Abstract
Stress is a common belief among breast cancer patients and the public to explain variation in breast cancer incidence. Epidemiological studies interrogating the relationship between stress and cancer have reported mixed results. The impact of the topic and the lack of consensus has sparked this review of the literature to investigate gaps in knowledge and identify areas of research. We first present a brief summary of the biopsychosocial model generally used to conduct research on stress. We then divide the overview of the literature into areas of research focus. These include the role of distressing life events in breast cancer incidence, the role of adverse childhood events in later breast cancer incidence, the importance of race and socioeconomic status (SES) as social determinants of breast cancer incidence, and the specific role of chronic stress in relation to breast cancer. For each topic, we discuss the potential of stress as a risk factor and possible intervention strategies that could reduce the effects of stress. We then identify further research questions to be probed to fill the gaps in knowledge. We conclude with a discussion of future research directions for stress research as it relates to breast cancer incidence.
Highlights
Stress is a common idea in the general public to explain variation in breast cancer incidence
Is stress related to breast cancer incidence, and, more importantly, can it be the target of an intervention to reduce breast cancer risk? This manuscript reviews evidence about the potential role of stress and identifies areas of future research activity to clarify and increase our understanding of stress in breast cancer
We conclude with a discussion of future research directions for stress research as it relates to breast cancer incidence
Summary
The American Psychological Association has conducted surveys of communities across the United States since 2007 to provide a yearly snapshot of the experience of stress and its impact. Most adults in the United States name police brutality toward Black, Indigenous and People of Color (BIPOC) as a significant stressor (59%) This is a 23% increase from 2016 (36%) when the question was added to the survey. In introducing a framework for the study of racism and health, Williams [46] outlines multiple basic causes that act on and interact with social status factors, proximal pathways, and their responses to create and perpetuate health outcomes (see Figure 2). Several systematic meta-analyses, meta-analyses, and and longitudinal longitudinal studies studies have have examined racism as a risk factor for negative health outcomes and specific immunological examined racism as a risk factor for negative health outcomes and specific immunological responses Gitudinal data have demonstrated links between the experience of racism and breast cancer
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