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Is Cancer Risk Associated With Anger Control and Negative Affect? Findings From a Prospective Cohort Study

From the Centre for Behavioural Research in Cancer (V.M.W.), The Cancer Council Victoria, Australia; Cancer Epidemiology Centre (D.R.E., G.G.G.), The Cancer Council Victoria, Australia; School of Population Health (D.R.E., G.G.G.), University of Melbourne, Australia; Department of Epidemiology and Preventive Medicine (D.R.E., G.G.G.), Monash University, Australia; Centre for the Study of Higher Education (H.C.), University of Melbourne, Australia; Department of Epidemiology and Biostatistics (M.L.), University of Western Ontario, Canada; VicHealth Centre for Tobacco Control (R.B.), The Cancer Council Victoria, Australia.

Address correspondence and reprint requests to Victoria M. White, Centre for Behavioural Research in Cancer, The Cancer Council Victoria, 1 Rathdowne Street, Carlton Vic 3053, Australia. E-mail: Vicki.White{at}cancervic.org.au

Objective: To examine the associations between anger control and negative affect and the risk of five common cancers and total cancers. Possible associations between emotional states and the risk of cancer have long been postulated.

Methods: Prospective cohort study with average follow-up of 9 years. A total of 19,730 adults (99% aged between 40 and 69 years) answered questions on negative affect and anger control at baseline. A total of 1952 cancers were diagnosed, including 352 breast cancers, 318 prostate cancers, 88 lung cancers, 280 colorectal cancers, and 261 melanomas.

Results: After adjustment for potential confounders, there was no significant association between anger control or negative affect and risk of breast cancer, melanoma, or total cancers. Weak associations were identified between anger control and prostate cancer, hazards ratio (HR) 1.17 (1.04–1.30) for a 1-unit increase in the standardized scale, negative affect, and lung cancer, HR 1.24 (1.01–1.52) and colorectal cancer, HR 1.14 (1.01–1.28). There was no evidence of an interaction effect between anger control and negative affect.

Conclusions: Results suggest that anger control and negative affect are not associated with breast cancer, melanoma, or total cancer risk, although they may have a small role in risk of prostate, colorectal, and lung cancer. Although more research is needed to confirm these latter associations, the results suggest that if affective states are associated with cancer development, the association may differ for different cancers and argue against the use of total cancer as an outcome measure for studies in this area.

Key Words: cancer risk • cohort study • anger control • negative affect

Abbreviations: BMI = body mass index; CECS = Courtauld Emotional Control Scale; CI = confidence interval; HR = hazards ratio; HRT = hormone replacement therapy; MCCS = Melbourne Collaborative Cohort Study; MMPI = Minnesota Multiphasic Personality Inventory; PANAS = Positive And Negative Affect Scale.