Does frequent anger really cause nodules? The truth is...

When it comes to which two words on a physical examination report are the most touching, "nodules" must be on the list. Lung nodules, thyroid nodules, breast nodules... You can always hear people discussing them around you.

So what exactly are nodules?

A nodule does not refer to a specific type of disease, but rather to a pattern that we discover 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.

Image source: unsplash

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

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

Infect

Mycobacterial infections (such as tuberculosis), fungal infections, pneumonia, lung abscesses, purulent emboli, 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, bronchogenic cyst, pulmonary sequestration, pulmonary varicose veins, bronchial atresia with bronchiocele

other

Rounded 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

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, follicular, oncocytic, anaplastic, medullary), thyroid lymphoma and metastases

These nodules are mainly benign, with malignant nodules accounting for 5% to 10%[4,5]. Although the proportion seems high, papillary carcinoma, which accounts for 97.9% of thyroid cancer[6], is an indolent cancer, with a 15-year survival rate of more than 90% in China, and even 99% in some regions[7,8]. So far, it has not been found that emotions such as anger can cause thyroid nodules.

Image source: pixabay

3

Breast nodules

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

Infect

Mastitis, tuberculosis, abscess

Congenital anomalies

Breast hypoplasia

Immune-mediated diseases

Rheumatoid nodules

other

Cysts, breast hyperplasia

There are many causes of breast nodules, most of which are benign nodules. Breast cancer is a rare condition, but there is no accurate statistical data. 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 less negative emotions. [13] To sum up: anger increases 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.

What should I do if I find a nodule?

Ultimately, we have to return to the 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 a lung nodule is found

No additional treatment is required for nodules <4 mm; for nodules 4-6 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 malignant risk of thyroid nodules.

Image source: Reference [15]

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

3

If a breast nodule is found

Breast nodules and thyroid nodules have a similar classification method, called BI-RADS classification. Similarly, if it is BI-RADS class 1 and 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 class 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.

References

[1] LoverdosK, FotiadisA, KontogianniC, etal. Lungnodules: A comprehensive review on current approach and management. Ann Thorac Med. 2019;14(4):226-238.

[2]McWilliamsA,TammemagiMC,MayoJR,etal.ProbabilityofcancerinpulmonarynodulesdetectedonfirstscreeningCT.NEnglJMed.2013;369(10):910-919.

[3]GharibH,PapiniE.Thyroidnodules:clinicalimportance,assessment,andtreatment.EndocrinolMetabClinNorthAm.2007;36(3):707-vi.

[4]DuranteC, GraniG, LamartinaL, etal.TheDiagnosisandManagementofThyroidNodules:AReview[publishedcorrectionappearsinJAMA.2018Apr17;319(15):1622].JAMA.2018;319(9):914-924.

[5]HegedüsL.Clinicalpractice.Thethyroidnodule.NEnglJMed.2004;351(17):1764-1771.

[6]LiuY,LaiF,LongJ,etal.ScreeningandtheepidemicofthyroidcancerinChina:Ananalysisofnationalrepresentativeinpatientandcommercialinsurancedatabases.IntJCancer.2021;148(5):1106-1114.

[7]CaoYM,ZhangTT,LiBY,etal.Prognosticevaluationmodelforpapillarythyroidcancer:aretrospectivestudyof660cases.GlandSurg.2021;10(7):2170-2179.

[8]ItoY,MiyauchiA,KiharaM,etal.OverallSurvivalofPapillaryThyroidCarcinomaPatients:ASingle-InstitutionLong-TermFollow-Upof5897Patients.WorldJSurg.2018;42(3):615-622.

[9]MalherbeF,NelD,MolabeH,etal.Palpablebreastlumps:Anage-basedapproachtoevaluationanddiagnosis.SAfrFamPract(2004).2022;64(1):e1-e5.

[10]NjezeGE.Breastlumps:a21-yearsingle-centerclinicalandhistologicalanalysis.NigerJSurg.2014;20(1):38-41.

[11]IqbalFM,AliH,VidyaR.Breastlumps:araresiteforrheumatoidnodules.BMJCaseRep.2015;2015:bcr2014208586.

[12]LongY, ZhangW, ZhengM, et al. Association between breastnodules, anxiety, depression and metabolic risk factors in Chinese. FrontPsychiatry. 2023;14:944354.

[13]XuC,GanesanK,LiuX,etal.PrognosticValueofNegativeEmotionsontheIncidenceofBreastCancer:ASystematicReviewandMeta-Analysisof129,621PatientswithBreastCancer.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.

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

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