Physical activity from menarche to first pregnancy and risk of breast cancer

Breast tissue is particularly susceptible to exposures between menarche and first pregnancy, and a longer interval between these reproductive events is associated with elevated breast cancer risk. Physical activity during this time period may offset breast cancer risk, particularly for those at highest risk with longer menarche‐to‐first‐pregnancy intervals. We used data from 65,576 parous women in the Nurses’ Health Study II free of cancer in 1989 (baseline) and recalled their leisure‐time physical activity at ages 12–34 in 1997. Current activity was collected at baseline and over follow‐up. Relative risks (RRs) were estimated using multivariable Cox proportional hazards regression models. Between 1989 and 2011, 2,069 invasive breast cancer cases were identified. Total recreational activity between menarche and first pregnancy was not significantly associated with the risk of breast cancer. However, physical activity between menarche and first pregnancy was associated with significantly lower breast cancer risk among women in the highest category of a menarche‐to first‐pregnancy interval (≥20 years; RR for the highest versus the lowest quartile = 0.73, 95% confidence interval = 0.55–0.97; P_trend = 0.045; P_interaction = 0.048). This was not observed in women with a shorter interval. Physical activity between menarche and first pregnancy was associated with a lower risk of breast cancer among women with at least 20 years between these reproductive events. This may provide a modifiable factor that women can intervene on to mitigate their breast cancer risk associated with a longer interval.     

Physical activity and breast cancer risk among female physical education and language teachers: a 34-year follow-up

The cohort consisted of 1,489 Finnish female physical education and 8,560 language teachers born after 1920 and alive in 1967. The 2 study populations were similar in social class and way of living and clearly discordant in physical activity both during their university studies and later in life. The incidence of breast cancer among these teachers up to the year 2000 was assessed through a record linkage with the Finnish Cancer Registry. The number of breast cancer cases among physical education teachers was 61 in 32,862 person-years and among language teachers was 404 in 177,188 person-years. In Poisson-regression analysis, the incidence rate ratio--adjusted for age, calendar time, number of children and age at first birth--for physical education vs. language teachers was overall 0.83 (95% confidence interval 0.63-1.09). This relative rate was 0.79 (0.46-1.36) in ages <50 years and 0.86 (0.62-1.18) in ages > or =50 years. Our study is concordant with the hypothesis that life-long physical activity may reduce the risk of breast cancer.     

Physical activity and breast cancer risk in Chinese women

Background:

The influence of different types and intensities of physical activity on risk for breast cancer is unclear.

Methods:

In a prospective cohort of 73 049 Chinese women (40–70 years), who had worked outside the home, we studied breast cancer risk in relation to specific types of self-reported and work history-related physical activity, including adolescent and adult exercise and household activity and walking and cycling for transportation. Occupational sitting time and physical activity energy expenditure were assigned based on lifetime occupational histories.

Results:

In all, 717 incident breast cancer cases were diagnosed. Breast cancer risk was lower for women in the lowest quartile of average occupational sitting time and in the highest quartile of average occupational energy expenditure (adjusted hazard ratio (HR): 0.81 and 0.73, respectively, P⩽0.05). Adult exercise at or above the recommended level (8 metabolic equivalent (MET) h per week per year) was associated with lower risk (adjusted HR: 0.73, P<0.05) in post-menopausal women. Analysis of joint effects showed that having both an active job and exercise participation did not confer an additional benefit. Other common daily activities were not associated with lower risk.

Interpretation:

These findings suggest that both exercise and occupational activity are associated with lower breast cancer risk, which supports current health promotion campaigns promoting exercise.     

