Breast Cancer Risk Factor: Psychological Stress - A healthy living risk factor e-article and stress self-test

Truth for Healthy Living - Tests with their answers that overcome and prevent probably the most serious threats to healthy living: psychological stress with inaccurate self-esteem, smoking and overweight.
Breast Cancer Risk Factor: Chronic Psychological Stress

Note: You can print a copy to make the quiz easier to score.

I asked the woman I love if she thought psychological stress* is one of a small number of risk factors that cause women to have breast cancer. Judy is a 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 30-plus years. She is also a two-time survivor.

    * Refers here to that biochemical response/strain not caused by "sympathomimetics" such as caffeine.

Judy responded with what I guessed was the usual 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 that stress does combine with a few other important risk factors to produce this cancer! You see, I research and help people with stress.

What scared me was the thought 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 last winter?"

    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 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 the stress (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 as dangerous.
  • 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 are not our fault. Tell a traffic court judge you didn't know what you did was against the "rules of the road," and 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: Feeling Good, a book written by Dr. David Burns, is a reasonable introduction to this. Also see Stress and Moods Mastery. It is the first chapters and drafts of the latest edition of my health promotion program, Stress Mastery. Access is free and will remain so.

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 . . . right away.

Lovelace Stress Scale

  • 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

    1 ...... 2 ....... 3 ....... 4 ........ 5 ........ 6 ........7

  • Be sure to type your numbers as you go and avoid skipping statements.

Copyright 1987-Present, Richard Terry Lovelace. All Rights Reserved.

I believe that I have too much stress.
_2. I worry about people or about things.
_3. 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.
_4. I believe that one or more of my relationships at work or elsewhere suffers because of my irritability or sadness.
_5. I doubt that I'm as successful in my work or at home as I should be.
_6. The way I eat and drink is nutritionally poor or I eat too much fattening food.
_7. 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.
_8. Most days, there are too many tasks that I should complete.
_9 . 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.
_10. I exercise - not activity done at work, yard or house work - too little, or the exercise I do doesn't help enough.

Please add your numbers.

Put that initial score here: __

Overstating Stress

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 47.

If needed, put your adjusted score here: ___

Note: Skip "Identifying Hidden Stress" below if you scored 40 or higher. Go directly to "What your number suggests."

Identifying Hidden Stress

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, stress.

  1. Worry (inventory item # two)
  2. hurtful eating (# six) and
  3. 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 five or more 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: ___

What your 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.

Please note: The 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 please use them to your benefit. Avoid making significant changes based on the results. Instead, use what you learn combined with appropriate professional support.


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Richard Terry Lovelace, Ph.D., MSW, ACSW, LCSW is in clinical practice with Winston Clinical Associates - Winston-Salem, North Carolina USA

Note: Dr. Lovelace is mostly retired from clinical work and doesn't see new patients needing more than one or two sessions.

Copyright Richard T. Lovelace. All Rights Reserved. You have permission to reproduce materials available on this Web site for your personal and non-commercial purposes. All copies should include this copyright statement. Link to lawyer, Laurel O. Boyles, P.A.