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the development of breast cancer. Thesetraits include abnormal release of anger(42); repression (43); a tendency to control
anger (44); non-assertiveness, calmness andeasy going, and keeping anger inside (45);commitment to social norms (46); depres-sion (47); a repressive coping style (48); and
a so-called cancer-prone (type C) personal-ity that is characterized by 1) personality traits of stoicism, niceness, perfectionism,sociability, conventionality, and more rigiddefensive controls; 2) difficulties in express-ing emotions; and 3) an attitude or ten-dency toward helplessness or hopelessness(49,50). We investigated eight of these risk
profiles and found that none of them wereassociated with the development of breastcancer ( Table 3). Specifically, the risk pro-file “high emotional control” plus “lowsocial support” was identified in approxi-mately the same percentage of bothgroups—in 16 (7.4%) of the 217 casepatients and 62 (7.1%) of control subjects— and so this risk profile was not associated with the development of breast cancer(odds ratio [OR] = 1.04, 95% confidenceinterval [CI] = 0.59 to 1.83;
P
= .91).Comparable results were found for othercombinations of traits, such as the type Cpersonality (49,50), which was identified in
39 (18.0%) of the 217 cases and 183 (21.1%)of the 868 control subjects (OR = 0.85, 95%CI = 0.62 to 1.17;
P
= .31).Personality traits alone, in combination with medical risk factors, or in combination with other personality factors were notassociated with breast cancer incidence inthis prospective study, which included a fol-low-up of 5–13 years after the assessment of personality traits. These results largely sup-port our previous findings that were basedon women diagnosed with breast cancerduring the first 5 years after they completedthe self-assessment personality question-naire. In our previous study sample (9), theonly personality factor that was statistically significantly associated with breast cancerincidence was antiemotionality (OR = 1.19;95% CI = 1.05 to 1.35;
P
= 006); however,the association between this factor andbreast cancer incidence was not found inthe follow-up of 5–13 years. One possibleexplanation as to why this association disap-peared is that an increased antiemotionality score may be a consequence of subclinicalpersonality symptoms caused by the cancer, which was present in the first 5 years of fol-low-up but absent in the next 5–13 years of follow-up, as noted previously by Nakayaet al. (26). Alternatively, the finding in our
Table 1
. Psychologic characteristics of case patients (n = 217) and control subjects (n = 868)*
Mean scale scorePersonality traitCase patientsControl subjectsDifference (95% CI)
P
value†
Anxiety38.638.40.21 (
1.38 to 1.81).80Anger17.518.0
0.47 (
1.25 to 0.30).23Depression36.336.7
0.32 (
1.50 to 0.86).59Rationality15.615.60.30 (
0.53 to 0.66).84Antiemotionality8.38.40.18 (
0.51 to 0.21).41Understanding8.58.40.13 (
0.16 to 0.42).37Optimism23.823.70.12 (
0.58 to 0.82).73Social support18.618.50.10 (
0.45 to 0.64).73Emotional expression–in12.913.2
0.24 (
0.82 to 0.35).43Emotional expression–out13.313.5
0.16 (
0.81 to 0.50).63Emotional control17.317.10.21 (
0.39 to 0.81).49
* We used the SAQ-N to assess personality traits (as opposed to states) and report the scores of the 11 scales of the SAQ-N. The followingdispositions were assessed: anxiety (27,28), anger (29,30), depression (31,32), rationality (33,34), antiemotionality (ie, an absence of emotional behavior or a
lack of trust in one’s own feelings) (33,34), understanding (ie, understanding others in spite of negative feelings) (33,34), optimism (35,36), social support (37),
emotional expression–in (ie, feelings are held in or suppressed) (34,38,39), emotional expression–out (ie, feelings are directed toward other people or objects)
(34,38,39), and emotional control (ie, control of outward expression of feelings) (34,38,39). The general question was “How do you usually feel or behave?” All
98 questions had the same response categories, ranging from 1 (almost never) to 4 (almost always). A high mean score on each of the 11 scales indicates a highfrequency of the self-reported trait. The Cronbach’s alpha values (an indication of validity) of the scales that were based on this study sample of 9705 women andthe test–retest reliability coefficients were reported in our previous paper (9). CI = confidence interval; SAQ-N = Self-Assessment Questionnaire-Nijmegen.
† A two-sided Student’s
t
test was used.
Table 2
. Medical characteristics of case patients (n
max
= 217) and control subjects (n
max
= 868)*
Medical risk factor% of case patientswith factor% of control subjectswith factorOR (95% CI)
P
value†
Positive family history751.43 (0.78 to 2.62).25Nulliparous12150.76 (0.43 to 1.34).33First live birth at age
≥
30 y or nulliparity32340.91 (0.61 to 1.34).62Estrogen use ever48490.98 (0.71 to 1.35).89Overweight (BMI
≥
27.5 kg/m
2
)20200.96 (0.60 to 1.53).86Age at menarche
≤
12 y26251.01 (0.66 to 1.55).96
* The following risk factors were included in the study: having a first-degree relative (mother or sister) with breast cancer (yes vs no); nulliparity (yes vs no);nulliparity or first live birth at age 30 or older vs first live birth when younger than 30 years; estrogen use (ever vs never); overweight (BMI
≥
27.5 vs BMI <27.5kg/m
2
); and early age at menarche (
≤
12 years vs >12 years). n
max
= maximal number (data were missing for some of the medical factors); OR = odds ratio;CI = confidence interval; BMI = body mass index.† A two-sided chi-square test was used.
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