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Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women

BMJ 2013; 346 doi: (Published 07 February 2013) Cite this as: BMJ 2013;346:f165
  1. Katriina Heikkilä, specialist reseacher1,
  2. Solja T Nyberg, statistician1,
  3. Töres Theorell, professor emeritus2,
  4. Eleonor I Fransson, senior lecturer234,
  5. Lars Alfredsson, professor of epidemiology3,
  6. Jakob B Bjorner, professor5,
  7. Sébastien Bonenfant, statistician67,
  8. Marianne Borritz, researcher8,
  9. Kim Bouillon, PhD candidate9,
  10. Herman Burr, scientist10,
  11. Nico Dragano, professor11,
  12. Goedele A Geuskens, researcher12,
  13. Marcel Goldberg, professor of epidemiology67,
  14. Mark Hamer, principal research associate9,
  15. Wendela E Hooftman, reseacher12,
  16. Irene L Houtman, senior researcher12,
  17. Matti Joensuu, psychologist1,
  18. Anders Knutsson, professor of public health13,
  19. Markku Koskenvuo, professor of epidemiology14,
  20. Aki Koskinen, statistician1,
  21. Anne Kouvonen, lecturer in sociology/social policy15,
  22. Ida E H Madsen, researcher5,
  23. Linda L Magnusson Hanson, researcher2,
  24. Michael G Marmot, professor of epidemiology and public health9,
  25. Martin L Nielsen, senior registrar8,
  26. Maria Nordin, lecturer in sociology16,
  27. Tuula Oksanen, assistant chief medical officer17,
  28. Jaana Pentti, statistician17,
  29. Paula Salo, specialist researcher1817,
  30. Reiner Rugulies, professor of psychosocial work environment research519,
  31. Andrew Steptoe, British Heart Foundation professor of psychology9,
  32. Sakari Suominen, adjunct professor2021,
  33. Jussi Vahtera, professor of public health1721,
  34. Marianna Virtanen, professor in mental health1,
  35. Ari Väänänen, adjunct professor1,
  36. Peter Westerholm, professor emeritus22,
  37. Hugo Westerlund, professor of epidemiology2,
  38. Marie Zins, assistant professor67,
  39. Jane E Ferrie, senior research fellow923,
  40. Archana Singh-Manoux, research director79,
  41. G David Batty, reader in epidemiology924,
  42. Mika Kivimäki, professor of social epidemiology9
  43. for the IPD-Work Consortium
  1. 1Finnish Institute of Occupational Health, 00250 Helsinki, Finland
  2. 2Stress Research Institute, Stockholm University, Stockholm, Sweden
  3. 3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4School of Health Sciences, Jönköping University, Jönköping, Sweden
  5. 5National Research Centre for the Working Environment, Copenhagen, Denmark
  6. 6Versailles-Saint Quentin University, Versailles, France
  7. 7Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
  8. 8Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
  9. 9Department of Epidemiology and Public Health, University College London, London, UK
  10. 10Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
  11. 11Institute for Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Essen, Germany
  12. 12TNO, Hoofddorp, Netherlands
  13. 13Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
  14. 14Department of Public Health, University of Helsinki, Helsinki, Finland
  15. 15School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Belfast, UK
  16. 16Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
  17. 17Finnish Institute of Occupational Health, Turku, Finland
  18. 18Department of Psychology, University of Turku, Turku, Finland
  19. 19Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
  20. 20Folkhälsan Research Center, Helsinki, Finland
  21. 21Department of Public Health, University of Turku, Turku, Finland
  22. 22Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
  23. 23School of Community and Social Medicine, University of Bristol, Bristol, UK
  24. 24Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
  1. Correspondence to: K Heikkilä katriina.heikkila{at}
  • Accepted 18 December 2012


Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers.

Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake

Results A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer.

Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.


  • Contributors: All authors participated in designing the study, generating hypotheses, interpreting the data, and writing and critically reviewing the paper. KH analysed the data and, with help from MK, wrote the first draft. KH, STN, and MK had full access to anonymised data from all studies, with the exception of data from POLS, COPSOQ-I, DWECS, IPAW, and PUMA. WEH had full access to anonymised data from POLS and IEHM had full access to the anonymised data from COPSOQ-I, DWECS, IPAW, and PUMA. KH is guarantor.

  • Funding: The IPD-Work Consortium is supported by the EU New OSH ERA research programme (funded by the Finnish Work Environment Fund, Finland, the Swedish Research Council for Working Life and Social Research, Sweden, the Danish National Research Centre for the Working Environment, Denmark), the Academy of Finland (grant 132944), the BUPA Foundation (grant 22094477), and the Economic and Social Research Council, UK. POLS is funded by the Ministry of Social Affairs and Employment, Netherlands. MK is supported by the Medical Research Council and a professorial fellowship from the Economic and Social Research Council, UK. AS is a British Heart Foundation professor. At the time of preparation of the manuscript, GDB was a Wellcome Trust Fellow. The funding bodies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Each constituent study in the IPD-Work consortium was approved by the relevant local or national ethics committees and all participants gave informed consent to take part. Details of the ethical approval are provided in appendix 1.

  • Data sharing: No additional data available.

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