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Childhood bereavement, stress resilience, and cancer risk: an integrated register-based approach
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-0066-4814
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Accumulating evidence suggests that psychosocial stress and susceptibility to stressful exposures – stress resilience – influence the risk of various health outcomes, but the potential link with cancer occurrence is unclear. The aims of this thesis were to test if loss of a close relative, a marker of severe psychological stress, and stress resilience measured during late adolescence are associated with cancer risk later in life, as well as to explore potential underlying mechanisms. National registers provided information on childhood bereavement, defined as death of a first-degree relative, as well as a measure of psychological functioning relevant to stress resilience that was obtained from mandatory military enlistment assessments. In a cohort comprising all individuals born in Sweden during 1961-2002, we found that bereavement during childhood (up to age 18 years) was associated with increased risks of HPVrelated malignancies and pancreatic cancer. Parental loss during early adulthood (ages 18-40 years) also entails a raised risk of pancreatic cancer as well as for gastric and lung cancer. In a cohort of men born during 1973-1983, we observed that childhood bereavement is also associated with low stress resilience during late adolescence. In our third cohort study, comprising men born during 1952-1956, we found that low stress resilience compared with high, was associated with 5-fold and 3-fold increased risks of subsequent liver and lung cancer, respectively. In contrast, low stress resilience is associated with reduced risks for prostate cancer and malignant melanoma. Finally, in a cohort of twin conscripts born during 1959-1985 who completed a survey in 2005- 2006 covering use of addictive substances, we found that low stress resilience was also associated with a raised occurrence of hazardous use of alcohol, alcohol dependence, cigarette smoking and nicotine dependence, as well as with other drug use. We conclude that the observed links with cancer risk for stressful exposures and low stress resilience, may be explained, at least in part, by disadvantageous health behavior.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 85
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 171
Keywords [en]
alcohol, bereavement, cancer, drug use, epidemiology, health behaviour, psychological resilience, smoking, stress
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-62605ISBN: 978-91-7529-224-3 (print)OAI: oai:DiVA.org:oru-62605DiVA, id: diva2:1157573
Public defence
2018-02-09, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-01-19Bibliographically approved
List of papers
1. Loss of a parent and the risk of cancer in early life: a nationwide cohort study
Open this publication in new window or tab >>Loss of a parent and the risk of cancer in early life: a nationwide cohort study
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2014 (English)In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 25, no 4, p. 499-506Article in journal (Refereed) Published
Abstract [en]

Background: While early-life exposure to stress has been associated with subsequent psychiatric and cardiovascular morbidity, little is known regarding its potential role in cancer development. We hypothesized that severe emotional stress, such as the loss of a parent through death during childhood, may increase the risk of cancer in early life.

Method: Based on the Swedish Multi-Generation Register, we identified a cohort of 4,219,691 individuals who had both parents identifiable in the same register and followed the cohort from birth to the age of 40 years between 1961 and 2006. Through information retrieved from the Swedish Causes of Death and Cancer Registers, we ascertained death among the parents and cancer diagnosis among the cohort individuals. We used Poisson regression to calculate the relative risks (RRs) and 95 % confidence intervals (CIs).

Results: Parental death was not associated with total cancer risk. However, parental death during childhood was associated with a higher risk of human papillomavirus (HPV) infection-related cancers (RR 1.4; 95 % CI 1.2-1.7), and loss during early adulthood (>18 years) entailed a higher risk of cancers of the stomach (RR 1.8; 95 % CI 1.3-2.6), lung (RR 1.7; 95 % CI 1.1-2.4), rectum (RR 1.4; 95 % CI 1.0-2.0), and breast (RR 1.1; 95 % CI 1.0-1.3). A significant association was observed for pancreatic cancer for both loss during childhood (RR 2.6; 95 % CI 1.6-4.2) and afterward (RR 2.8; 95 % CI 1.9-4.3).

Conclusion: Our results suggest that severe psychological stress in early life may be associated with premature development of certain malignancies, particularly cancers related to smoking and HPV infection.

Place, publisher, year, edition, pages
Dordrecht, Netherlands: Springer, 2014
Keywords
Sweden/epidemiology, Cohort studies, Psychological stress, Neoplasms/epidemiology/etiology, HPV/infection, Risk
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-41410 (URN)10.1007/s10552-014-0352-z (DOI)000332647500010 ()24500176 (PubMedID)2-s2.0-84896096677 (Scopus ID)
Funder
Swedish Research Council, K2009-70X-21087-01-2 SIMSAM 80748301
Note

Funding Agencies:

Alex och Eva Wallströms stiftelse

Research Committee in Örebro County Hospital

Svenska Sällskapet for Medicinsk Forskning (SSMF)

Available from: 2015-05-12 Created: 2015-01-14 Last updated: 2018-01-16Bibliographically approved
2. Childhood Bereavement and Increased Sensitivity to Stress in Late Adolescence
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(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-64312 (URN)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-01-16Bibliographically approved
3. Stress resilience and cancer risk: a nationwide cohort study
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2017 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 10, p. 947-953Article in journal (Refereed) Published
Abstract [en]

Background: Stress resilience is recognised as a determinant of both psychiatric and somatic health, but the potential link between stress resilience and cancer development has not been explored.

Methods: In this nationwide cohort study, we examined the association between stress resilience in adolescence and subsequent cancer risk. We identified a cohort of 284 257 Swedish men, born 1952-1956, who underwent compulsory military enlistment examinations including measures of psychological stress resilience (median age 18 years). The resulting score was categorised as low, moderate and high stress resilience. Individuals diagnosed with cancer during the follow-up time were identified through data linkage to the Swedish Cancer Register.

Results: Lowest stress resilience, compared with the highest, was associated with increased risks of liver (HR: 4.73, 95% CI 2.73 to 8.19) and lung (HR: 2.75, 95% CI 2.02 to 3.74) cancer after adjusting for markers of socioeconomic circumstances in childhood (p for trend <0.001 for both cancer types). Further adjustment for cognitive and physical fitness at conscription assessment had a marginal influence. In contrast, men with low stress resilience had a decreased risk of being diagnosed with prostate cancer (HR: 0.65, 95% CI 0.56 to 0.76) and malignant melanoma (HR: 0.65, 95% CI 0.55 to 0.76).

Conclusion: We conclude that adolescent stress resilience, plausibly by influencing behavioural choices and social patterns, constitutes an important determinant of adult cancer occurrence. Increased awareness of longterm consequences in susceptible individuals may help direct future efforts to reduce cancer burden in adults.

Place, publisher, year, edition, pages
London, UK: BMJ Publishing Group Ltd, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-61215 (URN)10.1136/jech-2016-208706 (DOI)000411146100002 ()28790142 (PubMedID)2-s2.0-85032566820 (Scopus ID)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2018-08-06Bibliographically approved
4. Low stress resilience and use of addictive substances
Open this publication in new window or tab >>Low stress resilience and use of addictive substances
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(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-64323 (URN)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-01-16Bibliographically approved

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