Will you grow nodules if you are often angry? The truth is...

Author: Jiang Yongyuan, Master of Internal Medicine, Third Military Medical University

Reviewer: Tang Qin, Director of the Science Popularization Department of the Chinese Medical Association

gossip

When it comes to the two words on a physical examination report that are most touching, "nodules" are definitely on the list. Lung nodules, thyroid nodules, breast nodules... I always hear people discussing them. Many people believe that getting angry can cause nodules . Is this really the case? What exactly are nodules?

analyze

A nodule does not refer to a specific type of disease, but rather a pattern that is discovered through imaging examinations such as ultrasound, CT, X-ray or MRI, which is denser than the surrounding tissue and clearly distinguishable from the surrounding tissue.

These nodules may be normal tissue, scars after tissue injury, or newly grown tissue. Nodules in the lungs may also be foreign matter, such as dust.

Can anger cause nodules?

How do these nodules grow? Are they caused by anger? Here I will talk about the sources of common lung nodules, thyroid nodules, and breast nodules in daily life.

1

Pulmonary nodules

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As chest CT scans become more accurate, more and more small nodules are being detected. These nodules may be the following [1]:

▶ Malignant tumors Bronchogenic carcinoma, lymphoma, carcinoid, sarcoma, lung metastasis

▶ Benign tumors Hamartoma, chondroma, lipoma, respiratory papillomatosis, benign metastatic leiomyoma of the lung

▶ Infections Mycobacterial infections (such as tuberculosis), fungal infections, spherical pneumonia, lung abscess, purulent embolus, Nocardia, hydatid cysts, Q fever

▶ Immune-mediated diseases Rheumatoid arthritis, Wegener's granulomatosis, sarcoidosis, organizing pneumonia (cryptogenic or secondary), lymphogranulomatosis, necrotizing granulomatosis

▶ Congenital anomalies Arteriovenous malformation, bronchial cyst, pulmonary sequestration, pulmonary varicose veins, bronchial atresia with bronchiocele

▶ Others Round atelectasis, intraparenchymal lymph nodes, progressive mass fibrosis, inflammatory pseudotumor, amyloidosis, lipoid pneumonia

The causes of these nodules are also varied. They may be caused by congenital development, infections such as bacteria, viruses, fungi, etc., carcinogenic factors such as smoking and asbestos, or they may be traces left by trauma or disease.

So far, it has not been found that emotions such as anger can cause lung nodules, but many people become extremely nervous after being diagnosed with lung nodules. Friends who read this should relax. It is not difficult to see from the previous article that the vast majority of lung nodules are not malignant tumors. According to statistics, malignant nodules only account for about 1% of all nodules [2].

2

Thyroid nodules

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Thyroid nodules are another common type of nodule. The common causes are as follows [3]:

▶ Benign nodules Colloid nodules, Hashimoto's thyroiditis, simple or hemorrhagic cysts, follicular adenomas, and subacute thyroiditis

▶ Malignant tumors Thyroid cancer (papillary carcinoma, follicular carcinoma, oncocytic carcinoma, undifferentiated carcinoma, medullary carcinoma), thyroid lymphoma and metastasis

Most of these nodules are benign, with malignant nodules accounting for 5% to 10% [4,5]. This may seem like a high proportion, but papillary carcinoma, which accounts for 97.9% of thyroid cancer [6], is an indolent cancer. Its 15-year survival rate has reached over 90% in China, and in some regions it can even reach 99% [7,8].

It has not been found that emotions such as anger can cause thyroid nodules.

3

Breast nodules

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Breast nodules are also very common and can represent a variety of conditions [9-11]:

▶ Malignant tumors Breast cancer

▶ Benign tumors Fibroadenoma, adenoma, lipoma, hamartoma, fibroma

▶ Infections: mastitis, tuberculosis, abscesses

▶ Congenital abnormalities Breast dysplasia

▶ Immune-mediated diseases Rheumatoid nodules

▶ Others Cysts, breast hyperplasia

There are many causes of breast nodules, mainly benign nodules. Breast cancer is a rare condition, but there is no accurate statistics yet.

Negative emotions such as anger and stress are considered to be one of the risk factors for breast nodules [12]. According to literature reports, women with negative emotions have a 59% increased risk of breast cancer compared to women with no or few negative emotions.[13]

What should I do if I find a nodule?

In the end, we still have to come back to this ultimate question: What should I do if I find a nodule?

