Stressful life experiences and risk of relapse of breast cancer: observational cohort study

ObjectiveTo confirm, using an observational cohort design, the relation between severely stressful life experiences and relapse of breast cancer found in a previous case-control study.DesignProspective follow up for five years of a cohort of women newly diagnosed as having breast cancer, collecting data on stressful life experiences, depression, and biological prognostic factors.SettingNHS breast clinic, London; 1991-9.ParticipantsA consecutive series of women aged under 60 newly diagnosed as having a primary operable breast tumour. 202/222 (91%) eligible women participated in the first life experiences interview. 170 (77%) provided complete interview data either up to 5 years after diagnosis or to recurrence.ResultsWe controlled for biological prognostic factors (lymph node infiltration and tumour histology), and found no increased risk of recurrence in women who had had one or more severely stressful life experiences in the year before diagnosis compared with women who did not (hazard ratio 1.01, 95% confidence interval 0.58 to 1.74, P=0.99). Women who had had one or more severely stressful life experiences in the 5 years after diagnosis had a lower risk of recurrence (0.52, 0.29 to 0.95, P=0.03) than those who did not.ConclusionThese data do not confirm an earlier finding from a case-control study that severely stressful life experiences increase the risk of recurrence of breast cancer. Differences in case control and prospective methods may explain the contradictory results. We took the prospective study as the more robust, and the results suggest that women with breast cancer need not fear that stressful experiences will precipitate the return of their disease.

What is already known on this topic

Women with apparently similar tumours at the time of presentation with breast cancer differ considerably in their disease-free survival and overall survivalSuch differences in outcome may well be explained by host and environmental factors, which could include psychological and social variablesData on the relation between severely stressful life experiences and cancer progression have been contradictory

What this study adds

Women who have a severely stressful life experience in the year before being diagnosed with breast cancer, or in the five years afterwards, do not seem to be at increased risk of developing a recurrence of the diseaseWomen with breast cancer need not fear that stressful experiences will precipitate the return of their disease.     

Parity and breast cancer.

Data from the 1961 and 1971 Censuses in England and Wales were used to estimate the age distribution of women of various parities in 1976. Applying the age-specific incidences of breast cancer for women in England and Wales in 1975 gave the expected number of cases of that disease in 1976 and permitted an estimate of the mean age at diagnosis of breast cancer at each parity. This showed that the highest average age for breast cancer occurred in nulliparous women (65.9 years) and that the lowest age for the disease occurred in women who had borne two children (60.4 years). The figures obtained were similar to those reported in a separate study of women treated in Birmingham. The results of that study, however, may have been due to the age distribution in the population of women by parity, rather than any direct influence of parity on the speed of growth of breast cancer.     

Identifying gene expression changes in breast cancer that distinguish early and late relapse among uncured patients

MOTIVATION: In recent years, microarray technology has revealed many tumor-expressed genes prognostic of clinical outcomes in early-stage breast cancer patients. However, in the presence of cured patients, evaluating gene effect on time to relapse is quite complex since it may affect either the probability of never experiencing a relapse (cure effect) or the time to relapse among the uncured patients (disease progression effect) or both. In this context, we propose a simple and an efficient method for identifying gene expression changes that characterize early and late recurrence for uncured patients. RESULTS: Simulation results show the good performance of the proposed statistic for detecting a disease progression effect. In a study of early-stage breast cancer, our results show that the proposed statistic provides a more powerful basis for gene selection than the classical Cox model-based statistic. From a biological perspective, many of the genes identified here as associated with the speed of disease recurrence have known roles in tumorigenesis.     

Steroids and human breast cancer.

Normal mammary gland cells are sensitive to a number of hormones, of which estrogen and prolactin exert the most obvious effects. Some breast cancer cells are also sensitive. Cytoplasmic receptor sites for each hormone are responsible for the interaction between the hormone and the cell. The presence of estrogen receptor has been especially studied in humans. Data collected from several sources are reviewed. The prese nce of estrogen receptors has been assayed in 154 primary breast tumors and 72 metastatic breast tumors for correlation with response to endocri ne therapy. Positive values were found in 70% of primary and 58% of metastatic specimens. Of 211 treatment trials, ablative therapy produced objective tumor regressions in 33%. Of the 94 trials with negative receptor values, only 8 were successful while 59 of the 107 trials in patients with positive receptor values succeeded. In those with borderline tumor receptor, values had a 30% response. With additive therapy, 34% of 170 trials showed tumor regression. Of these, 82 had negat ive receptor values but 8% were successful, whereas of 85 with positive receptor values, 60% were favorable. With miscellaneous therapy, 27% of 55 trials gave responses to a variety of endocrine therapies, including antiestrogens. The 32 with negative receptor values gave 16% of favorable responses whereas 43% of 23 trials in those with positive receptor values succeeded. Estrogen receptor assays performed routinely would spare patients with negative results from unnecessary major ablative therapy. Of those with positive findings, 55-60% might be benefited. The fact that all with positive receptor values do not respond is attributed to the fact that this is only part of the hormonal control system. Other biochemical lesions are assumed to have occurred in patients when endocrine therapy fails despite positive estrogen receptor levels as measured.     

Oncogenes and human breast cancer.

The role of oncogenes in breast tumorigenesis is unclear. Alterations and/or amplification of several oncogene sequences have been observed in primary human breast tumors, in breast tumor cell lines, and in mammary tumors in model systems. In principle, such alterations could be sites of primary lesions for human breast cancer, causes of tumor progression or metastasis, or simply secondary lesions of highly aberrant tumor genomes. The present study tested genetic linkage of breast cancer susceptibility to nine oncogenes in 12 extended families including 87 affected individuals. Lod scores for close linkage of each candidate sequence to breast cancer were -19.6 for HRAS, -12.3 for KRAS2, -1.0 for NRAS, -6.0 for MYC, -6.1 for MYB, -8.2 for ERBA2, -7.9 for INT2, and -5.1 for RAF1. Regions of chromosome 11p associated with tumor homozygosity and the region of 3p carrying the gene for Von Hippel-Lindau disease could also be excluded from linkage to human breast cancer. The 5-kb allele of the MOS oncogene, previously proposed to be associated with breast cancer, was absent in these families, suggesting that polymorphism at this locus is not associated with inherited susceptibility. These results strongly suggest that oncogenes are not the sites of primary alterations leading to breast cancer. On the other hand, alterations in one or more of these sequences may be associated with tumor progression.