Self reported stress and risk of breast cancer: prospective cohort study

doi:10.1136/bmj.38547.638183.06

BMJ 2005;331:548 (10 September), doi:10.1136/bmj.38547.638183.06 (published 15 August 2005)

Paper

Self reported stress and risk of breast cancer: prospective cohort study

Naja Rod Nielsen, student and research assistant¹, Zuo-Feng Zhang, professor², Tage S Kristensen, professor³, Bo Netterstrøm, research director⁴, Peter Schnohr, consultant⁵, Morten Grønbæk, professor²

¹ National Institute of Public Health, Øster Farimagsgade 5A, DK-1399 Copenhagen K, Denmark, ² Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA, ³ National Institute of Occupational Health, Copenhagen, ⁴ Clinic of Occupational Medicine, Hillerød Hospital, Hillerød, Denmark, ⁵ Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital, Copenhagen

Correspondence to: N R Nielsen nrn{at}niph.dk

Objective To assess the relation between self reported intensityand frequency of stress and first time incidence of primarybreast cancer.

Design Prospective cohort study with 18 years of follow-up.

Setting Copenhagen City heart study, Denmark.

Participants The 6689 women participating in the CopenhagenCity heart study were asked about their perceived level of stressat baseline in 1981-3. These women were followed until 1999in the Danish nationwide cancer registry, with < 0.1% lossto follow-up.

Main outcome measure First time incidence of primary breastcancer.

Results During follow-up 251 women were diagnosed with breastcancer. After adjustment for confounders, women with high levelsof stress had a hazard ratio of 0.60 (95% confidence interval0.37 to 0.97) for breast cancer compared with women with lowlevels of stress. Furthermore, for each increase in stress levelon a six point stress scale an 8% lower risk of primary breastcancer was found (hazard ratio 0.92, 0.85 to 0.99). This associationseemed to be stable over time and was particularly pronouncedin women receiving hormone therapy.

Conclusion High endogenous concentrations of oestrogen are aknown risk factor for breast cancer, and impairment of oestrogensynthesis induced by chronic stress may explain a lower incidenceof breast cancer in women with high stress. Impairment of normalbody function should not, however, be considered a healthy response,and the cumulative health consequences of stress may be disadvantageous.

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