Background. There still is much debate with regard to the role of psychosocial factors in cancer. Evidence suggests that cancer and coronary heart disease (CHD) may have common causes. This study examined the role of pessimism, anxiety and personality in the development of cancer among men who had been diagnosed with CHD but were free of cancer at baseline.

Methods. Two hundred and forty-six men who were treated for CHD, but were free of cancer, filled out psychological scales at baseline. Patients and their families were contacted after 6–10 years to determine the incidence of cancer.

Results. At follow-up, 12 patients (5%) had been diagnosed with cancer (9 cancer deaths). Development of cancer was unrelated to cardiac pathology but was associated with age [ges ]56 years, poor exercise tolerance, pessimism and anxiety. The rate of cancer was 8/60=13% for men with a distressed personality (type-D) and 4/186=2% for non-type-D men (P=0·002); rate of cancer death was 10% and 2%, respectively (P=0·007). Type-D refers to the interaction between high negative affectivity and high social inhibition. Regression analysis yielded older age (odds ratio 4·6, 95% CI 1·5–14·3) and type-D (odds ratio 7·2, 95% CI 2·9–18·1) as independent prognostic factors for cancer.

Conclusions. Type-D personality was a prognostic factor for the development of cancer in men with established CHD. Psychosomatic research should take a broad enough view of the specific and the global psychosocial variables that may play a role in both cancer and CHD.