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Physical Activity and Colon Cancer Risk among Women in the California Teachers Study

¹ Clinical Cancer Genetics Department, City of Hope National Medical Center, Duarte, California; ² Department of Preventive Medicine, University of Southern California Keck School of Medicine and USC/Norris Cancer Center, Los Angeles, California; ³ Northern California Cancer Center, Fremont, California; and ⁴ School of Medicine, University of California, Irvine, California

Requests for reprints: Leslie Bernstein, Department of Preventive Medicine, USC/Norris Comprehensive Cancer Center, University of Southern California, Room 4449, 1441 Eastlake Avenue, Los Angeles, CA 90033. Phone: 323-865-0421; Fax: 323-865-0128. E-mail: lbern{at}usc.edu

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 [4 versus 0.5 h/wk/y: RR, 0.75; 95% confidence interval, 0.57-1.00; P_trend = 0.23]. Lifetime physical activity reduced colon cancer risk among postmenopausal women who had never taken hormone therapy (4 versus 0.5 h/wk/y: RR, 0.51; 95% confidence interval, 0.31-0.85; P_trend = 0.02). Postmenopausal women with histories of hormone therapy use had lower colon cancer risk, but their risk was not associated with physical activity. The likelihood ratio test for interaction between hormone use and lifetime moderate plus strenuous physical activity was of borderline statistical significance (P = 0.05). We observed no effect modification by age, body mass index, smoking status, menopausal status, or folate intake.

Conclusions: Lifetime recreational physical activity may protect against colon cancer among postmenopausal women who have never used hormone therapy. Among hormone therapy users, who have lower risk of colon cancer, recreational physical activity does not seem to provide any additional benefit. With declining rates of hormone therapy use, physical activity offers one possible means for reducing women's colon cancer risk. (Cancer Epidemiol Biomarkers Prev 2007;16(3):517–25)

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