Psychological Blow Events And Breast Cancer Research

Part1The Association between striking life events and Breast Cancer in women:a meta-analysisPurpose:This study was designed to survey the existed study results to verify the association between striking life events and breast cancer incidence in women by means of Meta analysis and realize the update researches in this field.Methods:Searching the PUB MED,ScienceDirect,Embase and BMJ databases for all English-language by the keywords"breast cancer"+"life event" published from January1995to april2012, we found289papers totally. From which, there are23studies (case-control studies, cohort study) addressed whether severe life events are associated with breast cancer. We also manually searched current and conference abstracts, and searched relevant reviews and their reference. Finally we selected7papers matching the criteria including the Downs&Black.to perform a meta-analysis. RevMan5.1software was used.Results:We evaluated the heterogeneity among studies and used the random effects model to calculate the combined effect. Meta-analysis of these seven studies showed that pool OR=1.51(95%CI:1.15-1.97, P=0.003)based on the severe life events. It is that the risk is1.5times for which with severe life events to develop breast cancer. We further did subgroup analysis in more severe life events(stiking life events) regarding the association with breast cancer. And the meta-analysis showed the more significant association between striking life events and breast cancer, combined OR reached2.07(95%CI:1.06-4.03). Although there will be different result according to variable range for the striking events, we do get the conclusive item that there is statistically significant between striking life events and breast cancer risk.Conclusion:The results of the current meta-analysis show significant evidence of an association between striking life events and primary breast cancer incidence in women. Part IIStriking life events and breast cancer:case-control studyPurpose:To investigate the strength of association between striking life events and the development of primary breast cancer in women by the case-control study, meanwhile to validate the association between the confounders with breast cancer.Methods:This is a case-control with265subjects in each group. The cases were primary breast cancer patients treated in Peking Union Medical College Hospital from May,2011to December,2011. The controls were free of mental illness and breast cancer enrolled from medical healthy center or screening program. All the subjects were asked to complete a structured questionnaire including striking life events and other factors such as age, BMI, menarche, stress, menopause, breast cancer history, oral contraceptive pills and breast operation history. The information were collected in July2011to January2012. Logistic regression analysis were used to estimate the odds ratios(ORs) with95%confidence intervals(CIs) for striking life events with breast cancer. The other risk factors were analyzed all together.Results:There are39cases suffered striking life events and in which seven women suffered two events. The total events were46in case group and mainly due to family member's disease and due to marriage problem secondly. There were24subjects suffered striking life events in control group and only one woman suffered two events. The total events were25. There was no discrepancy regarding the number of subjects suffered but there was a discrepancy when assessing the number of events (P=0.04) in the two groups. The conditional logistic regression results showed below. When only adjustment for age, we found that women with striking life events had higher risk for breast cancer, OR=1.726(1.005-2.965). When adjusted for multiple factors, we found that the odd ratio was OR=1.716(0.976-3.017). Step But when adjusted for these confounders by step, the conditional logistic regression shows that women with striking life events had1.8times (OR=1.811(1.021-3.212) risk for breast cancer compared to those which did not experience such events. The three OR were slightly different and the last one was more reliable because of the confounder adjustment by step. Other risk factors were also estimated logistic regression and showed that larger BMI, family history of breast cancer, later menopause were associated with increase in breast cancer risk. The OR was1.680(95%CI:1.258-2.196),2.244(95%CI:1.065-4.729) and0.513(95%CI:0.303-0.868) for BMI, family history, menopause, respectively. Only by step logistic regressin estimate, we can find the association between menarche and stress with breast cancer risk. That was OR=1.612(95%CI:1.038-2.503) when menarche later than13years, and the risk was2times higher than those with no stress.Conclusion:These findings suggest an association between striking life events and breast cancer risk, and that meansl.8times risk for women suffered striking life events. Step conditional logistic regression also shows that larger BMI, family history, late age at menarche, late age at menopause, with stress are associated with increase in breast cancer risk (P<0.05). Part IIIThe development of cohort study on the association between striking life events and breast cancerPurpose:To establish the prospective database for analyzing the relationship between striking life events and breast cancer in women. To collect the sociodemographic and psychological data for the cohort and analyze the baseline characteristics.Methods:This study was performed as a cohort study. The women in cohort (n=1333) were recruited from the health examination persons in PUMCH medical management department and from women who take part in the community screening program held by PUMCH breast surgery department. All the subjects reported none of psychological disease or breast cancer. Statistical analysis was performed by SAS in order to acquire the baseline data, bias and characteristics of the cohort and provide important information for the upcoming follow-up.Results:1333patients were enrolled in this study.132patients reported at least one striking life event during the past three years,5of132patients experienced two striking life events, and none of them has more than two striking life events. Total incidence is9.9%, which means that almost10%patients have striking life events in the three years before our investigation. Most of the events are mainly related to death or diseases of their relatives or close friends; the others are due to family relationship, marital or social problems, such as legal disputes or loss of property. In our cohort, most of them are young women,64%of whom are between30and49. However, our result showed70%of events happened in this young group, statistical analysis show the trend of high incidence. And in order to ensure the routine follow-up for the cohort, most of the subjects were recruited from people for routine health screening, which may cause inclusion bias.Conclusion:our cohort mainly consisted of young women, which is more suitable to evaluate the risk of breast cancer in this group. At present, baseline events are137, incidence is10%. Striking life events mainly come from family affairs or marital problems, total incidence and events type are consistent with the previous case-control study.