Breast Cancer Research and Treatment

, Volume 176, Issue 1, pp 53–61 | Cite as

The relation between stressful life events and breast cancer: a systematic review and meta-analysis of cohort studies

  • Narjes Bahri
  • Tahereh Fathi Najafi
  • Fatemeh Homaei Shandiz
  • Hamid Reza TohidinikEmail author
  • Abdoljavad Khajavi



Breast cancer is the most common cancer among women with high rate of mortality. This systematic review and meta-analysis was conducted to investigate the relation between stressful life events and breast cancer.


We searched PubMed, Scopus, ScienceDirect, and Google scholar databases from their inception until June 2018. The keywords and phrases we used in the search were (life events AND stress AND breast cancer OR neoplasm) to identify potentially relevant cohort studies that reported relative risk estimates and confidence intervals of this association. Pooled Risk ratio and 95% confidence intervals (CIs) were calculated using random effects model.


Out of 168 potentially relevant publications, 11 documents met the inclusion criteria. The results showed that history of stressful life events slightly increases the risk of breast cancer [pooled Risk Ratio: 1.11 (95% CI 1.03 to 1.19)].


History of stressful life events could be associated with a moderate increase in the risk of breast cancer. We advise that receiving psychological and counseling services after occurrence of stressful life events of women should be taken seriously.


Stress Life events Neoplasm Breast cancer Psychological distress 



We specially thank all researchers and scientists that have developed their research projects in breast cancer since the past decades and have provided us a treasure of valuable knowledge in this field.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    World Health Organization. Breast cancer. Accessed 18 Mar 2018
  2. 2.
    International Agency for Research on Cancer. Estimated incidence, mortality and 5 year prevalence: both sexes. Accessed 10 Mar 2018
  3. 3.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. Google Scholar
  4. 4.
    Rudolph A, Chang-Claude J, Schmidt MK (2016) Gene-environment interaction and risk of breast cancer. Br J Cancer 114(2):125–133. Google Scholar
  5. 5.
    Autier P, Boniol M, Smans M, Sullivan R, Boyle P (2016) Observed and predicted risk of breast cancer death in randomized trials on breast cancer screening. PLoS ONE 11(4):e0154113. Google Scholar
  6. 6.
    Rojas K, Stuckey A (2016) Breast cancer epidemiology and risk factors. Clin Obstet Gynecol 59(4):651–672Google Scholar
  7. 7.
    Moslehi R, Freedman E, Zeinomar N, Veneroso C, Levine PH (2016) Importance of hereditary and selected environmental risk factors in the etiology of inflammatory breast cancer: a case-comparison study. BMC Cancer 16:334. Google Scholar
  8. 8.
    Santen RJ, Boyd NF, Chlebowski RT, Cummings S, Cuzick J, Dowsett M et al (2007) Critical assessment of new risk factors for breast cancer: considerations for development of an improved risk prediction model. Endocr Relat Cancer 14(2):169–187Google Scholar
  9. 9.
    Cedolini C, Bertozzi S, Londero AP, Bernardi S, Seriau L, Concina S, Cattin F, Risaliti A (2014) Type of breast cancer diagnosis, screening, and survival. Clin Breast Cancer 14(4):235–240. Google Scholar
  10. 10.
    Yiannakopoulou E (2014) Etiology of familial breast cancer with undetected BRCA1 and BRCA2 mutations: clinical implications. Cell Oncol (Dordr) 37(1):1–8. Google Scholar
  11. 11.
    Cormanique TF, Almeida LE, Rech CA, Rech D, Herrera AC, Panis C (2015) Chronic psychological stress and its impact on the development of aggressive breast cancer. Einstein (Sao Paulo) 13(3):352–356. Google Scholar
  12. 12.
    Lee TY, Chen HH, Yeh ML, Li HL, Chou KR (2013) Measuring reliability and validity of a newly developed stress instrument: Newly Diagnosed Breast Cancer Stress Scale. J Clin Nurs 22(17–18):2417–2425. Google Scholar
  13. 13.
    Payne JK (2014) State of the science: stress, inflammation, and cancer. Oncol Nurs Forum 41(5):533–540. Google Scholar
  14. 14.
    Hassan S, Karpova Y, Baiz D, Yancey D, Pullikuth A, Flores A (2013) Behavioral stress accelerates prostate cancer development in mice. J Clin Invest 123(2):874–886. Google Scholar
  15. 15.
    Zhao L, Xu J, Liang F, Li A, Zhang Y, Sun J (2015) Effect of chronic psychological stress on liver metastasis of colon cancer in mice. PLoS ONE 10(10):e0139978. Google Scholar
  16. 16.
    Surtees PG, Wainwright NW, Luben RN, Khaw KT, Bingham SA (2010) No evidence that social stress is associated with breast cancer incidence. Breast Cancer Res Treat 120(1):169–174. Google Scholar
  17. 17.
    Protheroe D, Turvey K, Horgan K, Benson E, Bowers D, House A (1999) Stressful life events and difficulties and onset of breast cancer: case-control study. BMJ 319(7216):1027–1030Google Scholar
  18. 18.
    Kruk K, Aboul-Enein HY (2004) Psychological stress and the risk of breast cancer: a case-control study. Cancer Detect Prev 28(6):399–408. Google Scholar
  19. 19.
    Tas F, Karalar U, Aliustaoglu M, Keskin S, Can G, Cinar FE (2012) The major stressful life events and cancer: stress history and cancer. Med Oncol 29(2):1371–1377. Google Scholar
  20. 20.
    Ollonen P, Lehtonen J, Eskelinen M (2005) Stressful and adverse life experiences in patients with breast symptoms; a prospective case-control study in Kuopio, Finland. Anticancer Res 25(1B):531–536Google Scholar
  21. 21.
    Kocic B, Filipovic S, Vrbic S, Pejcic I, Rancic N, Cvetanovic A, Milenkovic D (2015) Stressful life events and breast cancer risk: a hospital-based case-control study. J BUON 20(2):487–491Google Scholar
  22. 22.
    Kruk J (2012) Self-reported psychological stress and the risk of breast cancer: a case-control study. Stress 15(2):162–171. Google Scholar
  23. 23.
    Nielsen NR, Grønbaek M (2006) Stress and breast cancer: a systematic update on the current knowledge. Nat Clin Pract Oncol 3(11):612–620. Google Scholar
  24. 24.
    Lin Y, Wang C, Zhong Y, Huang X, Peng L, Shan G, Wang K, Sun Q (2013) Striking life events associated with primary breast cancer susceptibility in women: a meta-analysis study. J Exp Clin Cancer Res 32(1):53. Google Scholar
  25. 25.
    Duijts SF, Zeegers MP, Borne BV (2003) The association between stressful life events and breast cancer risk: a meta-analysis. Int J Cancer 107(6):1023–1029. Google Scholar
  26. 26.
    Antonova L, Aronson K, Mueller CR (2011) Stress and breast cancer: from epidemiology to molecular biology. Breast Cancer Res 13(2):208. Google Scholar
  27. 27.
    PRIZMA: preferred reporting items for systematic reviews and meta-analyses. Accessed 25 Jan 2019
  28. 28.
    The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed 28 Jun 2019
  29. 29.
    Hartling L, Hamm M, Milne A, Vandermeer B, Santaguida PL, Ansari M (2012) Validity and Inter-Rater Reliability Testing of Quality Assessment Instruments. Agency for Healthcare Research and Quality (US), Rockville (MD). Report No.: 12-EHC039-EF. Accessed 23 June 2019
  30. 30.
    Jacobs JR, Bovasso GB (2000) Early and chronic stress and their relation to breast cancer. Psychol Med 30(3):669–678Google Scholar
  31. 31.
    Lillberg K, Verkasalo PK, Kaprio J, Teppo L, Helenius H, Koskenvuo M (2001) Stress of daily activities and risk of breast cancer: a prospective cohort study in Finland. Int J Cancer 91(6):888–893Google Scholar
  32. 32.
    Price MA, Tennant CC, Butow PN, Smith RC, Kennedy SJ, Kossoff MB, Dunn SM (2001) The role of psychosocial factors in the development of breast carcinoma: Part II. Life event stressors, social support, defense style, and emotional control and their interactions. Cancer 91(4):686–689Google Scholar
  33. 33.
    Graham J, Ramirez A, Love S, Richards M, Burgess C (2002) Stressful life experiences and risk of relapse of breast cancer: observational cohort study. BMJ 324(7351):1420Google Scholar
  34. 34.
    Li J, Johansen C, Hansen D, Olsen J (2002) Cancer incidence in parents who lost a child: a nationwide study in Denmark. Cancer 95(10):2237–2242. Google Scholar
  35. 35.
    Lillberg K, Verkasalo PK, Kaprio J, Teppo L, Helenius H, Koskenvuo M (2003) Stressful life events and risk of breast cancer in 10,808 women: a cohort study. Am J Epidemiol 157(5):415–423Google Scholar
  36. 36.
    Helgesson O, Cabrera C, Lapidus L, Bengtsson C, Lissner L (2003) Self-reported stress levels predict subsequent breast cancer in a cohort of Swedish women. Eur J Cancer Prev 12(5):377–381. Google Scholar
  37. 37.
    Michael YL, Carlson NE, Chlebowski RT, Aickin M, Weihs KL, Ockene JK, Bowen DJ, Ritenbaugh C (2009) Influence of stressors on breast cancer incidence in the Women’s Health Initiative. Health Psychol 28(2):137–146. Google Scholar
  38. 38.
    Olsen MH, Bidstrup PE, Frederiksen K, Rod NH, Grønbaek M, Dalton SO, Johansen C (2012) Loss of partner and breast cancer prognosis—a population-based study, Denmark, 1994-2010. Br J Cancer 106(9):1560–1563. Google Scholar
  39. 39.
    Kennedy B, Valdimarsdóttir U, Sundström K, Sparén P, Lambe M, Fall K, Fang F (2014) Loss of a parent and the risk of cancer in early life: a nationwide cohort study. Cancer Causes Control 25(4):499–506. Google Scholar
  40. 40.
    Schoemaker MJ, Jones ME, Wright LB, Griffin J, McFadden E, Ashworth A, Swerdlow AJ (2016) Psychological stress, adverse life events and breast cancer incidence: a cohort investigation in 106,000 women in the United Kingdom. Breast Cancer Res 18(1):72. Google Scholar
  41. 41.
    Palesh O, Butler LD, Koopman C, Giese-Davis J, Carlson R, Spiegel D (2007) Stress history and breast cancer recurrence. J Psychosom Res 63(3):233–239. Google Scholar
  42. 42.
    Peled R, Carmil D, Siboni-Samocha O, Shoham-Vardi I (2008) Breast cancer, psychological distress and life events among young women. BMC Cancer 22(8):245. Google Scholar
  43. 43.
    Black AR, Woods-Giscombé C (2012) Applying the Stress and ‘Strength’ Hypothesis to Black women’s breast cancer screening delays. Stress Health 28(5):389–396. Google Scholar
  44. 44.
    Glaser R, Kiecolt-Glaser JK (2005) Stress-induced immune dysfunction: implications for health. Nat Rev Immunol 5(3):243–251. Google Scholar
  45. 45.
    Schernhammer ES, Hankinson SE, Rosner B, Kroenke CH, Willett WC, Colditz GA, Kawachi I (2004) Job stress and breast cancer risk: the nurses’ health study. Am J Epidemiol 160(11):1079–1086. Google Scholar
  46. 46.
    Obeid EI, Conzen SD (2013) The role of adrenergic signaling in breast cancer biology. Cancer Biomark 13(3):161–169. Google Scholar
  47. 47.
    Vajdic CM, van Leeuwen MT (2009) Cancer incidence and risk factors after solid organ transplantation. Int J Cancer 125(8):1747–1754. Google Scholar
  48. 48.
    Adami J, Gäbel H, Lindelöf B, Ekström K, Rydh B, Glimelius B, Ekbom A, Adami HO, Granath F (2003) Cancer risk following organ transplantation: a nationwide cohort study in Sweden. Br J Cancer 89(7):1221–1227. Google Scholar
  49. 49.
    Dhabhar FS (2014) Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res 58(2–3):193–210. Google Scholar
  50. 50.
    Clark SM, Song C, Li X, Keegan AD, Tonelli LH (2019) CD8 + T cells promote cytokine responses to stress. Cytokine 113:256–264. Google Scholar
  51. 51.
    Cheng Y, Jope RS, Beurel E (2015) A pre-conditioning stress accelerates increases in mouse plasma inflammatory cytokines induced by stress. BMC Neurosci 7(16):31. Google Scholar
  52. 52.
    Steptoe A, Hamer M, Chida Y (2007) The effects of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis. Brain Behav Immun 21(7):901–912. Google Scholar
  53. 53.
    McKim DB, Weber MD, Niraula A, Sawicki CM, Liu X, Jarrett BL (2018) Microglial recruitment of IL-1β-producing monocytes to brain endothelium causes stress-induced anxiety. Mol Psychiatry 23(6):1421–1431. Google Scholar
  54. 54.
    Vinay DS, Ryan EP, Pawelec G, Talib WH, Stagg J, Elkord E et al (2015) Immune evasion in cancer: mechanistic basis and therapeutic strategies. Semin Cancer Biol 35(Suppl):S185–S198. Google Scholar
  55. 55.
    King J, Mir H, Singh S (2017) Association of cytokines and chemokines in pathogenesis of breast cancer. Prog Mol Biol Transl Sci 151:113–136. Google Scholar
  56. 56.
    Santos MC, Horta BL, Amaral JJ, Fernandes PF, Galvão CM, Fernandes AF (2009) Association between stress and breast cancer in women: a meta-analysis. Cad Saude Publica 25(Suppl 3):S453–S463Google Scholar
  57. 57.
    Petticrew M, Fraser J, Regan MF (1999) Adverse lifeevents and risk of breast cancer: a meta-analysis. Br J Health Psychol 4:1–17Google Scholar
  58. 58.
    Stagl JM, Lechner SC, Carver CS, Bouchard LC, Gudenkauf LM, Jutagir DR (2015) A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up. Breast Cancer Res Treat 154(2):319–328. Google Scholar
  59. 59.
    Würtzen H, Dalton SO, Christensen J, Andersen KK, Elsass P, Flyger HL (2015) Effect of mindfulness-based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: results of a randomized controlled trial. Acta Oncol 54(5):712–719. Google Scholar
  60. 60.
    Mojalli M, Karimi Moonaghi H, Khosravan S, Mohammadpure A (2014) Dealing with coronary artery disease in early encountering: a qualitative study. Int Cardiovasc Res J 8(4):166–170Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Narjes Bahri
    • 1
  • Tahereh Fathi Najafi
    • 2
  • Fatemeh Homaei Shandiz
    • 3
  • Hamid Reza Tohidinik
    • 4
    • 5
    Email author
  • Abdoljavad Khajavi
    • 6
  1. 1.Department of Midwifery, Faculty of Medicine, Social Development and Health Promotion CenterGonabad University of Medical SciencesGonabadIran
  2. 2.Department of Midwifery, Mashhad BranchIslamic Azad UniversityMashhadIran
  3. 3.Department of Radiation Oncology, School of MedicineMashhad University of Medical SciencesMashhadIran
  4. 4.HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  5. 5.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
  6. 6.Department of Social Medicine, School of MedicineGonabad University of Medical SciencesGonabadIran

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