Physical activity and risk of breast cancer in premenopausal women

Physical activity appears to be inversely related to risk of breast cancer, yet the results remain inconsistent. To evaluate this relation among premenopausal women and examine variation in risk according to level of obesity and use of oral contraceptives (OCs), the authors examined data from the Nurses' Health Study II. During 10 years of follow-up, 849 cases of invasive premenopausal breast cancer were confirmed. Physical activity was assessed by self-report at baseline and during follow-up using a validated questionnaire. Total physical activity was unrelated to risk of breast cancer. Women engaging in >or=27 metabolic equivalent (MET)-h week(-1) had a multivariate-adjusted relative risk (RR) of 1.04 (95% confidence interval (CI) 0.82-1.33) compared to those in the <3 MET-h week(-1) category. Among women with a BMI >or=30 kg m(-2), we observed a significant positive dose-response relation (P=0.04). Activity was unrelated to breast cancer risk at lower levels of BMI. A test for interaction between activity and BMI (<30, >or=30 kg m(-2)) was statistically significant (P=0.02). Among current OC users, higher activity was associated with a non-significantly lower risk of breast cancer (RR=0.59, 95% CI 0.30-1.16 for >or=27 vs <9 MET-h week(-1), P for linear trend=0.14). These results show no overall association between physical activity and risk of breast cancer among premenopausal women, but suggest that the effect of physical activity could be substantially modified by the underlying degree of adiposity. The potential interactions between physical activity, adiposity, and current use of OCs require further study.     

Physical activity and risk of endometrial cancer: a report from the Shanghai endometrial cancer study.

We evaluated the type and amount of physical activity associated with risk of endometrial cancer. In this population-based case-control study, in-person interviews were completed among 832 incident endometrial cancer cases and 846 age-matched controls. Physical activity from exercise, household activities, and transportation was assessed in adolescence and adulthood, as was lifetime occupational activity. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence limits (95% CL). Women reporting exercise participation in both adolescence and adulthood were at nearly a 40% reduced risk (OR, 0.63; 95% CL, 0.42-0.95), compared with women reporting no exercise in either life period. Postmenopausal women who initiated exercise in adulthood were also at reduced risk (OR, 0.76; 95% CL, 0.56-1.02). Reductions in risk were also observed for common lifestyle activities, including household activity (both life periods) and walking for transportation (adulthood). Examination of the independent and combined effect of exercise and lifestyle activities revealed that women with less active lifestyles but who reported exercise were at 35% reduced risk (OR, 0.65; 95% CL, 0.41-1.02), whereas nonexercisers with more active lifestyles were at 40% to 45% reduced risk. These findings suggest that both lifestyle activities of lower intensity (e.g., walking and doing household chores) and intentional exercise can reduce endometrial cancer risk.     

Physical activity and breast cancer risk among Asian-American women in Los Angeles: a case-control study

BACKGROUND: To the authors' knowledge, there have been few studies published to date regarding physical activity patterns and breast cancer risk in Asian and Asian-American women. METHODS: The authors conducted a population-based case-control study of 501 Asian-American women with incident breast cancer and a control group of 594 Asian-American women in Los Angeles County to evaluate the role of lifetime physical activity on breast cancer risk. Information concerning lifetime recreational physical activity (i.e., type of activity, duration [years], and frequency [average hours per week]) and occupational physical activity was obtained using a structured questionnaire that was administered in person. RESULTS: Increasing years and levels (average metabolic equivalent [MET] hours per week) of lifetime recreational activity were associated with a significantly reduced risk of breast cancer after adjusting for demographic factors, migration history, and menstrual and reproductive factors. Compared with women who had no lifetime recreational physical activity, 3-6 MET hours per week, > 6-12 MET hours per week, and > 12 MET hours per week of activity were associated with significantly reduced risk, with odds ratios (and 95% confidence intervals) of 0.91 (0.55-1.49), 0.65 (0.39-1.10), 0.53 (0.31-0.90), and 0.47 (0.28-0.80), respectively (P value for trend < 0.001). The risk of breast cancer was associated inversely with occupational physical activity, although the result was not statistically significant. CONCLUSIONS: The findings of the current study provide further support for the finding that physical activity has a protective role in breast cancer.     

