ACE Study

In my cancer support group we recently discussed what stressors may have happened in our lives prior to our diagnosis with cancer. It’s generally unknown what specific situations may have caused individual cancers. But we do know that cancerous cells are circulating in all of us, all of the time. It’s up to our immune system to take care of them. Why our immune systems sometimes become overwhelmed and the cancers take hold, we don’t know. But we do know that immune system health is clearly tied to a variety of stressors in life.

One of the stressors we discussed in class is the ACE study. ACE stands for Adverse Childhood Experiences. It turns out, unsurprisingly, that childhood trauma is clearly linked to poor health outcomes, even much later in adult life. The study looked for 3 types of childhood abuse (psychological, physical & sexual) and 4 types of household dysfunction (substance abuse, mental illness, violence and criminal behavior). It then correlated those experiences with subsequent physical and mental health issues in adulthood resulting in statically decreased life expectancies.

Of course as well all know, correlation does not imply causation. Just because something happened first and something else happened second, and they are statistically related, does not mean the first thing caused the second thing. But correlation is by itself important and interesting, even in the absence of causation. Correlation does imply some sort of common risk factor, even if causation is unknown.

There have been numerous ACE-type studies. Here’s the CDC webpage about the original study, https://www.cdc.gov/violenceprevention/aces/about.html

Here’s a link to the large study published in the American Journal of Preventative Medicine in 1998. https://www.ajpmonline.org/action/showPdf?pii=S0749-3797%2898%2900017-8

Here’s some key findings from that study, “More than half of respondents reported at least one, and one-fourth reported ≥ 2 [two or more] categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied. Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4-to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, ≥ 50 [50 or more] sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.“

If you’re curious what your ACE score is, there are lots of places on the internet you can take the survey. And you don’t have to actually submit your answers. In fact, here’s the questions; there’s only 10 of them, you can keep track of your points in your head or on a little scrap of paper. You get one point per question you answer in the affirmative, for a total possible of 10 points.

While you were growing up, during your first 18 years of life:

• Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? …or… Act in a way that made you afraid that you might be physically hurt?
  • Yes
  • No
• Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? …or… Ever hit you so hard that you had marks or were injured?
  • Yes
  • No
• Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
  • Yes
  • No
• Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
  • Yes
  • No
• Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
  • Yes
  • No
• Were your parents ever separated or divorced?
  • Yes
  • No
• Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
  • Yes
  • No
• Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
  • Yes
  • No
• Was a household member depressed or mentally ill, or did a household member attempt suicide?
  • Yes
  • No
• Did a household member go to prison?
  • Yes
  • No

(Credit: https://byronclinic.com/finding-your-ace-score/)

• “ACEs are common…nearly two-thirds (64%) of adults have at least one.
• They cause adult onset of chronic disease, such as cancer and heart disease, as well as mental illness, violence and being a victim of violence.
• ACEs don’t occur alone….if you have one, there’s an 87% chance that you have two or more.
• The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence…People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.”

Twenty years. I first heard about this study a long time ago, and I’ve sometimes wondered, what if some people with high (poor) scores from childhood managed somehow during early adulthood to get off to a fairy good start as adults anyway? What if they kept their noses clean, managed to stay off of drugs and alcohol, went to college, got a good job, exercised, kept their weight down, never smoked, did all the right things…do the shortened lifespan statistics still apply to that cohort? Maybe to a diminished extent?

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