Original articleThe sense of coherence and incidence of cancer—role of follow-up time and age at baseline
Introduction
Aaron Antonovsky's [1], [2] salutogenic approach focuses on what keeps people healthy instead of why they fall ill. The result of Antonovsky's deliberations was the concept “sense of coherence” (SOC) consisting of three components, namely, (a) comprehensibility, (b) manageability, and (c) meaningfulness. Antonovsky describes this as a global orientation that expresses the extent to which one has a pervasive, enduring, though dynamic feeling of confidence that (a) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable, and explicable; (b) the resources are available to one to meet the demands posed by these stimuli; and (c) these demands are challenges, worthy of investment and engagement [2].
The association of the SOC with different diseases including psychiatric conditions like depression and suicidality has been studied [3], [4], [5], [6]. Large population-based follow-up studies on the SOC and mortality or morbidity are still very rare. One recent study was carried out in England, the EPIC-Norfolk Study [7], where there was a strong negative association between the SOC and all-cause mortality and a weak negative association with cancer mortality. In the Helsinki Heart Study (HHS), the risk of all-cause mortality for those with a weak SOC compared with those with a strong SOC was 1.23 (NS), while white-collar workers with a weak SOC had a significantly higher relative risk (RR), 2.27, of death when compared to white-collar workers with a strong SOC [8].
Here we report the HHS 12-year follow-up and explore the effect of the SOC on the incidence of cancer with special focus on time-related factors: we studied whether the risk persisted over increasing follow-up time and explored the role of age at baseline in SOC–cancer association.
Section snippets
The HHS
The HHS was a 5-year randomized, double-blind, placebo-controlled primary prevention trial of gemfibrozil, a lipid-lowering drug [9], [10]. The participants were selected via two successive screenings from among those employed at two state agencies and five industrial companies. All male employees aged 40–55 years were invited to the first screening. To be eligible for the trial as well as for the second screening, the subjects' non-HDL cholesterol level had to be 5.2 mmol/L or higher, and for
Association of the SOC with some risk factors for cancer
There was a higher percentage of blue-collar workers among those with a weak SOC than among those with a strong SOC (Table 1). Those with a weak SOC were more often heavy smokers (20.0%) than those with a moderate or strong SOC. They were also more often heavy consumers of alcohol (15.3%) compared to those with a strong SOC (10.3%). Of those with a strong SOC, 38.0% belonged to the oldest age group compared to 34.6% of those with a weak SOC. The association of the SOC with all these factors was
Discussion
Our main findings were that among those with a strong SOC, the occurrence of cancer was delayed but not prevented: the risk of cancer was inversely associated with the level of the SOC during the first 8 years of follow-up, but this difference almost disappeared during the longer 12-year follow-up, especially in the younger cohort (<55 years). In the older cohorts (≥55 years), the difference remained even during the 12-year follow-up.
In the EPIC-Norfolk Study [7], an association between the SOC
Conclusion
In individuals with a strong SOC, the incidence of cancer was lower than in those with a weak SOC after a short period of follow-up. During the full 12-year follow-up, the difference remained significant only among the oldest participants. Thus, a strong SOC seemed to delay the onset of cancer more among older than among younger men.
Acknowledgments
The authors thank the Finnish Work Environment Fund for financing the study. We also thank Virginia Mattila, Language Centre, University of Tampere, for revision of the English.
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2010, Oral OncologyCitation Excerpt :These controversies may be due for instance to small sample size, different populations studied, and different instruments used to measure alcohol and tobacco consumption. The literature, including a systematic review, reports SOC to be associated with better self-rated and clinical health, however, no association between SOC and any of the clinical characteristics was found in our study.43 One suggestion is that the low level of education and socioeconomic condition of our subjects may have affected their illness perception,44,45 thus not reflecting the clinical characteristics of their disease.
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