Breast Cancer Research and Treatment

, Volume 173, Issue 1, pp 217–224 | Cite as

Psychosocial stress is associated with benign breast disease in young Chinese women: results from Project ELEFANT

  • Timothy M. Barrow
  • Cheng Peng
  • Ander Wilson
  • Hao Wang
  • Hongbin Liu
  • Lilin Shen
  • Nai-jun Tang
  • Chanachai Sae-Lee
  • Peng-hui Li
  • Liqiong GuoEmail author
  • Hyang-Min Byun



Psychosocial stress, including bereavement and work-related stress, is associated with the risk of breast cancer. However, it is unknown whether it may also be linked with increased risk of benign breast disease (BBD).


Our study leveraged 61,907 women aged 17–55 years old from the Project ELEFANT study. BBD was diagnosed by clinician. Self-reported data on psychosocial stress over a 10-year period was retrospectively collected from questionnaires and categorised by cause (work, social and economic) and severity (none, low and high). Odd ratios (ORs) for the development of BBD were estimated using logistic regression. The model was adjusted for age, BMI, TSH levels, smoking, alcohol consumption, family history, age of menarche, oral contraceptive usage, education and occupation.


Within our study, 8% (4,914) of participants were diagnosed with BBD. Work-related stress [OR 1.57, 95% confidence interval (CI) 1.46–1.69] and financial stress (OR 1.34, 95% CI 1.24–1.44) were significantly associated with BBD incidence, with a smaller but still significant association with social stress (OR 1.11, 95% CI 1.01–1.21). The associations remained significant after exclusion of participants with first- and second-degree family history of breast disease. The presence of multiple forms of stress did not synergistically increase risk. The neutrophil–lymphocyte ratio (NLR), a marker of systemic inflammation and prognostic marker for breast cancer, was not associated with BBD.


Psychosocial stress, particularly work-related and financial stress, is associated with increased risk of benign breast disease among young Chinese women.


Benign breast disease Stress Psychosocial stress Neutrophil–lymphocyte ratio 



Benign breast disease


Body Mass Index


Neutrophil–lymphocyte ratio


Odds ratio


Standard deviation



We are extremely grateful to the Tianjin Research Institute for Family Planning which provided the data and samples for the study.


This work was supported by the National Natural Science of China, Foundation of China Youth Science Fund Projects (Grant Numbers: 81602827 for LG and 41601548 for PL), and by the Tianjin Natural Science Foundation (Grant Number: 18JCQNJC11700 for LG).

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflicts of interest.

Ethical approval

All procedures and study protocols were approved by the ethical committee of Tianjin Medical University and were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

All the participants within the study provided written informed consent.

Supplementary material

10549_2018_4979_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Timothy M. Barrow
    • 1
  • Cheng Peng
    • 2
  • Ander Wilson
    • 3
  • Hao Wang
    • 4
  • Hongbin Liu
    • 4
  • Lilin Shen
    • 4
  • Nai-jun Tang
    • 5
  • Chanachai Sae-Lee
    • 6
    • 7
  • Peng-hui Li
    • 8
  • Liqiong Guo
    • 5
    Email author
  • Hyang-Min Byun
    • 6
  1. 1.Faculty of Health Sciences & WellbeingUniversity of SunderlandSunderlandUK
  2. 2.Channing Division of Network Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of StatisticsColorado State UniversityFort CollinsUSA
  4. 4.Tianjin Research Institute for Family PlanningTianjinChina
  5. 5.Department of Occupational & Environmental Health, School of Public HealthTianjin Medical UniversityTianjinChina
  6. 6.Human Nutrition Research Centre, Institute of Cellular MedicineNewcastle UniversityNewcastle Upon TyneUK
  7. 7.Research Division, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
  8. 8.School of Environmental Science and Safety EngineeringTianjin University of TechnologyTianjinChina

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