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    Does Stress Really Cause Breast Cancer? Stop Worrying Says New Study

    People have been making a connection between severe emotional stresses and diseases for centuries. More recently, studies have suggested that cancers may be affected by stressful life events, similar to the way that stress can increase your risk of getting the common cold. But studies trying to get to the bottom of this association when it comes to breast cancer show mixed results.

    For instance, just as many studies have found a link between earlier stressful events and breast cancer as those that didn't. The researchers in this study think the inconsistency can be explained by the small number of women involved in the samples, and by the fact that they all looked at women in hospitals, which is not the same as looking at the general population.

    This study was done in Wisconsin to explore the causes of breast cancer. It measured the link between stressful life events and the risk of breast cancer among 258 breast cancer patients and 614 women without breast cancer, all between the ages of 50 and 79. All the women were of similar age, race and menopausal status; there was an even spread between smokers and nonsmokers, and employed and unemployed.

    In 35-minute telephone interviews, these women were asked for information on a variety of risk factors for breast cancer: if they were physically active, whether or not they'd had children, what kind of diet they ate, if they drank alcohol, and if they had a family history of cancer. One section of the questionnaire had 11 questions asking about specific stressful events that had happened over the last five years: if there was a death of a family member or a friend, health problems of family members or friends, and if other distressing life changes such as change in marital status, financial losses and retirement. There was a twelfth open-ended category allowing for "other" responses: here, women most often described difficulties with children, marital problems, and hardships with caretaking of family members.

    Some interesting differences between the two groups did show up. For instance, those without cancer were more likely to be currently married, and the cancer patients tended to be slightly older with a higher level of education. The breast cancer patients had started menstruation earlier and were older when they had their first child.

    The life events reported most often were the same for both groups: death of a close family member, illness of a close family member and the death of a close friend were the top three. The average number of stressful life events reported by both groups was 2.4 and 2.6 respectively, which is not statistically significant. When the severity of life events was taken into consideration, there was still no significant difference between the two groups.

    The only stress factor that figured differently was that of death of a close friend, which was reported by 36.2% of the cancer patients and 44.5% of those without cancer. Otherwise there were, again, no significant differences. When the 35 women from each group were re-tested six months later, they still agreed (91% to 100%) with their original answers.

    So, do stress and the risk of breast cancer go together? According to this study, no. The researchers say that the size and selection process of this study make it more reliable than others that have been done on the same question.

    Questions for Felicia Roberts:

    1. Do you think that most women believe that stress causes breast cancer? What about doctors?

    Doctors do not believe that stress causes breast cancer. And as for women, it depends what you mean by "most": one study asked women what they thought caused their breast cancer, and between 30% and 35% said that they believed that stress or emotional difficulties caused their cancer. In our own study, we never actually counted how many women were reporting "I think it was stress", but we heard it said enough times that we thought it was worth exploring.

    As I can only cite one other study that did look at this, I'd have to say that probably about a third of women feel that stress and emotional upset are related to breast cancer. One third is a lot; a significant number.

    2. Why do some studies show that stress is a significant factor in the risk of breast cancer?

    Evidence is equivocal. There are really an equal number of studies that show breast cancer is related to stress and those that say that it's not. What you need to look at are studies that have large sample sizes -- who talk to more than 100 people at least. We think that the studies that find an association have sample sizes that are too small, or they used specific kinds of methods that aren't considered valid for doing this kind of work. Our study did have a very large sample size, and we show that the evidence is very strong that there's no relationship between self-reported stressful events and breast cancer.

    3. Why are the studies based in hospitals unreliable?

    Well, that's a tough question. It probably has to do with the fact that people who are hospitalized are already different just by being in the hospital. However, there are probably several factors involved, including feeling ill or having specific conditions, that make them different from people you can telephone at home.

    Also, it's a perfectly reasonable assumption to make that people who are interviewed in hospitals are under unusual stress and may tend to overreport the level of stress they're experiencing.

    4. You said that the women without breast cancer were more likely to be currently married. Does your study explain why?

    That's really just a detail of the fact that cancer is a disease of the elderly; as you get older you're also more likely to get cancer; older women are more likely to be widowed. There's really nothing weird about the statistic; it just reflects the fact that being older often goes hand-in-hand with being widowed.

    Comment from Felicia Roberts:

    Our study should reassure women that exposure to stressful life events does not increase your risk for breast cancer. This doesn't mean that there isn't a relationship between physical health and stress: we do know that stress tends to suppress the immune system and this does affect physical health. However, we also know that people who have suffered extreme exposure to stress, such as prisoners of war or people who have been in concentration camps, have no higher incidence of cancer than the general population. So there's really no good evidence to worry about a relationship between cancer and stress.

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