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Physical Activity and Breast Cancer Risk: The European Prospective Investigation into Cancer and Nutrition

¹ Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany; ² Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada; ³ National Institute of Public Health and the Environment, Bilthoven, the Netherlands; ⁴ Institute of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands; ⁵ Molecular and Nutritional Epidemiology Unit, Centro per lo Studio e la Prevenzione Oncologica, Scientific Institute of Tuscany, Florence, Italy; ⁶ Cancer Research UK, Epidemiology Unit, University of Oxford, Oxford, United Kingdom; ⁷ Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, United Kingdom; ⁸ MRC Dunn Human Nutrition Unit, Cambridge, United Kingdom; ⁹ MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, United Kingdom; ¹⁰ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands; ¹¹ Department of Clinical Sciences in Malmö, Clinical Research Center, Lund University, Lund, Sweden; ¹² Department of Surgery, Malmö University Hospital, Malmö, Sweden; ¹³ Department of Epidemiology, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; ¹⁴ Public Health Institute of Navarra, Pamplona, Spain; ¹⁵ Department of Public Health of Gipuzkoa, San Sebastian, Spain; ¹⁶ Health Information Unit, Public Health and Planning Directorate, Health and Health Services Council, Principality of Asturias, Oviedo, Spain; ¹⁷ Epidemiology Department, Murcia Health Council, Murcia, Spain; ¹⁸ Andalusian School of Public Health, Granada, Spain; ¹⁹ Epidemiology Unit, National Cancer Institute, Milan, Italy; ²⁰ Cancer Registry, Azienda Ospedaliera "Civile-M.P. Arezzo," Ragusa, Italy; ²¹ Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy; ²² Imperial College London, and University of Torino, Turin, Italy; ²³ Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece; ²⁴ Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; ²⁵ Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany; ²⁶ Institut National de la Santé et de la Recherche Médicale, ERI20, Institut Gustave Roussy, Villejuif, France; ²⁷ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ²⁸ Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, Aalborg, Denmark; ²⁹ Nutrition and Hormones Group, IARC (WHO), Lyon, France; ³⁰ Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany; and ³¹ Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College, London, United Kingdom

Requests for reprints: Petra H. Lahmann, MRC Human Nutrition Research, 120 Fulbourn Road, Cambridge CB1 9NL, United Kingdom. Phone: 44-0-1223-426356; Fax: 44-0-1223-437515. E-mail: Petra.Lahmann{at}mrc-hnr.cam.ac.uk

There is convincing evidence for a decreased risk of breast cancer with increased physical activity. Uncertainties remain, however, about the role of different types of physical activity on breast cancer risk and the potential effect modification for these associations. We used data from 218,169 premenopausal and postmenopausal women from nine European countries, ages 20 to 80 years at study entry into the European Prospective Investigation into Cancer and Nutrition. Hazard ratios (HR) from multivariate Cox regression models were calculated using metabolic equivalent value–based physical activity variables categorized in quartiles, adjusted for age, study center, education, body mass index, smoking, alcohol use, age at menarche, age at first pregnancy, parity, current oral contraceptive use, and hormone replacement therapy use. The physical activity assessment included recreational, household, and occupational activities. A total physical activity index was estimated based on cross-tabulation of these separate types of activity. During 6.4 years of follow-up, 3,423 incident invasive breast cancers were identified. Overall, increasing total physical activity was associated with a reduction in breast cancer risk among postmenopausal women (P_trend = 0.06). Specifically, household activity was associated with a significantly reduced risk in postmenopausal (HR, 0.81; 95% confidence interval, 0.70-0.93, highest versus the lowest quartile; P_trend = 0.001) and premenopausal (HR, 0.71; 95% confidence interval, 0.55-0.90, highest versus lowest quartile; P_trend = 0.003) women. Occupational activity and recreational activity were not significantly related to breast cancer risk in both premenopausal and postmenopausal women. This study provides additional evidence for a protective effect of physical activity on breast cancer risk. (Cancer Epidemiol Biomarkers Prev 2007;16(1):36–42)

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