Stress as a Risk Factor for Breast Cancer and Recurrence

Stress impacts the immune system, sleep, and hormones

Major life events and changes—and even the day-to-day grind—can bring on stress. Some short-term stress can be a positive force, but once it becomes chronic, stress can take a toll on the body. It can contribute to poor sleep, an unhealthy lifestyle, and even certain conditions.

It is thought that stress may affect your nervous, endocrine, and immune systems. Chronic stress may weaken your defenses, leaving you less resistant to disease.

An ongoing focus of research is whether these effects raise the risk of cancer. Specifically, does stress cause breast cancer or trigger it to spread? Does it raise the risk of recurrence and lower survival? And, importantly, does reducing stress make a difference?

This article will look at the evidence available to answer those questions. Read on to learn about how stress affects the mind and body and whether there is a connection to breast cancer.

Can Stress Cause Breast Cancer?

hands holding a pink breast cancer ribbon
Is stress a risk factor for breast cancer?.

dolgachov / istockphoto.com

"You can't tell me I didn't have break-up cancer," said writer Katherine Russell Rich in her book, The Red Devil. She found a breast lump right after her divorce and was diagnosed with stage IV breast cancer, which has a five-year survival rate of 29%. On a positive note, she survived 25 years with chronic breast cancer.

You may know somebody with a similar story: After a period of chronic stress or significant loss, they found a lump and were diagnosed with cancer. But research has had conflicting results.

A study of 858 women in Poland looked at whether the cumulative effect of stress over time (death of a loved one, divorce, retirement, etc.) had a relationship with breast cancer rates. The study assessed potential stressors in the participants' lives, as well as certain health factors like their family history and lifestyle habits.

The study found that young women who had endured traumatic life events had an increased breast cancer risk.

Another study out of the United Kingdom was less conclusive. The Breakthrough Generations Study was a cohort study of over 106,000 women aged 16 or older, focused on breast cancer diagnosis as it related to stressful life events such as divorce or the death of a loved one. It also looked at similar lifestyle factors as the Poland study.

In that study, the researchers found no consistent evidence that self-reported frequency of stress and adverse life events affected breast cancer risk.

It may seem natural to associate negative emotions with breast cancer, but researchers are not sure if, or why, your body may be more vulnerable to cancer due to stress. 

Although optimism and a fighting spirit are important, it's just as important to have a support group or counselor to help you work through your emotions, both positive and negative.

Can Stress Cause Breast Cancer to Recur or Spread?

letters spelling the words stressed out

Phlebotomy Tech / Flickr / CC by 2.0

Although it's not clear whether breast cancer is a direct result of stress, it appears that stress can have an impact on people who already have or had breast cancer.

Researchers have looked at this question from several angles, albeit mostly in cells in a dish or in rodents thus far.

From a biological standpoint, it would make sense that stress could stimulate breast cancer to grow or spread. When we are stressed we release a hormone called norepinephrine, one of our "stress hormones." 

Norepinephrine in turn may stimulate both the formation of new blood vessels that help feed cancers (angiogenesis) and hasten the spread of cancer (metastasis). Other studies looking at something called "telomerase activity" also suggest that there could be a biological basis behind stress facilitating the recurrence or spread of cancer.

Does this translate to living creatures? For mice who were placed in a simulated stressful environment, their tumors were more likely to spread.

Studies in humans also seem to point the finger at stress, though it's more difficult to separate out other factors. In a fairly large study, women with some types of breast cancer lived longer if they participated in mindfulness stress reduction activities.

Use of Alcohol and Breast Cancer

Some people who are stressed may turn to alcohol to cope. Studies show that alcohol abuse is correlated with an increased risk of breast cancer. This is one way that stress could indirectly contribute to breast cancer.

As a final note, we know that stress can cause insomnia. We've also learned that insomnia can be dangerous for people who have had cancer. It has been associated with lower survival rates for women with some types of breast cancer.

