Stressful life experiences and risk of relapse of breast cancer: observational cohort study
Stressful life experiences and risk of relapse of breast cancer: observational cohort study
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DOI：
10.1136/bmj.324.7351.1420
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发表时间：
2002-06-15
影响因子：
--
通讯作者：
Burgess, C
中科院分区：
文献类型：
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作者：
Graham, J;Ramirez, A;Burgess, C
目的采用观察性队列设计，证实严重压力性生活经历与乳腺癌复发之间的关系，该关系在以前的病例对照研究中发现。设计前瞻性对一组新诊断为乳腺癌的妇女进行为期5年的随访，收集有关压力性生活经历、抑郁和生物学预后因素的数据。1991- 9.参与者一系列60岁以下新诊断为原发性可手术乳腺肿瘤的妇女，202/222（91%）符合条件的妇女参加了第一次生活经历访谈，170（77%）提供了完整的随访资料，包括诊断后5年或复发时的资料，主要指标为疾病复发。结果发现，在确诊前一年内有过一次或多次严重压力生活经历的女性与无此经历的女性相比，复发风险没有增加（风险比1.01，95%置信区间0.58至1.74，P=0.99）。妇女谁有一个或多个严重的压力生活经历，在5年后诊断复发的风险较低（0.52，0.29至0.95，P=0.03）比那些没有。结论这些数据并没有证实早期发现的病例对照研究，严重的压力生活经历增加乳腺癌复发的风险。病例对照和前瞻性方法的差异可以解释矛盾的结果。我们认为前瞻性研究更可靠，结果表明，乳腺癌患者不必担心压力经历会促使疾病复发。
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.Design Prospective Mow 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.Setting NHS breast clinic, London; 1991-9.Participants 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.Main outcome measure 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.Conclusion 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.