title: Stressful life experiences and risk of relapse of breast cancer: observational cohort study.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Prospective 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.
  
  
  METHODS
  NHS breast clinic, London; 1991-9.
  
  
  METHODS
  A 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.
  
  
  METHODS
  Recurrence of disease.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Cancer Research UK London Psychosocial Group, Adamson Centre, Guy's, King's and St Thomas's School of Medicine, St Thomas's Hospital, London SE1 7EH. jill.graham@kcl.ac.uk
authors.forename: Jill
authors.initials: J
authors.lastname: Graham
authors.forename: Amanda
authors.initials: A
authors.lastname: Ramirez
authors.forename: Sharon
authors.initials: S
authors.lastname: Love
authors.forename: Michael
authors.initials: M
authors.lastname: Richards
authors.forename: Caroline
authors.initials: C
authors.lastname: Burgess
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000209:etiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*