Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer

Objective: Review empirical evidence for a relationship between psychosocia l factors and breast cancer development. Methods: Standardised quality asse ssment criteria were utilised to assess the evidence of psychosocial predic tors of breast cancer development in the following domains: (a) stressful l ife events, (b) coping style, (c) social support, and (d) emotional and per sonality factors. Results: Few well-designed studies report any association between life events and breast cancer, the exception being two small studi es using the Life Events and Difficulties Schedule (LEDS) reporting an asso ciation between severely threatening events and breast cancer risk. Seven s tudies show anger repression or alexithymia are predictors, the strongest e vidence suggesting younger women are at increased risk. There is no evidenc e that social support, chronic anxiety, or depression affects breast cancer development. With the exception of rationality/anti-emotionality, personal ity factors do not predict breast cancer risk. Conclusion: The evidence for a relationship between psychosocial factors and breast cancer is weak. The strongest predictors are emotional repression and severe life events. Futu re research would benefit from theoretical grounding and greater methodolog ical rigour. Recommendations are given. (C) 2000 Elsevier Science Inc. All rights reserved.