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No Link Found Between Stress And Breast Cancer Relapse

There is no evidence that women who have a severely stressful life experience in the year before being diagnosed with breast cancer, or the following five years, are at increased risk of recurrence of their disease.

Dr Amanda Ramirez and colleagues, Cancer Research UK London Psychological Group, Guy's, King's and St Thomas's School of Medicine, London, England, said that their findings contradict an earlier study that showed severely stressful life experiences increase the risk of recurrence of breast cancer. It is possible different study methods may explain the contradictory results.

Dr Ramirez points out that some 25 to 33 percent of women diagnosed with operable breast cancer will have a recurrence within five years of diagnosis. While axillary lymph node involvement and histological grade can influence the prognosis, women with apparently similar tumors at the time of presentation differ markedly in their disease free survival and over. all survival.

This raises the possibility that such differences in outcome may be explained by host and environmental factors, which could include psychological and social variables.

Two hundred and two women under the age of 60 who were diagnosed with a primary operable breast tumour between May 1991 and July 1994 were studied. The team collected data on stressful life experiences and depression and 170 provided complete interview data either up to five years after diagnosis or to recurrence.

Biological factors known to influence prognosis of breast cancer also were taken into account.

There was no evidence that women who have a severely stressful life experience in the year before being diagnosed with breast cancer, or in the five years afterwards, are at any increased risk of developing a recurrence of their disease. In fact, women who had one or more severely stressful life experiences after diagnosis had a lower risk of recurrence than those who did not.

The researchers said that "it is difficult to formulate a rationale to explain how stressful life experiences might reduce a woman's chance of experiencing a recurrence of her disease," adding that "the data in this study were collected from a sufficiently large sample of women to enable identification of a doubling of the risk of recurrence after a severe life experience - a conservative estimate based on previous findings. The follow up period was longer than that in the only other similar prospective study, so, if stressful life experiences cause recurrence only after a latent period, the longer follow up would have increased the likelihood of an association being detected."
BMJ 2002; 324: 1420-2.

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