Abstract
A vast body of research has been carried out to examine the relationship between psychological stress and the risk of breast cancer. Previous reviews on this issue have mainly focused on stressful life events and have included both prospective and retrospective studies. The results from these reviews have revealed conflicting data. We evaluate whether stressful life events, work-related stress, or perceived global stress are differentially associated with breast cancer incidence and breast cancer relapse in prospective studies. Systematic and explicit methods were used to identify, select, and critically appraise relevant studies. The substantial variability in the manner in which stress was conceptualized and measured did not allow for the calculation of a quantitative summary estimate for the association between stress and breast cancer. Despite the heterogeneity in the results obtained, it is concluded that stress does not seem to increase the risk of breast cancer incidence. Whether stress affects the progression of breast cancer is still unclear. Studies with more thorough adjustment for confounding factors and larger studies on stress and breast cancer relapse are required to address this issue.
Key Points
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Previous reviews on stress and breast cancer have included both prospective and retrospective studies, and the results have been conflicting
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This Review only included prospective studies and separately addressed the effect of stressful life events, work-related stress, and perceived global stress on risk of breast cancer incidence and relapse
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Despite some heterogeneity in the results, stress does not seem to increase the risk of breast cancer incidence in large prospective studies
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Whether stress affects risk of breast cancer relapse is still uncertain, and larger studies are needed to address this issue
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References
Parkin DM et al. (2001) Cancer burden in the year 2000: the global picture. Eur J Cancer 37 (Suppl): S4–S66
Reiche EM et al. (2004) Stress, depression, the immune system, and cancer. Lancet Oncol 5: 617–625
Rivier C (1995) Luteinizing-hormone-releasing hormone, gonadotropins, and gonadal steroids in stress. Ann NY Acad Sci 771: 187–191
Breen KM and Karsch FJ (2004) Does cortisol inhibit pulsatile luteinizing hormone secretion at the hypothalamic or pituitary level? Endocrinology 145: 692–698
Duijts SF et al. (2003) The association between stressful life events and breast cancer risk: a meta-analysis. Int J Cancer 107: 1023–1029
Dalton SO et al. (2002) Mind and cancer: do psychological factors cause cancer? Eur J Cancer 38: 1313–1323
Bleiker EM and van der Ploeg HM (1999) Psychosocial factors in the etiology of breast cancer: review of a popular link. Patient Educ Couns 37: 201–214
Gerits P (2000) Life events, coping and breast cancer: state of the art. Biomed Pharmacother 54: 229–233
Petticrew M et al. (1999) Adverse life-events and risk of breast cancer: a meta-analysis. Br J Health Psychol 4: 1–17
Hilakivi-Clarke L et al. (1994) Psychosocial factors in the development and progression of breast cancer. Breast Cancer Res Treat 29: 141–160
Garssen B (2004) Psychological factors and cancer development: evidence of 30 years of research. Clin Psychol Rev 24: 315–338
De Boer MF et al. (1999) Psychosocial correlates of cancer relapse and survival: a literature review. Patient Educ Couns 37: 215–230
Holmes TH and Rahe RH (1967) The social readjustment rating scale. J Psychosom Res 11: 213–218
Karasek RA (1979) Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q 24: 285–308
Lazarus RS (1993) From psychological stress to the emotions: a history of changing outlooks. Annu Rev Psychol 44: 1–21
Burke MA and Goodkin K (1997) Stress and the development of breast cancer: a persistent and popular link despite contrary evidence. Cancer 79: 1055–1059
Cox T and Mackay C (1982) Psychosocial factors and psychophysiological mechanisms in the aetiology and development of cancers. Soc Sci Med 16: 381–396
Jackson N et al. (2005) Criteria for the systematic review of health promotion and public health interventions. Health Promot Int 20: 367–374
Geyer S (1993) Life events, chronic difficulties and vulnerability factors preceding breast cancer. Soc Sci Med 37: 1545–1555
