Prospective Study on Physical Activity and Risk of <i>In Situ</i> Breast Cancer

Steindorf, Karen; Ritte, Rebecca; Tjønneland, Anne; Johnsen, Nina Føns; Overvad, Kim; Østergaard, Jane Nautrup; Clavel‐Chapelon, Françoise; Fournier, Agnès; Dossus, Laure; Lukanova, Annekatrin; Chang‐Claude, Jenny; Boeing, Heiner; Wientzek, Angelika; Trichopoulou, Antonia; Karapetyan, Tina; Trichopoulos, Dimitrios; Masala, Giovanna; Mattiello, Amalia; Tumino, Rosario; Quiŕos, J. Ramón; Travier, Noémie; Sánchez, María José; Navarro, Carmen; Ardanáz, Eva; Amiano, Pilar; Bueno-de-Mesquita, H. Bas; Duijnhoven, Fränzel J.B. van; Monninkhof, Evelyn M.; May, Anne M.; Khaw, Kay Tee; Wareham, Nick; Key, Tim; Travis, Ruth C.; Borch, Kristin Benjaminsen; Fedirko, Veronika; Rinaldi, Sabina; Romieu, Isabelle; Wark, Petra A.; Norat, Teresa; Riboli, Elio; Kaaks, Rudolf

doi:10.1158/1055-9965.epi-12-0961

Cited by 15 publications

(28 citation statements)

References 35 publications

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“…The multinational European Prospective Investigation into Cancer and Nutrition (EPIC) reported that the association between occupational activity and overall breast cancer risk did not differ by menopausal status [36]. However, when results were stratified by age at diagnosis (age < 50 years versus age ≥ 50 years), inverse risks for invasive [32] and in situ [44] tumors were stronger, but not significant, among women diagnosed at age 50 or older. The EPIC study is also the only other prospective cohort that has evaluated breast cancer risk by body mass index.…”

Section: Discussionmentioning

confidence: 99%

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A prospective study of occupational physical activity and breast cancer risk

Ekenga

Parks

Sandler

2015

Cancer Causes Control

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Purpose Physical activity has been associated with reduced breast cancer risk, but studies of occupational activity have produced inconsistent results. The purpose of this study was to evaluate the relationship between occupational physical activity and breast cancer in a prospective study of women with a family history of breast cancer. Methods We studied breast cancer risk in 47,649 Sister Study participants with an occupational history. Information on occupational activity and breast cancer risk factors was collected during baseline interviews (2004-2009). Physical activity at each job was self-reported and categorized as mostly sitting, sitting and standing equally, mostly standing, and active. Multivariable Cox proportional hazards regression was used to evaluate associations between lifetime occupational activity and incident breast cancer, after adjusting for established risk factors and recreational activity. Results During follow-up, a total of 1,798 breast cancer diagnoses were reported. Compared with women who did not spend any time in active jobs, women who spent a high proportion (≥75%) of their working years in active jobs had a reduced risk of breast cancer (HR = 0.72; 95% CI = 0.52-0.98). Associations were strongest among overweight (HR = 0.64; 95% CI = 0.42-0.98) and postmenopausal (HR = 0.67; 95% CI = 0.45-0.98) women. Conclusions Occupational activity was associated with a reduced risk of breast cancer. Occupational activity is a domain of physical activity that should be further examined in studies of postmenopausal breast cancer risk. Additional research is necessary to better understand the mechanisms between occupational activity, body size, and breast cancer.

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Section: Discussionmentioning

confidence: 99%

“…The EPIC study is also the only other prospective cohort that has evaluated breast cancer risk by body mass index. There were no significant differences in the association between self-reported occupational activity and breast cancer risk among BMI subgroups in the EPIC cohort [44]. …”

Section: Discussionmentioning

confidence: 99%

A prospective study of occupational physical activity and breast cancer risk

Ekenga

Parks

Sandler

2015

Cancer Causes Control

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“…Second, inclusion of in-situ breast cancer could have weakened the preventive effect of physical activity. Four studies that examined risk of in-situ breast cancer in relation to physical activity found no or equivocal association [51,57,72,73]. However, the meta-analysis restricted to studies that included invasive cancer only showed no difference in SRR.…”

Section: Dose-response Analysismentioning

confidence: 99%

Physical activity, hormone replacement therapy and breast cancer risk: A meta-analysis of prospective studies.

