles and uplifts versus major life events. J. Behav. Med. 4: 1-39.

    Google Scholar 

  • Kiecolt-Glaser, J. K., and Glaser, R. (1987). Psychosocial moderators of immune function. Ann. Behav. Med. 9(2): 16-20.

    Google Scholar 

  • Kiecolt-Glaser, J. K., Stephens, R. E., Lipetz, P. D., Speicher, C. E., and Glaser, R. (1985). Distress and DNA repair in human lymphocytes. J. Behav. Med. 8: 311.

    Google Scholar 

  • Kiecolt-Glaser, J. K., Glaser, R., Shuttleworth, E. C., Dyer, C. S., Ogrocki, P., and Speicher, C. E. (1987). Chronic stress and immunity in family caregivers of Alzheimer's disease victims. Psychosom. Med. 49: 523-535.

    Google Scholar 

  • Kiecolt-Glaser, J. K., Maruha, P. T., Malarkey, W. B., Mercado, A. M., and Glaser, R. (1995). Slowing of wound healing by psychological stress. Lancet 346: 1194-1196.

    Google Scholar 

  • Levine, A. J. (1993). The tumor suppressor genes. Annu. Rev. Biochem. 62: 623-651.

    Google Scholar 

  • Levy, S., Herberman, R., Lippman, M., and d'Angelo, T. (1987). Correlations of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with breast cancer. J. Clin. Oncol. 5: 348-353.

    Google Scholar 

  • Levy, S. M., Herberman, R. B., Lippman, M., et al. (1991). Immunological and psychosocial predictors of disease recurrence in patients with early-stage breast cancer. Behav. Med. 17: 67-75.

    Google Scholar 

  • Marshall, G. D., Agarwal, S. K., Lloyd, C. S., Cohen, L., Henninger, E. M., and Morris, G. J. (1998). Cytokine dysregulation in healthy medical students associated with exam stress. Brain Behav. Immun. 12(4): 297-307.

    Google Scholar 

  • Marucha, P. T., Kiecolt-Glaser, J. K., and Favagehi, M. (1998). Mucosal wound healing is impaired by examination stress. Psychosom. Med. 60(3): 362-365.

    Google Scholar 

  • McCuchan, J. H., and Pagano, J. S. (1968). Enhancement of the infectivity of simian virus 40 deoxyribonucleic acid with diethylaminoethyl-dextran. J. Natl. Cancer Inst. 41: 351-356.

    Google Scholar 

  • McNair, D. M., Lorr, M., and Droppleman, L. F. (1971/1981). Profile of Mood States, Educational and Industrial Testing Service, San Diego.

    Google Scholar 

  • Morris, T., Greer, S., Pettingale, K. W., and Watson, M. (1981). Patterns of expression of anger and their psychological correlates in women with breast cancer. J. Psychosom. Res. 25: 111-117.

    Google Scholar 

  • Papadopoulos, N., Nicolaides, N. C., Wei, Y. F., Ruben, S. M., Carter, K. C., Rosen, C. A., Haseltine, W. A., Fleischmann, R. D., Fraser, C. M., Adams, M. D., Venter, J. C., Hamilton, S. R., Peterson, G. M., Watson, P., Lynch, H. T., Peltomaki, P., Mecklin, J. P., de la Chapelle, A., Kinzler, K. W., and Vogelstein, B. (1994). Mutation of a mutL homolog in hereditary colon cancer [see Comments]. Science 263(5153): 1625-1629.

    Google Scholar 

  • Patterson, S. M., Zakowski, S. G., Hall, M. H., Cohen, L., Wollman, K., and Baum, A. (1994). Psychological stress and platelet activation: Differences in platelet reactivity in healthy men during active and passive stressors. Health Psychol. 13: 34-38.

    Google Scholar 

  • Penninx, B.W., Guralnik, J. M., Pahor, M., Ferrucci, L., Cerhan, J. R., Wallace, R. B., and Havlik, R. J. (1998). Chronically depressed mood and cancer risk in older persons. J. Natl. Cancer Inst. 90: 1888-1893.

