Does stress increase risk of breast cancer? A 15‐year prospective study

Dolphin

Dolphin

Senior Member (Voting Rights)
https://onlinelibrary.wiley.com/doi/abs/10.1002/pon.4740

PAPER
Free Access
Does stress increase risk of breast cancer? A 15‐year prospective study.
Phyllis Butow
Melanie Price
Joseph Coll
Katherine Tucker
Bettina Meiser
Roger Milne
Judith Wilson
Louise Heiniger
Brandi Baylock
Tracey Bullen
Prue Weideman

Abstract
Objective
The possible impact of stress on cancer incidence remains controversial. We prospectively evaluated associations between life event stressors, social support, personality characteristics (optimism, anger control, anti‐emotionality) and risk of developing primary breast cancer (BCa), in women at increased familial risk of BCa.

Methods
A prospective cohort, repeated measures design was employed. Recruitment was through the Kathleen Cuningham Foundation Consortium for Research into Familial breast cancer (kConFab), which collects genetic, epidemiological and clinical data from Australasian families with multiple BCa cases. Acute and chronic stressors for the prior three years, and psychosocial, clinical and epidemiological variables were measured at cohort entry and at three‐yearly intervals. Cox proportional hazards regression analysis controlling for BCa risk factors and familial clustering, was undertaken. The primary outcome was histopathologically confirmed BCa (invasive or ductal carcinoma in situ (DCIS), including occult cases diagnosed during risk‐reducing mastectomy).

Results
Of 3,595 consecutive women invited to participate, 3,054 (85.0%) consented. Of these, 2,739 (89.7%) from 990 families (range 1‐16 per family) completed at least one assessment point. During the study 103 women were diagnosed with BCa. No stressor or psychosocial variable or interaction between them, was significantly associated with BCa in unadjusted or adjusted models (total acute stressors HR=1·03 (0·99‐1·08), p=0·19; total chronic stressors HR=1·0 [0·90‐1·11], p=0·98).

Conclusions
This study did not demonstrate an association between acute and chronic stressors, social support, optimism, anti‐emotionality or anger control, and BCa risk. Women should focus on proven methods of BCa risk reduction.
 
It looks like a good study. From the paper:

The results may not generalise to women in the general population, not at increased familial
risk. However, internationally, most rigorous studies have also failed to find an association
between psychosocial factors and cancer, such as a large prospective study of life events in
11,000 women from the general population with 313 incident <breast cancers>, (Surtees et al, 2010),
the UK Million Women study, a recent registry-based Danish study exploring prolonged
job strain and risk of cancer in 6,571 women, a prospective study of 10,519 Finnish women
measuring self-perceived stress levels in Finland, and a prospective cohort study of 30,277
Japanese residents.

In contrast, the Finnish Twin Cohort, involving 10,808 women (180 incident <breast cancers>) found
that severe events, (including divorce/separation, death of a husband/close relative/friend),
were associated with increased risk of <breast cancer>. Thus, the literature on the general population
remains somewhat conflicted. None of these studies used the gold-standard approach to
measuring stressors used here. It is also possible that moderating variables not measured,
such as coping strategies tailored to different stressors, may influence impact of stressors on
<breast cancer> risk.

Clinical Implications
Over the past 40 years, women have been exposed to strong messages about the importance
of ‘thinking positively’ and reducing stress in their lives, which can add to the burden of guilt
in those who develop cancer, who feel they have somehow failed.

Our results, based on rigorous methodology, add to the growing literature providing reassurance to women at increased risk of <breast cancer>, who are concerned that the (often unavoidable) stressors in their lives may increase their risk of <breast cancer>. Of course, reducing the impact of stress on general health and quality of life remains a worthwhile goal for women.​
 
Sadly, those i have know who have had cancer all had prolonged stress prior. None are here today.

Stress ( prolonged chronic stress) does make your immune system vulnerable, however this is no different for cancer than many other diseases/ infections.
 
@Amw66, as much as that might be true, how many of your friends/collegues etc. have had phases of prolonged stress and did not develop cancer or any other disease? It may be more of a coincidence than a cause.

I am very happy with this study, as cancer patients too have to struggle with BPS concepts, implying that they are somehow guilty for developing the disease or of not being strong enough to fight it. Men and women alike. So would be happy if the study would be replicated with prostrate cancer patients.
 