If you've had breast cancer and are feeling worried after considering this, take heart. Yes, it does appear that stress is unhealthy for those who have had cancer. But we've also learned that there is also something called posttraumatic growth. Cancer really can change people for the better!

Stress and Survival

What about stress and survival? Data is limited, but one trial found that people who received a 10-week stress management intervention had significantly lower mortality rates than those who didn't get the counseling. That suggests, but doesn't prove, that reducing stress improves survival.

However, it may not be the stress itself, but how the stress plays out, that affects outcomes.

For example, if a person is having anxiety about a cancer scan, maybe some days they can't leave the couch. They might miss appointments as a result of their stress and anxiety, which might affect their survival.

If at any point in your cancer journey you feel so stressed that you are missing appointments, call a social worker or therapist to help you assess your stress and make a plan to learn coping mechanisms.

Stress and Living with Cancer - Finding Resilience

Woman meditating in the sunshine

MariaVu / istockphoto.com

Coping with cancer and its side effects is an important part of the cancer journey. People with cancer may try some of the following techniques to help cope with stress:

Summary

A cancer diagnosis can be stressful, but does it have a direct correlation to a recurrence? The science leans that way but it is not conclusive. Certain effects of stress like abusing alcohol or missing medical appointments could contribute to cancer and worse treatment outcomes. Knowing your stress triggers and learning coping mechanisms can improve your quality of life.

Frequently Asked Questions

  • Does stress cause cancer?

    The evidence is mixed on that question. But stress could indirectly play a role in cancer development by causing you to adopt unhealthy lifestyle choices such as eating a high-fat diet or overindulging in alcohol.

  • How do depression and anxiety affect cancer outcomes?

    A large study concluded that depression and anxiety both have adverse effects on recurrence and mortality in patients with breast cancer. However, only depression was associated with cancer-specific mortality (as opposed to death from other causes), while anxiety was not.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. Impact of attitudes and feelings on cancer.

  2. Susan G. Komen. Understanding breast cancer survival rates.

  3. Kruk J. Self-reported psychological stress and the risk of breast cancer: a case-control study. Stress. 2012;15(2):162-171. doi:10.3109/10253890.2011.606340.

  4. Schoemaker MJ, Jones ME, Wright LB, et al. Psychological stress, adverse life events and breast cancer incidence: a cohort investigation in 106,000 women in the United KingdomBreast Cancer Res. 2016;18(1):72. doi:10.1186/s13058-016-0733-1

  5. National Cancer Institute. Psychological stress and cancer.

  6. Kuol N, Stojanovska L, Apostolopoulos V, Nurgali K. Role of the nervous system in cancer metastasis. J Exp Clin Cancer Res. 2018;37(1):5. doi:10.1186/s13046-018-0674-x

  7. Law E, Girgis A, Lambert, Sylvie L, Levesque J, Pickett H. Telomeres and stress: promising avenues for research in psycho-oncology. Asia Pac J Oncol Nurs. 2016;3(2):137-147. doi:10.4103/2347-5625.182931

  8. Zhang J, Zhou Y, Feng Z, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivorsPsychology, Health & Medicine. 2017;22(1):94-109. doi:10.1080/13548506.2016.1146405

  9. Jung S, Wang M, Anderson K, et al. Alcohol consumption and breast cancer risk by estrogen receptor status: in a pooled analysis of 20 studiesInt J Epidemiol. 2016;45(3):916-928. doi:10.1093/ije/dyv156

  10. Lengacher C, Reich R, Paterson C, et al. The effects of mindfulness-based stress reduction on objective and subjective sleep parameters in women with breast cancer: a randomized controlled trialPsychooncology. 2015;24(4):424-432. doi:10.1002/pon.3603

  11. Stagl J, Lechner S, Carver C, et al. A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up. Breast Cancer Research and Treatment. 2015;154(2):319-328. doi:10.1007/s10549-015-3626-6

  12. Wang X, Wang N, Zhong L, et al. Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Mol Psychiatry. 2020;25:3186–3197. doi:10.1038/s41380-020-00865-6

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
Learn about our editorial process