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Perceived Psychologic Stress and Colorectal Cancer Mortality: Findings From the Japan Collaborative Cohort Study

From the Department of Health Promotion and Preventive Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (M.K., S.T., S.S.); the Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan (K.W.); the Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.W., A.T.); the Department of Public Health/Health Information Dynamics, Nagoya University Graduate School of Medicine, Nagoya, Japan (K.T., H.T.); the Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan (Y.W.); the Department of Epidemiology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan (N.H.); the Department of Public Health, Fujita Health University School of Health Sciences, Aichi, Japan (K.S., Y.I.); and the Department of Hygiene, Fujita Health University School of Medicine, Aichi, Japan (S.H., M.K.).

Address correspondence and reprint requests to Masayo Kojima, MD, PhD, Department of Health Promotion and Preventive Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. E-mail: masayok{at}med.nagoya-cu.ac.jp

Objective: The purpose of this research was to examine the relationship between perceived psychologic stress and colorectal cancer mortality in a prospective large-scale study.

Methods: Between the years 1988 and 1990, 32,153 men and 45,854 women aged 40 to 79 years were enrolled. Participants completed a self-administered questionnaire that addressed demographic, lifestyle, and psychosocial characteristics. Subjects were subsequently followed for mortality until the end of 1999. Perceived psychologic stress was assessed using the question "Do you feel stress during your daily life?" The 4 possible responses, ranging from "little or none" (1) to "extreme" (4), were dichotomized as low (1 or 2) or high (3 or 4) stress. Relative risks (RRs) with 95% confidence intervals (CIs) for colon and rectal cancer according to the perceived level of stress were estimated using Cox’s proportional hazard model.

Results: During the follow-up period (average, 9.6 years), 193 colon cancer deaths (96 men and 97 women) and 127 rectal cancer deaths (88 men and 39 women) were confirmed within the study group. Women who reported high stress had a 1.64-fold higher risk of colon cancer mortality (multivariate-adjusted RR, 1.64; 95% CI, 1.01–2.66) compared with those reporting low stress. There was no significant association between perceived stress and female rectal cancer or male colon and rectal cancer mortality.

Conclusions: Perceived psychologic stress was weakly associated with increased mortality from colon cancer in women. No positive or inverse association was found in men. Further studies are needed to confirm our results.

Key Words: colorectal carcinoma • psychosocial factors • perceived stress • cohort study

Abbreviations: BMI = body mass index; CI = confidence interval; HPA axis = hypothalamic–pituitary–adrenocortical axis; ICD-10 = 10^th Revision of the International Classification of Diseases; OR = odds ratio; RR = relative risk; SAM system = sympathetic–adrenal–medullary system.

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