Pizot

Boniol

Mullie

et al. 2015

JCO

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Background: Lower risk of breast cancer has been reported among physically active women, but the risk in women using hormone replacement therapy (HRT) appears to be higher. We quantified the association between physical activity and breast cancer, and we examined the influence that HRT use and other risk factors had on this association. Methods: After a systematic literature search, prospective studies were meta-analysed using random-effect models applied on highest vs. lowest level of physical activity. Dose-response analyses were conducted with studies reporting physical activity either in hours/week or in hours of metabolic equivalent per week (MET-h/week). Results: The literature search identified 38 independent prospective studies published between 1987 and 2014 that included 116,304 breast cancer cases. Compared to the lowest level of physical activity, the highest level was associated with a summary relative risk (SRR) of 0.88 (95% CI (0.85, 0.90)) for all breast cancer, 0.89 (95%CI (0.83, 0.95)) for ER+/PR+ breast cancer and 0.80 (95%CI (0.69, 0.92)) for ER-/PR-breast cancer. Risk reductions were not influenced by the type of physical activity (occupational or non-occupational), adiposity, and menopausal status. Risk reductions increased with increasing amounts of physical activity, without threshold effect. In six studies, the SRR was 0.78 (95% CI (0.70, 0.87)) in women who never used HRT and 0.97 (95% CI (0.88, 1.07)) in women who ever used HRT, without heterogeneity in results. Findings indicate that a physically inactive women engaging in at least 150 minutes per week of vigorous physical activity would reduce their lifetime risk of breast cancer by 9%, a reduction that might be two times greater in women who never used HRT. Conclusion: Increasing physical activity is associated with meaningful reductions in the risk of breast cancer, but in women who ever used HRT, the preventative effect of physical activity seems to be cancelled out.

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“…Hereby, PA acts partly by changing body composition, but effects have also been observed independently of body mass index (BMI) . Moreover, several studies suggest that PA might affect tumor progression rather than tumor initiation …”

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confidence: 99%

“…3,5,7 Moreover, several studies suggest that PA might affect tumor progression rather than tumor initiation. [10][11][12][13] Some of these primary-preventive effects of PA on breast cancer development might also act after a breast cancer diagnosis, inhibiting progression and improving prognosis. Indeed, evidence is emerging that PA improves survival after breast cancer.…”

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Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer

et al. 2013

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Evidence is emerging that physical activity (PA) may improve overall survival after breast cancer diagnosis. However, the effect of PA on breast cancer recurrence and on cause-specific mortality is less investigated. We assessed the association of pre-diagnosis PA with recurrence, overall and cause-specific survival in a prospective cohort study in Germany including 3,393 nonmetastatic breast cancer patients aged 50-74 years. Cox proportional hazards models were calculated adjusted for relevant prognostic factors. During a median follow-up of 5.6 years, 367 patients deceased. Overall mortality was significantly inversely associated with pre-diagnosis recreational PA. However, this effect was mainly attributed to deaths due to causes other than breast cancer. Multiple fractional polynomial analyses yielded a nonlinear association with markedly increased nonbreast cancer mortality for women who did not engage in any sports or cycling in the years before the breast cancer diagnosis with a hazard ratio (HR, none vs. any) of 1.71, 95% confidence interval (1.16, 2.52). There were no further risk reductions with increasing activity levels. The association with breast cancer-specific mortality showed a similar dose-response but was far less pronounced with HR (none vs. any) 5 1.22 (0.91, 1.64). In contrast, regarding cancer recurrence the dose-response was linear. However, this association was restricted to estrogen/progesterone receptor-negative (ER2/PR2) cases (p interaction 5 0.033) with HR (highest vs. no recreational PA) 5 0.53 (0.24, 1.16), p trend 5 0.0045. Thus, breast cancer patients with a physically inactive lifestyle pre-diagnosis may decease prematurely irrespective of their cancer prognosis. Higher levels of exercise may reduce the risk of recurrence of ER2/PR2 breast tumors.There is convincing evidence that physical activity (PA) is a preventive factor for postmenopausal breast cancer. 1 Several biological pathways may take effect on cancer development or progression. Studies have shown that PA reduces endogenous estrogens, 2-5 insulin resistance 6,7 and inflammation. 8,9 Hereby, PA acts partly by changing body composition, but effects have also been observed independently of body mass index (BMI). 3,5,7 Moreover, several studies suggest that PA might affect tumor progression rather than tumor initiation. [10][11][12][13] Some of these primary-preventive effects of PA on breast cancer development might also act after a breast cancer diagnosis, inhibiting progression and improving prognosis. Indeed, evidence is emerging that PA improves survival after breast cancer. A meta-analysis published in 2010 investigating the effect of PA on survival after breast cancer (n 5 12,108 patients) identified four studies on pre-diagnosis and three on post-diagnosis PA. 14 This meta-analysis resulted in a hazard ratio (HR) of 0.82 with a 95% confidence interval (CI) of (0.67, 0.99) for the association of pre-diagnosis PA with overall mortality. Post-diagnosis PA was associated with an even stronger risk reduction with HR ...

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Prospective Study on Physical Activity and Risk of In Situ Breast Cancer

Cited by 15 publications

References 35 publications

A prospective study of occupational physical activity and breast cancer risk

A prospective study of occupational physical activity and breast cancer risk

Physical activity, hormone replacement therapy and breast cancer risk: A meta-analysis of prospective studies.

Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer

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