    Google Scholar 

  • Peterson, M. C., and Smith, P. J. (1979). Ataxia telangiectasia: An inherited human disorder involving hypersensitivity to ionizing radiation and related DNAdamaging chemical. Annu. Rev. Genet. 13: 291-318.

    Google Scholar 

  • Petticrew, M., Fraser, J. M., and Regan, M. F. (1999). Adverse life-events and risk of breast cancer: A meta-analysis. Br. J. Health Psychol. 4: 1-17.

    Google Scholar 

  • Protheroe, D., Turvey, K., Horgan, K., Benson, E., Bowers, D., and House, A. (1999). Stressful life events and difficulties and onset of breast cancer: Case-control study. Br. Med. J. 319: 1027-1030.

    Google Scholar 

  • Protic-Sabljic, M., and Kraemer, K.H. (1985). One pyrimidine dimer inactivates expression of a transfected gene in xeroderma pigmentosum cells. Proc. Natl. Acad. Sci.USA 82: 6622-6626.

    Google Scholar 

  • Ramirez, A. J., Craig, T. K. J., Watson, J. P., Fentiman, I. S., North, W. R. S., and Rubens, R. D. (1989). Stress and relapse of breast cancer. Br. Med. J. 298: 291-293.

    Google Scholar 

  • Schneiderman, N., McCabe, P., and Baum, A. (eds.) (1992). Stress and Disease Processes, Lawrence Erlbaum Associates, Hillsdale, NJ.

    Google Scholar 

  • Setlow, R. B. (1978). Deficient human disorders and cancer. Nature 271: 713-717.

    Google Scholar 

  • Sherr, C. J. (1996). Cancer cell cycles. Science 274: 1672-1677.

    Google Scholar 

  • Solomon, E., Borrow, J., and Goddard, A. D. (1991). Chromosome aberrations and cancer. Science 254(5035): 1153-1160.

    Google Scholar 

  • Stone, A. A., and Bovbjerg, D. H. (1994). Stress and humoral immunity: A review of the human studies. Adv. Neuroimmunol. 4(1): 49-56.

    Google Scholar 

  • Van der Pompe, G., Antoni, M. H., Mulder, C. L., Heijnen, C., Goodkin, K., De Graeff, A., Garssen, B., and De Vries, M. J. (1994). Psychoneuroimmunology and the course of breast cancer: An overview. The impact of psychosocial factors on progression of breast cancer through immune and endocrine mechanisms. Psycho-Oncology 3: 271-288.

    Google Scholar 

  • Watson, M., Haviland, J. S., Greer, S., Davidson, J., and Bliss, J. M. (1999). Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet 354(9187): 1331-1336.

    Google Scholar 

  • Wei, Q., and Spitz, M. R. (1997). The role of DNA repair capacity in susceptibility to lung cancer: A review. Cancer Metastasis Rev. 16: 295-307.

    Google Scholar 

  • Wei, Q., Matanoski, G. M., Farmer, E. R., Hedayati, M., and Grossman, L. (1993). DNA repair and aging in basal cell carcinoma: A molecular epidemiology study. Proc. Natl. Acad. Sci. USA 90: 1614-1618.

    Google Scholar 

  • Wei, Q., Matanoski, G. M., Farmer, E. R., Hedayati, M. A., and Grossman, L. (1994). DNA repair and susceptibility to skin cancer. Am. J. Epidemiol. 140: 589-607.

    Google Scholar 

  • Wei, Q., Spitz, M. R., Gu, J., Cheng, L., Xu, X., Strom, S. S., Kripke, M. L., and Hsu, T. C. (1996). DNA repair capacity correlates with mutagen sensitivity in lymphoblastoid cell lines. Cancer Epidemiol. Biomarkers Prey. 5: 199-204.

    Google Scholar 

  • Ye, N., Bianchi, M. S., Bianchi, N. O., and Holmquist, G. P. (1999). Adaptive enhancement and kinetics of nucleotide excision repair in humans. Mutat. Res. 435: 43-61.

    Google Scholar 

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Cohen, L., Marshall, G.D., Cheng, L. et al. DNA Repair Capacity in Healthy Medical Students During and After Exam Stress. J Behav Med 23, 531–544 (2000). https://doi.org/10.1023/A:1005503502992

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