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Energy Balance and Breast Cancer Risk

¹ Department of Surgery, Meharry Medical College; ² Division of General Internal Medicine, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical School, Nashville, Tennessee; and ³ Shanghai Cancer Institute, Shanghai, People's Republic of China

Requests for reprints: Alecia Malin, Department of Surgery, Meharry Medical College, 1005 Dr. D.B. Todd Boulevard, Nashville, TN 37208. Phone: 615-327-5719; Fax: 615-327-5579. E-mail: amalin{at}mmc.edu

We evaluated the hypothesis that a pattern of behavioral exposures indicating positive energy balance [i.e., less exercise/sport activity, high body mass index (BMI), or high energy intake] would be associated with an increased breast cancer risk in the Shanghai Breast Cancer Study, a population-based study of 1,459 incident breast cancer cases and 1,556 age frequency-matched controls. Participants completed in-person interviews that collected information on breast cancer risk factors, usual dietary intake and physical activity in adulthood. Anthropometric indices were measured. Odds ratios and 95% confidence intervals were estimated by logistic regression to describe the individual and joint effects of the exposures on breast cancer risk. Lack of exercise/sport activity, low occupational activity, and high BMI were all individually associated with increased risk of breast cancer [odds ratios (OR) ranged from 1.49 to 1.86]. In general, women with lower exercise/sport activity level and higher BMI, or those with higher energy intake, were at an increased risk compared with women who reported more exercise/sport activities, had lower BMIs, or reported less energy intake. There was a significant multiplicative interaction (P = 0.02) between adult exercise/sport activity and BMI, with inactive women in the upper BMI quartile being at increased risk (OR, 2.16; 95% confidence interval, 1.25-3.74) compared with their active and lean counterparts. This association was stronger in postmenopausal than in premenopausal women, and nonexercising postmenopausal women with higher BMIs were at substantially increased risk (OR, 4.74; 95% confidence interval, 2.05-12.20). Our study suggests that promotion of behavior patterns that optimize energy balance (weight control and increasing physical activity) may be a viable option for breast cancer prevention.

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