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      Work stress and the risk of cancer: A meta‐analysis of observational studies

      Author(s): 1 , 2 , 1 , 3 , 3 , 1
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      Journal: International Journal of Cancer
      Publisher: Wiley

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          Abstract

          <p class="first" id="d5294027e109">Epidemiological studies have explored the relationship between work stress and the risk of cancer, but it remains unclear on whether work stress could increase the risk of cancer, or by other factors such as smoking and physical activity. Our study aimed to investigate the association between work stress and the risk of cancer and in relation to major potential confounding and modifying factors. We systematically searched three electronic databases, hand-searched references and citations of retrieved articles, and consulted experts to identify studies on assessing the association between work stress and the risk of cancer. The relative risks (RRs) of cancer associated with work stress were estimated using a random-effects model, and stratified by exposure measurement, study design, gender, study location, cancer site, smoking, drinking, body mass index, and physical activity. A total of 281,290 participants were included in this analysis. The significant association between work stress and the risk of colorectal (RR = 1.36; 95%CI: 1.16-1.59), lung (RR = 1.24; 95%CI: 1.02-1.49), and esophagus (RR = 2.12; 95%CI: 1.30-3.47) cancers were found. A statistically significant effect of work stress on colorectal cancer risk was observed in North America (RR = 1.51, 95% CI: 1.23-1.86, but not significant in Europe (RR = 1.16, 95% CI: 0.90-1.48). By contrast, a significant association between work stress and esophagus cancer was found in Europe, but not in North America. In addition, we did not observe any association between work stress and the risk of prostate, breast, or ovarian cancers. Findings of our study show that work stress is an important risk factor for colorectal, lung, and esophagus cancers. General public should be aware of the increased risk of cancer in employers with work stress. More efforts should be focused on understanding and studying the potential mechanisms which would help to identify employees at higher risk of these cancers. </p>

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          Observational studies: cohort and case-control studies.

          Jae Song, Kevin C Chung (2010)
          Observational studies constitute an important category of study designs. To address some investigative questions in plastic surgery, randomized controlled trials are not always indicated or ethical to conduct. Instead, observational studies may be the next best method of addressing these types of questions. Well-designed observational studies have been shown to provide results similar to those of randomized controlled trials, challenging the belief that observational studies are second rate. Cohort studies and case-control studies are two primary types of observational studies that aid in evaluating associations between diseases and exposures. In this review article, the authors describe these study designs and methodologic issues, and provide examples from the plastic surgery literature.
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            Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study

            David W. J. Brown, Robert Anda, Vincent Felitti … (2010)
            Background Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood. Methods Baseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index. Results The ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000-1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000-1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs → smoking → lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs. Conclusions Adverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.
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              Stress and Type 2 Diabetes: A Review of How Stress Contributes to the Development of Type 2 Diabetes

              Shona Kelly, Mubarak Ismail (2015)
              Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.
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                Author and article information

                Journal
                Title: International Journal of Cancer
                Abbreviated Title: Int. J. Cancer
                Publisher: Wiley
                ISSN (Print): 0020-7136
                ISSN (Electronic): 1097-0215
                Publication date Created: December 08 2018
                Publication date (Electronic): December 08 2018
                Affiliations
                [1 ]Department of Nutrition, Henan Provincial People's Hospital Zhengzhou Henan People's Republic of China
                [2 ]Department of Prevention and HealthcareTianjin Union Medical Center Tianjin People's Republic of China
                [3 ]Department of Social Medicine and Health ManagementSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology Wuhan Hubei People's Republic of China
                Article
                DOI: 10.1002/ijc.31955
                PubMed ID: 30484859
                SO-VID: 9729be56-0a00-4dd4-896e-7ce7b9a655c3
                Copyright © © 2018
                License:

                http://doi.wiley.com/10.1002/tdm_license_1.1

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