Physical activity and risk for breast cancer a prospective cohort study among Swedish twins

The epidemiologic association between physical activity and breast cancer has been corroborated in many studies. Some inconsistencies remain, possibly due to variation in life periods for exposure assessment, confounding and undetected effect modification. In our cohort study, we address some of these questions by taking into account physical activity in different periods of life and by investigating effect modification by birth cohort and body mass index (BMI). Altogether 9,539 same-sex twin women aged 42-70 years who answered a questionnaire about their work and leisure-time physical exercise from ages 25 to 50 during 1967 and 1970 were included in our cohort. During follow-up, 506 breast cancer cases occurred through 1997. We used multivariate Cox models to estimate relative risk (RR) with 95% confidence interval (CI). We found no associations between physical activity and breast cancer overall. Women born between 1901 and 1917 (aged 51-70 at baseline) who reported regular leisure-time activity had a borderline significant 40% lower risk compared with those who reported no activity (RR 0.6; 95% CI 0.4-1.0; test for trend, p = 0.07). This association appeared to be confined to women with a low BMI after the age of 50 and to women with a high BMI during the premenopausal period. We found no evidence that work activity reduces risk for breast cancer. The importance of physical activity for breast cancer risk seems to depend on birth cohort. The association may be limited to normal-weight postmenopausal women and overweight premenopausal women.     

High breast cancer incidence rates among California teachers: results from the California Teachers Study (United States)

Objective: To determine risk factor profiles and cancer incidence rates among participants in the California Teachers Study (CTS), a study designed to document high breast cancer incidence rates of California teachers and to investigate emergent hypotheses in the etiology of breast and other cancers. Methods: The CTS is a prospective study of 133,479 California female teachers and administrators, established in 1995–1996 with members of the California State Teachers Retirement System completing a detailed mailed questionnaire regarding possible risk factors for breast and other cancers. Cancer outcomes were identified by linkage with the California Cancer Registry. Results: CTS participants have a 51% higher age-standardized invasive breast cancer incidence rate and a 67% higher in-situ breast cancer incidence rate than would be expected based on race-specific statewide rates after three years of follow-up. CTS participants also have substantially elevated rates of endometrial cancer (rate ratio, RR = 1.72), ovarian cancer (RR = 1.28), melanoma (RR = 1.59), non-Hodgkin's lymphoma (RR = 1.53), and leukemia (RR = 1.28), but low rates of invasive cervix cancer (RR = 0.53) and lung cancer (RR = 0.66). Conclusions: CTS members have high rates of several major cancers, particularly breast cancer, and low rates of lung and cervix cancer. Although late age at first birth can explain a portion of the observed excess risk of breast cancer in this cohort, the unique risk factor profile of CTS members may account for much of their higher risk of breast and selected other cancers. The CTS offers a rich resource for future studies of cancer risk and of women's health, in general.     

Physical activity and risk of breast cancer: a meta-analysis of prospective studies

We conducted a meta-analysis to summarize the evidence from prospective studies regarding the association between physical activity and breast cancer risk. A comprehensive search was conducted to identify eligible studies. The fixed or random effect model was used based on heterogeneity test. The dose–response relationship was assessed by restricted cubic spline model and multivariate random-effect meta-regression. Overall, 31 studies with 63,786 cases were included, and the combined relative risk (RR) with 95 % CI of breast cancer was 0.88 (0.85–0.91). In subgroup analysis by activity type, data from 27 studies including 37,568 cases for non-occupational activity (including recreational activity and household activity) and seven studies including 28,268 cases for occupational activity were used, and the RR (95 % CI) of breast cancer was 0.87 (0.83–0.91) and 0.90 (0.83–0.97), respectively. The inverse association was consistent among all subgroups analyses. Stronger association was found for subjects with BMI <25 kg/m² [0.72 (0.65–0.81)], premenopausal women [0.77 (0.72–0.84)], and estrogen and progesterone receptor-negative breast cancer [0.80 (0.73–0.87)]. Dose–response analysis suggested that the risk of breast cancer decreased by 2 % (P < 0.00) for every 25 metabolic equivalent (MET)-h/week increment in non-occupational physical activity, 3 % (P < 0.00) for every 10 MET-h/week (roughly equivalent to 4 h/week of walking in 2 miles/h or 1 h/week of running in 6 miles/h) increment in recreational activity, and 5 % (P < 0.00) for every 2 h/week increment in moderate plus vigorous recreational activity, respectively. Physical activity could significantly reduce the risk of breast cancer.     

