One of the most common questions I get asked as a surgeon is whether “stress” contributed to one’s cancer diagnosis. First of all, what is stress? A good scientific definition is that it is the “emotional and physical strain caused by our response to pressure from the outside world”. Every animal knows stress from moths to man. To be alive is to have stress in some fashion.

The effect of stress on decreasing immunity is well documented. However, the National Cancer Institute reports, “Although studies have shown that stress factors, such as death of a spouse, social isolation, and medical school examinations, alter the way the immune system functions, they have not provided scientific evidence of a direct cause-and-effect relationship between these immune system changes and the development of cancer.” Holocaust survivors have been shown to have a 2-4 times higher rate of cancer. This is primarily believed to be from the severe calorie restrictions and starvation they underwent. Even this 2-4 times higher risk is quite minimal for most cancer. For example, the average woman’s risk of breast cancer (with no family history of the disease) is 0.8%. A 2 time higher risk is 1.6%. This is lower than the risk for a woman who has more than 2 first degree relatives with breast cancer. Genetics trumps stress very quickly.

Our more colloquial definition of stress is a packed day. When we are overextended, we define it as stress. Chances are, if you ask any of your friends if they have stress, the answer will be “yes”. Stress is also very subjective. I had a young woman with cancer who was dismayed with the diagnosis. She was happily married with no children. She worked because she wanted to and not because she needed the income. When she told me she thought stress was the cause of her cancer, I couldn’t help but be amused. She was telling a surgeon with two kids married to another surgeon that her life with no kids and a 9-5 job was more stressful. Has stress become a competition?

Isn’t it nice that we as a society have time to think about stress? I wonder if women in Africa who have to walk with their babies on their backs for two miles just to get marginally clean water think it’s stressful. I suspect they just consider it life. Is our life more stressful now than 200 years ago when we had no refrigeration, dishwasher, or other modern conveniences?

Maybe the real issue here is that we need to blame something for cancer and control it. The media constantly bombards us with information that the plastics in our water bottle cause cancer or that eating broccoli will prevent it. This makes us think that all the bad health issues that happen to us are within our power to prevent and control. While some things are – like smoking or obesity – most are not. The people who feel the most gypped are the ones who do eat right and exercise. They somehow feel that this is a guarantee to good health. When they get cancer, they are angry and shocked. It must just be the stress. In reality, we can limit our risk but cannot control it. It’s just life.