Melanie said:
What a waste of 15 years and money.
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The registry tracks lots of variables - enabling a whole lot of things to be looked at including the impact of specific genetic mutations on cancer incidence, and presumably the outcome of preventative surgical interventions and of treatments after a diagnosis. So the cost of this particular study probably wasn't particularly high; the registry was there already.

Melanie said:
They focussed on breast cancer, predominantly a woman's disease, instead of prostrate cancer.
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It's possible that they focussed on breast cancer because funds have been directed in the past to setting up this very good registry, making the research easy. Whereas maybe there hasn't been the same level of funding for the research infrastructure for prostate cancer in Australia? So arguably the underfunding of men's health issues played a role in this research being done on breast cancer rather than prostate cancer. ;)

I'm with you Melanie that there's way too much writing off of women as hysterical. But I think these researchers had a good reason for doing the research and the outcome will hopefully contribute to lessening prejudice against sick women and sick people in general.

Sorry, that was all a bit earnest - I guess it's personal. My mum died at a relatively early age because of breast cancer. She had some stress in her life, like every adult woman who has lived a life worth living, but nothing out of the ordinary apart from the illness itself.

I'm happy that this study can reduce the likelihood that women with breast cancer (and even, by inference, men with prostate cancer) and their families feel guilt for somehow causing the cancer.
 
Hutan said:
I'm happy that this study can reduce the likelihood that women with breast cancer (and even, by inference, men with prostate cancer) and their families feel guilt for somehow causing the cancer.
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This is what I hear from friends affected by breast cancer, too. First they're made to feel they brought it on themselves by stressing too much. Second, they are made to feel guilty if they don't meditate, raw juice diet, positively visualise healing, wearing make up to make themselves (more likely those having to look at them) feel better, etc. etc. And if they don't beat the cancer, clearly it's because they weren't positive enough :banghead:

Sounds familiar? Sadly ME isn't the only illness afflicted by the pervasive illusion in modern society that we can control absolutely everything 100% with our minds. Any study, especially any good quality study, that calls out that illusion as the BS it is is a good thing IMHO.
 
Amw66 said:
Stress ( prolonged chronic stress) does make your immune system vulnerable
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There are some studies that show stress can boost Th2 immunity, while suppressing Th1 immunity:

Academic stress-induced changes in Th1- and Th2-cytokine response

Psychological stress may induce increased humoral and decreased cellular immunity

That would make sense from the evolutionary perspective: for our ancestors, stress may often have been caused by fighting dangerous animals or warring with rival tribes, and by performing dangerous and risky tasks — activities which would typically involve cuts, wounds and injuries.

Now with increased Th2 immunity, you may better fight off any bacterial infections that had got into your wounds. You would not need the antiviral Th1 immunity under these circumstances, as wounds do not usually get infected with viruses, just bacteria.

So that may be why stress appears to boost Th2 but suppresses Th1.
 
interesting. is this rigorously done? what does prior 3y refer to? prior to the start of the 15 year study? thus in principle 18y?

it would be good to also measure whatever can be determined concerning adverse childhood experiences [i do not know if that body of research is useful or bogus]. in particular what if anything results from long-term severe stress? are there 15y prospective studies on any of the diseases we talk about? m.e. autoimmune etc.

what is the scientific backing for this statement "Of course, reducing the impact of stress on general health and quality of life remains a worthwhile goal for women."?
 
Samuel said:
interesting. is this rigorously done? what does prior 3y refer to? prior to the start of the 15 year study? thus in principle 18y?
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Good questions. You can click through to read the paper. From memory, the length of time that stresses were tracked varied and might only have been for 7 years or less. They did measure chronic stress - so perhaps the effects of a childhood trauma might count as chronic stress but that is something I'm not sure about.

Samuel said:
what is the scientific backing for this statement "Of course, reducing the impact of stress on general health and quality of life remains a worthwhile goal for women."?
Click to expand...

I'm not sure that it needs a scientific backing - I took it to mean the following were good things to do even if they don't lower breast cancer risk
1. reducing the amount of stress - e.g. reducing the risk of domestic abuse increases quality of life; and
2. improving methods of coping with stress - e.g. taking part in a support group as opposed to smoking or drinking more might help with general health
 
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