Physical activity and colon cancer risk among women in the California Teachers Study.

BACKGROUND: Existing data suggest that physical activity reduces colon cancer risk, but the association is not consistently observed in women. One potential explanation for this inconsistency is that hormone therapy, which is associated with lower colon cancer risk, acts as a modifier of the physical activity/colon cancer relationship. METHODS: Participants in the California Teachers Study (N = 120,147), a prospective cohort of female teachers and administrators residing in California, ages 22 to 84 years at baseline and with no prior history of colon cancer were eligible for study. Between 1996 and 2002, 395 patients were diagnosed with invasive colon cancer. The relative risks (RR) associated with lifetime (high school through age 54 years or current age) and recent (past 3 years) strenuous and moderate recreational physical activity were estimated using Cox proportional hazards regression models. RESULTS: Combined lifetime moderate and strenuous recreational physical activity was only modestly associated with colon cancer risk in the cohort [>or=4 versus or=4 versus 相似文献   

Physical activity and risk of ovarian cancer: an Italian case-control study

The relationship between physical activity and the risk of ovarian cancer was analyzed using data from a case-control study conducted between 1992 and 1999 in Italy. Cases were 1,031 women with incident, histologically confirmed, invasive epithelial ovarian cancer and controls were 2,411 women admitted to hospital for acute non-neoplastic, non-hormonal conditions. Compared to women with the lowest level of occupational physical activity, the ORs of ovarian cancer obtained adjusting for center, year of interview and age for women with the highest level of physical activity were 0.70, 0.52 and 0.64 (all statistically significant) respectively, at ages 15-19, 30-39 and 50-59 years, with significant trends in risk for the 2 youngest age groups. The corresponding ORs became 0.89, 0.67 and 0.76 after further allowance for several co-variates of ovarian cancer, including education, which was positively associated with cancer risk. No significant association was found with leisure-time physical activity though the risk was below unity in women with the highest level of activity. The multivariate OR was 0.44 for women with the highest level of combined occupational plus leisure-time physical activity. The inverse relationship between occupational physical activity and ovarian cancer risk was not heterogeneous across strata of selected co-variates.     

Body fat distribution and breast cancer risk: findings from the Nigerian breast cancer study

Purpose  

The relationship between overall obesity and breast cancer risk has been well recognized, but the role of central obesity in breast cancer development is uncertain.     

Physical activity and breast cancer risk: the Women's Health Study (United States)

Objective: It is biologically plausible for physical activity to decrease breast cancer risk; however, epidemiologic studies have yielded inconsistent findings. We therefore examined physical activity and breast cancer risk in the Women's Health Study. Methods: We assessed physical activity among 39,322 apparently healthy women, aged 45 years, and prospectively followed them for an average of 48 months. Four hundred eleven women developed breast cancer, with 222 positive for both estrogen and progesterone receptors. Results: Among all women the multivariate relative risks of all breast cancer associated with <840, 840–2519, 2520–6299, and 6300 kJ/week expended on recreational activities and stair climbing were 1.00 (referent), 1.04 (95% confidence interval, 0.77–1.40), 0.86 (0.64–1.17), and 0.80 (0.58–1.12), respectively; p-trend = 0.11. However, among postmenopausal women there was a significant inverse trend for all breast cancer; the corresponding relative risks were 1.0 (referent), 0.97 (0.68–1.4), 0.78 (0.54–1.1), and 0.67 (0.44–1.0), respectively; p-trend = 0.03. Physical activity was unrelated to breast cancers positive for both estrogen and progesterone receptors either among all or postmenopausal women (p-trend = 0.50 and 0.26, respectively). When we assessed only vigorous recreational activity, requiring 6 METs or multiples of resting metabolic rate, we observed no significant associations with all or steroid hormone receptor positive breast cancer, either among all or postmenospausal women. Conclusions: These data suggest that physical activity during middle age and older is not uniformly associated with decreased breast cancer risk. Among postmenopausal women only, higher levels of physical activity may decrease the risk of breast cancer. This study, however, had limited statistical power to detect small effects.     

