Polymorphisms in Tumor Necrosis Factor-α Are Associated with Higher Anxiety Levels in Women after Breast Cancer Surgery

Christine Miaskowski, Charles Elboim, Steven M. Paul, Judy Mastick, Bruce A. Cooper, Jon D. Levine, Bradley E. Aouizerat

Research output: Contribution to journalArticlepeer-review


Introduction Before and after breast cancer surgery, women have reported varying anxiety levels. Recent evidence has suggested that anxiety has a genetic basis and is associated with inflammation. The purposes of the present study were to identify the subgroups of women with distinct anxiety trajectories; to evaluate for differences in the phenotypic characteristics between these subgroups; and to evaluate for associations between polymorphisms in cytokine genes and subgroup membership. Patients and Methods Patients with breast cancer (n = 398) were recruited before surgery and followed up for 6 months. The patients completed the Spielberger State Anxiety Inventory and provided a blood sample for genomic analyses. Growth mixture modeling was used to identify the subgroups of patients with distinct anxiety trajectories. Results Two distinct anxiety subgroups were identified. The women in the higher anxiety subgroup were younger and had a lower functional status score. Two single nucleotide polymorphisms in tumor necrosis factor-α (rs1799964, rs3093662) were associated with the higher anxiety subgroup. Conclusion The results of the present exploratory study suggest that polymorphisms in cytokine genes could partially explain the interindividual variability in anxiety. The determination of phenotypic and molecular markers associated with greater levels of anxiety can assist clinicians to identify high-risk patients and initiate appropriate interventions.

Original languageEnglish (US)
Pages (from-to)63-71.e3
JournalClinical Breast Cancer
Issue number1
StatePublished - Feb 1 2016


  • Cytokine genes
  • Depression
  • Growth mixture modeling
  • Psychological distress
  • Symptom trajectories

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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