Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study

Lisa A Cadmus Bertram, Marcia L Stefanick, Nazmus Saquib, Loki Natarajan, Ruth E Patterson, Wayne Bardwell, Shirley W Flatt, Vicky A Newman, Cheryl L Rock, Cynthia A Thomson, John P Pierce, Lisa A Cadmus Bertram, Marcia L Stefanick, Nazmus Saquib, Loki Natarajan, Ruth E Patterson, Wayne Bardwell, Shirley W Flatt, Vicky A Newman, Cheryl L Rock, Cynthia A Thomson, John P Pierce

Abstract

Objective: Research suggests that physical activity is associated with improved breast cancer survival, yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes. The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality.

Methods: A total of 2,361 post-treatment breast cancer survivors (Stage I-III) enrolled in a randomized controlled trial of dietary change completed physical activity measures at baseline and one year. Physical activity variables (total, moderate-vigorous, and adherence to guidelines) were calculated for each time point. Median follow-up was 7.1 years. Outcomes were invasive breast cancer events and all-cause mortality.

Results: Those who were most active at baseline had a 53% lower mortality risk compared to the least active women (HR = 0.47; 95% CI: 0.26, 0.84; p = .01). Adherence to activity guidelines was associated with a 35% lower mortality risk (HR = 0.65, 95% CI: 0.47, 0.91; p < .01). Neither baseline nor 1-year change in activity was associated with additional breast cancer events.

Conclusions: Higher baseline (post-treatment) physical activity was associated with improved survival. However, change in activity over the following year was not associated with outcomes. These data suggest that long-term physical activity levels are important for breast cancer prognosis.

Figures

Fig. 1
Fig. 1
a All-cause mortality for WHEL Study participants (N = 2,361) stratified by baseline physical activity level. b All-cause mortality stratified by change in physical activity from baseline to 1 year

References

    1. Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and site-specific. Med Sci Sports Exerc. 2001;33(6 Suppl):S530–S550.
    1. Sternfeld B, Lee I-M. Physical activity and cancer: the evidence, the issues, and the challenges. In: Lee I-M, editor. Epidemiologic methods in physical activity studies. New York: Oxford University Press; 2008.
    1. Bull FC, Armstrong TP, Dixon T, Ham S, Neiman A, Pratt M. Physical inactivity. In: Ezzati M, Lopez AM, Rodgers A, Murray C, editors. Comparative quantification of health risks: global and regional burden of disease attribution to selected major risk factors. Geneva: World Health Organization; 2004.
    1. Monninkhof EM, Elias SG, Vlems FA, et al. Physical activity and breast cancer: a systematic review. Epidemiology. 2007;18(1):137–157. doi: 10.1097/01.ede.0000251167.75581.98.
    1. Emaus A, Veierod MB, Tretli S, et al. Metabolic profile, physical activity, and mortality in breast cancer patients. Breast Cancer Res Treat. 2010;121(3):651–660. doi: 10.1007/s10549-009-0603-y.
    1. John EM, Horn-Ross PL, Koo J. Lifetime physical activity and breast cancer risk in a multiethnic population: the San Francisco Bay area breast cancer study. Cancer Epidemiol Biomarkers Prev. 2003;12(11 Pt 1):1143–1152.
    1. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. Jama. 2005;293(20):2479–2486. doi: 10.1001/jama.293.20.2479.
    1. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2008;17(2):379–386. doi: 10.1158/1055-9965.EPI-07-0771.
    1. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26(24):3958–3964. doi: 10.1200/JCO.2007.15.9822.
    1. Sternfeld B, Weltzien E, Quesenberry CP, Jr, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev. 2009;18(1):87–95. doi: 10.1158/1055-9965.EPI-08-0595.
    1. Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer. 2009;124(8):1954–1962. doi: 10.1002/ijc.24155.
    1. Pasanisi P, Berrino F, De Petris M, Venturelli E, Mastroianni A, Panico S. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer. 2006;119(1):236–238. doi: 10.1002/ijc.21812.
    1. Irwin ML, Varma K, Alvarez-Reeves M, et al. Randomized controlled trial of aerobic exercise on insulin and insulin-like growth factors in breast cancer survivors: the Yale Exercise and Survivorship study. Cancer Epidemiol Biomarkers Prev. 2009;18(1):306–313. doi: 10.1158/1055-9965.EPI-08-0531.
    1. McTiernan A, Ulrich C, Slate S, Potter J. Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control. 1998;9(5):487–509. doi: 10.1023/A:1008853601471.
    1. Pierce JP, Faerber S, Wright FA, et al. A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials. 2002;23(6):728–756. doi: 10.1016/S0197-2456(02)00241-6.
    1. Pierce JP, Natarajan L, Caan BJ, et al. Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. Jama. 2007;298(3):289–298. doi: 10.1001/jama.298.3.289.
    1. Gold EB, Flatt SW, Pierce JP, et al. Dietary factors and vasomotor symptoms in breast cancer survivors: the WHEL Study. Menopause. 2006;13(3):423–433. doi: 10.1097/01.gme.0000185754.85328.44.
    1. Pierce JP, Stefanick ML, Flatt SW, et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 2007;25(17):2345–2351. doi: 10.1200/JCO.2006.08.6819.
    1. McTiernan A, Kooperberg C, White E, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. Jama. 2003;290(10):1331–1336. doi: 10.1001/jama.290.10.1331.
    1. Hong S, Bardwell WA, Natarajan L, et al. Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study. Breast Cancer Res Treat. 2007;101(2):225–232. doi: 10.1007/s10549-006-9284-y.
    1. Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498–S504.
    1. Johnson-Kozlow M, Rock CL, Gilpin EA, Hollenbach KA, Pierce JP. Validation of the WHI brief physical activity questionnaire among women diagnosed with breast cancer. Am J Health Behav. 2007;31(2):193–202.
    1. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health survey 1.0. Health Econ. 1993;2(3):217–227. doi: 10.1002/hec.4730020305.
    1. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–1445. doi: 10.1249/mss.0b013e3180616aa2.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa