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Premorbid psychological factors as related to cancer incidence

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Abstract

In planning for studies relating psychological factors and/or stress (PF&/0S) to cancer, one should be aware of epidemiological findings that might contribute to or even account wholly for any found relationships. Most studies have not examined the known biological causes of cancer, nor have they described a rationale for relationships sought. The two broad mechanisms leading to cancer, carcinogenesis and lowered resistance to it, include physical and chemical causes, viruses and chronic infection, medication, genetic predisposition, hormonal stimuli, and aging. Interfering variables may bias or dilute a real relationship. Validity and reliability of instruments measuring PF&/oS are so variable as to warrant considerable care in their use. The latent periods of different cancers are measured in years, not months, with consequent potent impact on possible inferences drawn from prebiopsy and short prospective studies. In these and in retrospective studies, cancer can have strong and biasing effects on apparently straightforward PF&/oS measurements, as can iatrogenic effects. Some theoretical issues are discussed. The known prospective studies are discussed and reasons are given for the view that they are less convincing than many seem to think. A sketch of a model relating PF&/oS to cancer appearance is outlined, with some theoretical implications, and issues in research design are addressed.

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  1. National Cancer Institute, 20014, Bethesda, Maryland

    Bernard H. Fox

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This article was originally written for potential applicants for a Cancer Research Emphasis Grant at the National Cancer Institute as an orientation to some issues in this area. It was and is not intended as a review of literature on psychological factors and cancer. Some corrections of the original article were made here, and a new section was added. This article discusses some areas I am not well conversant with and espouses certain views that some might disagree with. To those who may have been misquoted or misinterpreted, I apologize and ask for corrections; from those who might disagree with some things said, I ask for response, clarification if needed, and any suggestions; and from all, because of the unsettled state of this subject, I ask for comments and suggestions. I thank various members of this Institute, and especially Dr. John Bailar, for a number of helpful observations.

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Fox, B.H. Premorbid psychological factors as related to cancer incidence. J Behav Med 1, 45–133 (1978). https://doi.org/10.1007/BF00846586

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