As we can see from the previous article, most nodules are not malignant, so we don’t have to take drastic measures right away.

1. If lung nodules are found

No additional treatment is required for nodules <4 mm; for nodules between 4 and 6 mm, a chest CT scan can be performed once a year; for nodules >6 mm, the patient needs to take the CT scan to a specialist for advice. [14]

2. If a thyroid nodule is found

We can first look at the C-TIRADS classification on the report, which is a classification method for distinguishing the risk of malignancy of thyroid nodules.

Image source: Reference [15]

If it is C-TIRADS 1 or 2, the risk of malignancy is very small. If there are no other symptoms, you do not need to do anything extra and just keep the habit of physical examinations. If it is C-TIRADS 3 or above, follow-up is required and the specialist will decide on further treatment methods.

3. If breast nodules are found

Breast nodules and thyroid nodules have a similar classification method, called BI-RADS classification. Similarly, if it is BI-RADS 1 or 2, the risk of malignancy is very small. If there are no other symptoms, you do not need to do anything extra and just maintain the habit of physical examinations. If it is BI-RADS 3 or above, follow-up is required and the specialist will decide on further treatment methods.

From now on, remove the wrong information that "nodules = cancer" from your mind, respond scientifically, and take it seriously, but don't be overly anxious or panic.

in conclusion

Being angry will increase the risk of breast nodules. There is no evidence that "anger" is related to lung nodules and thyroid nodules, but frequent anger still has a great impact on our bodies. Let us stay away from people and things that make us angry and keep a good mood.

References:

[1] Loverdos K, Fotiadis A, Kontogianni C, et al. Lung nodules: A comprehensive review on current approach and management. Ann Thorac Med. 2019;14(4):226-238.

[2]McWilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013;369(10):910-919.

[3]Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007;36(3):707-vi.

[4]Durante C, Grani G, Lamartina L, et al. The Diagnosis and Management of Thyroid Nodules: A Review [published correction appears in JAMA. 2018 Apr 17;319(15):1622]. JAMA. 2018;319(9):914-924.

[5]Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004;351(17):1764-1771.

[6]Liu Y, Lai F, Long J, et al. Screening and the epidemic of thyroid cancer in China: An analysis of national representative inpatient and commercial insurance databases. Int J Cancer. 2021;148(5):1106-1114.

[7]Cao YM, Zhang TT, Li BY, et al. Prognostic evaluation model for papillary thyroid cancer: a retrospective study of 660 cases. Gland Surg. 2021;10(7):2170-2179.

[8]Ito Y, Miyauchi A, Kihara M, et al. Overall Survival of Papillary Thyroid Carcinoma Patients: A Single-Institution Long-Term Follow-Up of 5897 Patients. World J Surg. 2018;42(3):615-622.

[9]Malherbe F, Nel D, Molabe H, et al. Palpable breast lumps: An age-based approach to evaluation and diagnosis. S Afr Fam Pract (2004). 2022;64(1):e1-e5.

[10]Njeze GE. Breast lumps: a 21-year single-center clinical and histological analysis. Niger J Surg. 2014;20(1):38-41.

[11]Iqbal FM, Ali H, Vidya R. Breast lumps: a rare site for rheumatoid nodules. BMJ Case Rep. 2015;2015:bcr2014208586.

[12]Long Y, Zhang W, Zheng M, et al. Association between breast nodules, anxiety, depression and metabolic risk factors in a Chinese cohort. Front Psychiatry. 2023;14:944354.

[13]Xu C, Ganesan K, Liu X, et al. Prognostic Value of Negative Emotions on the Incidence of Breast Cancer: A Systematic Review and Meta-Analysis of 129,621 Patients with Breast Cancer. Cancers (Basel). 2022;14(3):475.

[14] Liu C, Cui Y. Comparative analysis of four major guidelines for pulmonary nodule evaluation. Zhongguo Fei Ai Za Zhi. 2017;20(7):490-498.

[15] Chinese Society of Endocrinology, Chinese Society of Surgery, Thyroid and Metabolic Surgery Group, Chinese Anti-Cancer Association Head and Neck Tumor Committee, et al. Guidelines for the diagnosis and treatment of thyroid nodules and differentiated thyroid cancer (Second Edition) [J]. Chinese Journal of Endocrinology and Metabolism, 2023, 39(3): 181-226.

Planning | Wang Mengru

Editor｜Li Mengxin

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