Abstract
Due to increasing incidence of breast cancer, recognition of risk factors has become increasingly important. Over the past few decades, among risk factors of this disease, stressful life events have attracted particular attention, but their relationship with breast cancer incidence and survival remains a mystery. This study aimed to examine the relationship between severe stressful life events and incidence and survival of women with breast cancer. In this case-control study, using a structured telephone interview with 355 women with breast cancer and also with 516 women with benign breast diseases who were matched in demographic characteristics, necessary information about the experience of major stressful events in the years before the diagnosis were collected. Data were analyzed using statistical methods of χ2, t, and Kaplan-Meier with a significance level of <0.05. Generally, in the case and control groups, there were no significant association between experience of stressful life events and incidence of breast cancer. Regarding associations between each of the events and incidence of breast cancer only "severe interpersonal problems with spouse" was significant. In the breast cancer group, even after controlling confounding variables, there was no significant association between major stressful events and disease-free survival, or overall 5-and 10-year survival. In this study, only "severe interpersonal problems with spouse" was confirmed as a risk factor. This result can be useful in developing preventive policies. More research regarding the interactive effects of psycho-social factors in the incidence and survival of breast cancer with stressful life events is recommended.
Highlights
Due to advances in diagnosis and treatment of breast cancer, its mortality rate has declined in recent decades in Iran
This study aimed to examine the relationship between severe stressful life events and incidence and survival of women with breast cancer
In this case-control study, using a structured telephone interview with 355 women with breast cancer and with 516 women with benign breast diseases who were matched in demographic characteristics, necessary information about the experience of major stressful events in the years before the diagnosis were collected
Summary
Due to advances in diagnosis and treatment of breast cancer, its mortality rate has declined in recent decades in Iran. The study of risk factors associated with this disease has found great importance (Santos et al, 2009). Estimates from various studies indicate that well-known breast cancer risk factors such as age, genetics, use of hormones (Richie and Swanson, 2003), reproductive history, breast feeding (Akbari et al, 2011), abortion and fatty diets (Raza et al, 2011), age at menopause (Eskelinen and Ollonen, 2009), smoking (Nagata et al, 2006) and alcohol (Longnecker and Tseng, 1998) can only partially explain 40% to 50% causes of this disease in women (Bleiker and Ploeg, 1999; Duijts et al, 2003), and other causes still remain unclear (Ollonen et al, 2005). With varied spectrum of results obtained from those studies indicating non-significant to completely significant association between stressful life events and cancer (Lillberg et al, 2003; Wise et al, 2011; Surtees et al, 2010; Schraub et al, 2009), still the problem of whether such events can affect breast cancer remains unresolved (Maunsell et al, 2001; Sood and Lutgendorf, 2011)
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