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Stress resilience and cancer risk: a nationwide cohort study
  1. Beatrice Kennedy1,
  2. Fang Fang2,
  3. Unnur Valdimarsdóttir2,3,4,
  4. Ruzan Udumyan1,
  5. Scott Montgomery1,5,6,
  6. Katja Fall1,2
  1. 1 Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
  2. 2 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  3. 3 Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
  4. 4 Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
  5. 5 Department of Epidemiology and Public Health, University College London, London, UK
  6. 6 Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Beatrice Kennedy, Örebro University Hospital, 701 85 Örebro, Sweden; beatrice.kennedy{at}


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 long-term consequences in susceptible individuals may help direct future efforts to reduce cancer burden in adults.

  • Stress
  • Cancer epidemiology
  • Cohort studies
  • Health behavior.

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  • Contributors KF devised the hypothesis and developed the initial study protocol with SM, FF and UV. KF prepared the ethics applications together with SM, FF and UV, and then KF and RU were responsible for obtaining data from national registers. BK and RU performed the statistical analysis. BK conducted the literature review and wrote the first draft. All contributors were involved in critical review of the manuscript. BK will act as guarantor. All authors have had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval Regional Ethical Review Board in Uppsala, Sweden (DNR 2012/361).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We do not have ethical approval to share the data, but it originates from Swedish national registers and can be obtained from the relevant authorities for research by others who have ethical permission.