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(Reuters Health) - Torn from their homes and families, Jewish holocaust survivors endured starvation, enslavement and staggering physical and emotional abuse at the hands of the Nazis during World War II.
Now, a study released on Monday shows that survivors suffer an elevated risk of cancer, especially lung and colorectal malignancies.
Israeli researchers examined the medical records of more than 152,000 holocaust survivors over more than 45 years and compared those who qualified for compensation as a result of their persecution during the war to those whose compensation bids were rejected.
Survivors whose compensation bids were rejected were generally those who had been caught up in the war but who spent little or no time in a closed ghetto or a concentration camp and who survived with minimal disability.
Cancer was diagnosed in 22 percent of those granted compensation and 16 percent of those denied it, according to the report in the journal Cancer.
The differences were most striking for lung and colon cancers. Survivors granted compensation had a 37 percent higher risk of lung cancer and a 12 percent higher risk of colorectal cancer than those denied compensation, after adjustments for age, gender and country of origin.
“This study brings to light again that outside forces can cause cancer,” said cancer epidemiologist Electra Paskett of The Ohio State University in Columbus. “Stress really does get under your skin to cause disease.”
“Many have not given this hypothesis its due justice,” she said in an email. Paskett was not involved with the study but was one of the authors of an accompanying editorial.
The study also found heightened cancer risk for survivors born in countries occupied by Nazi Germany compared to survivors born elsewhere.
Survivors born in Nazi-occupied countries had an 8 percent higher risk of developing cancer than survivors born elsewhere, the study found. Those born in occupied countries also had a 12 percent higher risk of lung cancer and an 8 percent higher risk of colorectal cancer.
Holocaust survivors experienced a myriad of potential risk factors for cancer, including infectious disease, severe and prolonged hunger, mental stress, physical abuse and overcrowding, lead author Dr. Siegal Sadetzki of the Chaim Sheba Medical Center in Tel Hashomer, Israel said in a phone interview.
Although the study cannot explain the reasons for heightened risk, Sadetzki speculated about a possible explanation for the increase in lung cancer among compensated holocaust survivors.
“I believe the risk for lung cancer is by a secondary, indirect mechanism,” she said. “Due to the stress, maybe the holocaust survivors smoked more and experienced lifestyle habits that are not so good for you.”
Previous studies have found that starvation might protect against colon cancer. But prolonged starvation and deprivations from all vitamins and nutrients, such as what holocaust survivors experienced, might have had a different effect, Sadetzki said.
An alternative theory for the rise in colon cancer rates could be that survivors compensated for their lack of food during the war by overeating afterward, she said.
A previous study also found an overall increased risk of cancer, and in particular colorectal and lung cancer, among Jewish holocaust survivors. The prior study also reported an increased risk of breast cancer among women survivors.
The new study, however, showed no increase in risk for breast or gynecologic cancer among female survivors.
Nearly 95 percent of Hungarian Jewish women held in concentration camps during the war stopped menstruating, another previous study found.
Not menstruating appears to protect against breast cancer. The longer women menstruate, the more likely they are to be diagnosed with hormone-related cancers, like breast cancer, the authors write.
In their editorial, Paskett and her colleagues draw parallels between the privations experienced by holocaust survivors and those experienced by poor racial minority groups in the United States today.
“Both groups had or have stressors of violence, lack of food, housing insecurity, discrimination and loss of power,” Paskett said. “Today we can think about those living in urban neighborhoods or rural areas with crumbling housing, drug use and unemployment, or low wages, contributing to increasing violence, lack of good food in area food markets, discrimination and even environmental pollution caused by large businesses.”
“We need people who are willing to go into these communities and work with the people who live there to develop strategies and solutions to be able to help themselves,” she said.