Geyer S (1991) Life events prior to manifestation of breast cancer: a limited prospective study covering eight years before diagnosis. J Psychosom Res 35: 355–363
Chen CC et al. (1995) Adverse life events and breast cancer: case-control study. BMJ 311: 1527–1530
Price MA et al. (2001) The role of psychosocial factors in the development of breast carcinoma—part II: life event stressors, social support, defense style, and emotional control and their interactions. Cancer 91: 686–697
Ollonen P et al. (2005) Stressful and adverse life experiences in patients with breast symptoms: a prospective case-control study in Kuopio, Finland. Anticancer Res 25: 531–536
Protheroe D et al. (1999) Stressful life events and difficulties and onset of breast cancer: case-control study. BMJ 319: 1027–1030
Cooper CL and Faragher EB (1993) Psychosocial stress and breast cancer: the inter-relationship between stress events, coping strategies and personality. Psychol Med 23: 653–662
Schwarz R and Geyer S (1984) Social and psychological differences between cancer and noncancer patients: cause or consequence of the disease? Psychother Psychosom 41: 195–199
Li J et al. (2002) Cancer incidence in parents who lost a child: a nationwide study in Denmark. Cancer 95: 2237–2242
Kvikstad A et al. (1994) Widowhood and divorce related to cancer risk in middle-aged women: a nested case-control study among Norwegian women born between 1935 and 1954. Int J Cancer 58: 512–516
Kvikstad A and Vatten LJ (1996) Risk and prognosis of cancer in middle-aged women who have experienced the death of a child. Int J Cancer 67: 165–169
Johansen C and Olsen JH (1997) Psychological stress, cancer incidence and mortality from non-malignant diseases. Br J Cancer 75: 144–148
Levav I et al. (2000) Cancer incidence and survival following bereavement. Am J Public Health 90: 1601–1607
Ewertz M (1986) Bereavement and breast cancer. Br J Cancer 53: 701–703
Schernhammer ES et al. (2004) Job stress and breast cancer risk: the nurses' health study. Am J Epidemiol 162: 1133–1134
Helgesson O et al. (2003) Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women. Eur J Cancer Prev 12: 377–381
Kroenke CH et al. (2004) Caregiving stress, endogenous sex steroid hormone levels, and breast cancer incidence. Am J Epidemiol 159: 1019–1027
Lillberg K et al. (2001) Stress of daily activities and risk of breast cancer: a prospective cohort study in Finland. Int J Cancer 91: 888–893
Nielsen NR et al. (2005) Self reported stress and risk of breast cancer: prospective cohort study. BMJ 331: 548
Jacobs JR and Bovasso GB (2000) Early and chronic stress and their relation to breast cancer. Psychol Med 31: 565–568
Lillberg K et al. (2003) Stressful life events and risk of breast cancer in 10,808 women: a cohort study. Am J Epidemiol 157: 415–423
Hislop TG et al. (1987) The prognostic significance of psychosocial factors in women with breast cancer. J Chronic Dis 40: 729–735
Barraclough J et al. (1992) Life events and breast cancer prognosis. BMJ 304: 1078–1081
De Brabander B and Gerits P (1999) Chronic and acute stress as predictors of relapse in primary breast cancer patients. Patient Educ Couns 37: 265–272
Forsen A (1991) Psychosocial stress as a risk for breast cancer. Psychother Psychosom 55: 176–185
Graham J et al. (2002) Stressful life experiences and risk of relapse of breast cancer: observational cohort study. BMJ [doi: 10.1136/bmj.324.7351.1420]
Schernhammer ES et al. (2001) Rotating night shifts and risk of breast cancer in women participating in the nurses' health study. J Natl Cancer Inst 93: 1563–1568
McEwen BS and Wingfield JC (2003) The concept of allostasis in biology and biomedicine. Horm Behav 43: 2–15
Plante GE (2002) Vascular response to stress in health and disease. Metabolism 51: 25–30
Luecken LJ and Compas BE (2002) Stress, coping, and immune function in breast cancer. Ann Behav Med 24: 336–344
Jones DR et al. (1984) Bereavement and cancer: some data on deaths of spouses from the longitudinal study of Office of Population Censuses and Surveys. Br Med J (Clin Res Ed) 289: 461–464
Achat H et al. (2000) A prospective study of job strain and risk of breast cancer. Int J Epidemiol 29: 622–628
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Nielsen, N., Grønbæk, M. Stress and breast cancer: a systematic update on the current knowledge. Nat Rev Clin Oncol 3, 612–620 (2006). https://doi.org/10.1038/ncponc0652
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DOI: https://doi.org/10.1038/ncponc0652
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