An important risk factor
e-article and self-test for women and people who love them.
Note:You can print
a copy of this article/quiz to make scoring easier.
I asked the woman I love if she thought that psychological
stress* is one of a small number of risk factors that cause women to get
breast cancer. Judy isa good person to ask. You see she is a clinical nurse specializing in cancer research for a university
medical center and has worked there for 35 years. She is also a survivor.
That gives her two excellent reasons for keeping up with the latest information.
* Refers here to that biochemical response/strain not
caused by "sympathomimetics" such as caffeine.
Judy responded with what I guessed was the current standard answer to that question. She said, "There is no clear-cut evidence
that stress is one of the risk factors for breast cancer." Then she
explained that a few studies report that it does contribute. Most suggest
the opposite ... it doesn't.
What I thought about her response hurt my feelings. You would think that
from reading what I've written she would pay little attention to some of
that research. She wouldn't believe that the evidence is uncertain. I'm
convinced thatstress does combine with a few other important risk
factors to produce this cancer!You see, I research and help people
with stress while Judy studies cancer and helps folks who suffer with it.
What scared me was the thought that she might be at greater risk for having
cancer again because of her understandable misconception. It wasn't my
fear, but my affection for her, that encouraged me to tell Judy what I
believe that follows. If you have had breast cancer or you are at risk
for it, please pay attention!
Higher levels of ongoing or chronic stress (primarily
the hidden kind) do cause breast cancer and as much
as any other risk factor. Meaning no criticism any study, book or article
that says or implies otherwise is mistaken.
How do I know? Every piece of research that I can find
that uses a better measure of stress says so. At least one study, that
used the less accurate way of calculating stress, also suggested that it
is one of the important risks for breast cancer.
The popular "life events" way of measuring
stress doesn't work well enough. The more recent version of that less accurate
means of measuring stress asks you which life events (serious illness,
divorce, fired from a job, a move to another home, marriage, etc.) you've
experienced during the past year. The test assigns points--ranging from
18 to 123--to those you've experienced. If when you add your numbers you
get between 250 and 500, then you are supposed to have a "moderate
level" of stress.
To me, that's like trying to find out if someone is
cold by asking her questions such as, "How many snows did you
get last year?" or "Did you sleep with a blanket on your bed
The studies that alleged that stress wasn't a risk factor
for this cancer used the "life events" test. Little wonder they
found what they did!
The better way to gauge stress is to
ask people how much they believe they have;
find out if they have symptoms of chronic stress and
see if they use "home remedies" (hurtful eating,
etc.) to try to get some relief.
Using the "someone is cold" analogy again ...
if you want to find out if someone feels cold, simply ask her, "Do
you feel cold?" In case she has been chilled so long that she somehow
doesn't recognize it (like with hidden stress), you can ask her if she
has symptoms, "Do you have 'goose bumps?'"
Note: There is an example
of a better way to measure stress further along in this article. Feel free
to take and score it.
"Life events" measures of stress discourage
a sense of competence ... while fostering guilt in women at risk. Neither
of those outcomes will be useful. One liability in saying or implying that
life events cause stress is that people can easily hear the message: "There
is nothing much you can do to avoid stress. After all, there is little
you can (or would want to) do to sidestep many life events." Another
negative is that the "life events stress tests" at least imply
that women deserve blame. For example, "You made yourself stressed
and sick by getting married and moving into a new home."
Our ancestors got to be our ancestors by surviving. When
a dangerous animal, for instance, attacked they didn't stand around that
long scratching whatever and trying to decide what to do. Anyone who did
got "chomped" and didn't get to be a progenitor. What those who
survived did have were thoughts that happened so quickly they didn't know
they were there. Those "fast thoughts" caused thestress(the biochemical response to subconscious perceptions/thoughts of threat)
that created the uncomfortable emotions that fueled their defensive behaviors.
They fought, ran away or hid from what their super-quick thoughts identified
We have inherited that "fast thinking" ability.
Those subconscious thoughts, NOT life events, cause our stress. Since we
don't know the thoughts are present when they happen, they arenot
our fault. Tell a traffic court judge you didn't know what you did
was against the "rules of the road," and he or she will tell
you, "Ignorance of the law is no excuse." In what I call the
"court of life," not knowing is one of the best defenses we have.
If it doesn't work, we all get "sent up the river."
We need to sense the presence and question those unknown-to-us
(at the time) stress-making thoughts. Then we can learn to counter them
to avoid most stress. We do that by telling ourselves what's more likely
going on and true. Just as it is important to discover which germ is causing
a disease, it's crucial to acknowledge and answer those honest, but mistaken,
thoughts causing our stress. Note: FeelingGood, a book written
by Dr. David Burns, is a reasonable introduction. Also
see this Adobe
Acrobat (TM) file Stress
and Moods Mastery. This is the first chapters
and drafts of the new edition of our health promotion program, STRESS MASTER.