Lifetime physical activity and the risk of breast cancer: a case-control study

BACKGROUND: The association between breast cancer and lifetime histories of physical activity was studied to determine whether exercise may reduce development of this cancer. METHODS: The case-control study was based on 250 women living in the Region of Western Pomerania with histological confirmed breast cancer operated during 1999-2003 in the Szczecin hospitals, and 301 controls, free of any cancer diagnosis, aged 35-75 years. Physical activity was assessed using a self-administered questionnaire with questions on type of activity, duration, frequency, and intensity for each type of activity. Data on physical activity from exercise/sports, household and outdoor chores, and occupational activity separately throughout a woman's lifetime were collected. Recreational physical activity was examined for the four age periods (14-20, 21-34, 35-50, and after the age of 50 years). Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CI) and a full assessment of confounding was included in analysis. RESULTS: Lifetime total physical activity among all women was associated with a reduced breast cancer risk; after controlling for potential confounders the multivariate ORs associated with <110, 110-150, and >150 metabolic equivalent (MET)-hours/week/year were 1.00 (referent), 0.60 (95% CI: 0.60-1.06), and 0.43 (95% CI: 0.25-0.75), respectively (P(trend)=0.004). Analyses by type of lifetime activity for household and recreational activities revealed significant risk reductions: 1.00 (referent); 0.51, 95% CI: 0.29-0.87; 0.54, 95% CI: 0.31-0.94 (P(trend)=0.002), and 1.00 (referent); 0.54, 95% CI: 0.31-0.94; 0.40, 95% CI: 0.22-0.70 (P(trend)<0.001), respectively. For lifetime occupational activity a modest association could not be ruled out when measured the activity by average annual hours/week; the ORs were 0.51, 95% CI: 0.29-0.91, and 0.58, 95% CI: 0.33-1.00, the inverse trend in risk was not significant (P(trend)=0.51). Women who started recreational activity after age of 20 years had much more higher breast cancer risk than either those who were active between ages 14 and 20 years and were inactive after age 20 years or continued their activity throughout adult life. CONCLUSIONS: These data are in concordance with the hypothesis that lifetime total physical activity is associated with decreased breast cancer risk. They also suggest that recreational physical activity at ages 14-20 years is the most beneficial. In addition, these findings confirm the majority of previous reports which implicated physical inactivity as important risk factor for breast cancer.     

Physical activity and breast cancer survival

Physical activity improves quality of life after a breast cancer diagnosis, and a beneficial effect on survival would be particularly welcome. Four observational studies have now reported decreased total mortality among physically active women with breast cancer; the two largest have also reported decreased breast cancer specific mortality. The estrogen pathway and the insulin pathway are two potential mechanisms by which physical activity could affect breast cancer survival. Randomized trials are ongoing but trials of lifestyle factors are notoriously challenging to perform. Women with breast cancer have little to lose and may possibly gain from moderate exercise.     

Physical activity and the risk of ovarian cancer: a case-control study in Canada

We evaluated the impact of recreational and occupational physical activity on ovarian cancer risk using data from a population-based case-control study of 442 cases with histologically confirmed incident ovarian cancer and 2,135 controls aged 20-76 years, conducted in 1994-1997 in Canada. Frequency and intensity of physical activity were collected through self-administered questionnaires. Compared to women in the lowest tertiles of moderate, vigorous and total recreational activity, those in the highest tertiles had multivariable-adjusted odds ratios (and 95% confidence intervals) of 0.67 (0.50-0.88), 0.93 (0.70-1.24) and 0.73 (0.58-0.98), respectively. There were statistically significant trends of decreasing risk with increasing levels of moderate and total recreational activity, with similar patterns for premenopausal and postmenopausal women. A significant reduction in risk associated with higher level of moderate recreational activity was observed for serous, endometrioid and other but not mucinous types of tumors. The analyses in one province with the largest number of cases and controls indicated that occupational activity was associated with reduced ovarian cancer risk by lifetime activity and by various life periods (early 20s, early 30s, early 50s and 2 years before interview). Our study suggests that occupational and regular moderate recreational physical activity reduce ovarian cancer risk.     

Asian ethnicity and breast cancer subtypes: a study from the California Cancer Registry

The distribution of breast cancer molecular subtypes has been shown to vary by race/ethnicity, highlighting the importance of host factors in breast tumor biology. We undertook the current analysis to determine population-based distributions of breast cancer subtypes among six ethnic Asian groups in California. We defined immunohistochemical (IHC) surrogates for each breast cancer subtype among Chinese, Japanese, Filipina, Korean, Vietnamese, and South Asian patients diagnosed with incident, primary, invasive breast cancer between 2002 and 2007 in the California Cancer Registry as: hormone receptor-positive (HR+)/HER2− [estrogen receptor-positive (ER+) and/or progesterone receptor-positive (PR+), human epidermal growth factor receptor 2-negative (HER2−)], triple-negative (ER−, PR−, and HER2−), and HER2-positive (ER±, PR±, and HER2+). We calculated frequencies of breast cancer subtypes among Asian ethnic groups and evaluated their associations with clinical and demographic factors. Complete IHC data were available for 8,140 Asian women. Compared to non-Hispanic White women, Korean [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.5–2.2], Filipina (OR = 1.3, 95% CI = 1.2–1.5), Vietnamese (OR = 1.3, 95% CI = 1.1–1.6), and Chinese (OR = 1.1, 95% CI = 1.0–1.3) women had a significantly increased risk of being diagnosed with HER2-positive breast cancer subtypes after adjusting for age, stage, grade, socioeconomic status, histology, diagnosis year, nativity, and hospital ownership status. We report a significant ethnic disparity in HER2-positive breast cancer in a large population-based cohort enriched for Asian-Americans. Given the poor prognosis and high treatment costs of HER2-positive breast cancer, our results have implications for healthcare resource utilization, cancer biology, and clinical care.     

Physical activity and epithelial ovarian cancer risk: a case-control study in China

A case-control study was conducted in China during 1999-2000 to investigate the effects of intensity and duration of physical activity on the risk of epithelial ovarian cancer. Cases were 254 patients with histologically confirmed epithelial ovarian cancer. The 652 controls comprised 340 hospital visitors, 261 non-neoplasm hospital outpatients and 51 women recruited from the community. Physical activity was measured by a validated questionnaire. The risks of ovarian cancer were assessed using multivariate logistic regression analysis accounting for age, demographic, lifestyle and familial factors, hormonal status, family ovarian cancer history and total energy intake. The study found that increasing total physical activity was associated with a lower ovarian cancer risk among Chinese women. The odds ratio was 0.54 (95% CI 0.34-0.87) for high vs. low levels of total weekly metabolic equivalent tasks. Ovarian cancer risk tended to decline with increasing duration of strenuous sports and frequency of activity-induced sweating among pre-menopausal women, with adjusted OR 0.13 (95% CI 0.03-0.64) and 0.45 (95% CI 0.24-0.85), respectively. Increasing duration of moderate activity in post-menopausal women also appeared to be protective against ovarian cancer, with adjusted OR 0.36 (95% CI 0.18-0.73).