If after you read it you want us to let you know when we add more chapters
and audio, you'll find an easy way to do that. Access will remain free.
Here is an example of a more accurate measure of stress
I promised to share. If you find out or confirm that you have too much
stress, I very much hope you will begin to get real and safe relief ...
Lovelace Stress Inventory
Please read each of the ten statements below.
As you go ... gauge how well each statement describes
you in recent times. (The last six months or so.)
Respond to each statement with a number from one to seven.
The more you believe the statement describes you, the higher
the number you give.
Not at all like me ......................................................
Just like me
I have a fear that interferes or
holds me back. You might relate the fear to activities such as asserting
yourself, calling or meeting with friends or relatives, being rejected,
dealing with criticism, driving or maybe flying.
I believe that one or more of my
relationships at work or elsewhere suffers because of my irritability or
I doubt that I'm as successful
in my work, or at home, as I should be.
The way I eat and drink is nutritionally
poor or I eat too much fattening food.
I have a physical problem that
I suspect, or someone tells me, comes from pressures in my life. The problem
could be headaches, stomach upsets, back or neck pain, difficulty sleeping,
teeth grinding, bitten finger nails, excessive sweating, too much body
fat, decreased romantic interest, skin problems or cold hands. Please note
that factors other than stress can cause some of these physical concerns.
If you haven't already, check with your physician.
Most days, there are too many tasks
that I should complete.
I use something to calm or relax
me. Or, I use something to pep me up or to give me energy/excitement. You
might, for example, use nicotine, caffeine, a medicine, a dietary supplement,
alcohol, a forbidden drug, gambling, risky relationships or maybe "too
much" watching television.
I exercise--not activity done at
work, yard or house work--too little, or the exercise I do doesn't help
Please add your numbers.
Put that initial score here: ___
If your "initial score"
(above) was 59 or higher, check to see how often you gave a response of
seven. (The total presence of something so infrequently happens that it's
reasonable to consider such a response to be a subconscious attempt to
overstate it.) Deduct two points from your "initial score" for
each response of seven. If, for example, your "initial score"
was 61, and you gave seven responses of seven, then subtract 14 points
from your "initial score" for an "adjusted score" of
If you got an "initial score"
of 39 or less, you still might have some "hidden stress." Three
key items can tell you if you have this concealed, and particularly menacing,
Worry (inventory item # two)
hurtful eating (# six) and
using "home remedy" or
"painkillers" (# nine) are common ways to unwittingly
avoid an awareness of stress.
If you scored 39
or less and still rated yourself with a fiveormore on statement two, six
or nine, then add seven points for each statement to your initial score.
That means, for example, if your score totaled 37 and you rated yourself
as five (or higher) on statement number two and statement nine then add
14 (two statements time seven) to your 37 for a new total of 51.
Did you respond to any of the 10
items by rating yourself with a number one?
If so, add three points to your score for each. (It infrequently happens
that there is a total absence of something. It's appropriate to consider
such a response to be a subconscious attempt to ignore stress.) For instance,
if you answered two of the statements with a number one, you would add
another six points to the 51 for a final adjusted total of 57. The difference
between the 37 you started with and 57 represents Hidden Stress.
Type your adjusted score here: ___
number (initial or adjusted) suggests:
If you got an "initial score"
of 33 or less, that suggests that you are using subconscious denial of
how much stress you have. Don't take this as criticism. Instead, see it
as a possibility you need to consider. Also with an "initial score"
that low (33 or less), you may have misunderstood how to respond to this
inventory. (The more you believe a statement describes you, the higher
the number you give.)
If your "initial score"
was 34 to 39, that implies that you have a low level of stress.
If you scored (initial or adjusted)
40 to 45, chances are you have a moderate level of stress. Your score clearly
points to a need to reduce your stress.
Scores (initial or adjusted) of
46 and higher suggest a high level of stress. Doing something soon that
safely works to significantly lower your stress is, I believe, easily justified.
Obvious stress is harmful enough.
Hidden stress is worse. It can be difficult to get yourself to work on
what, understandably, you don't realize is there.
author and publisher offer this inventory for educational purposes. No
lifestyle health risk appraisal tells absolute facts. Such assessments
suggest possibilities to consider. When the results make sense, then use
them to your benefit. Avoid making significant changes based on the results.
Instead, use what you learn combined with appropriate professional support.