Physical Activity and Breast Cancer Risk: The European Prospective Investigation into Cancer and Nutrition
- Petra H. Lahmann1,
- Christine Friedenreich2,
- A. Jantine Schuit3,4,
- Simonetta Salvini5,
- Naomi E. Allen6,
- Tim J. Key6,
- Kay-Tee Khaw7,
- Sheila Bingham8,9,
- Petra H.M. Peeters10,
- Evelyn Monninkhof10,
- H. Bas Bueno-de-Mesquita3,
- Elisabet Wirfält11,
- Jonas Manjer12,
- Carlos A. Gonzales13,
- Eva Ardanaz14,
- Pilar Amiano15,
- José R. Quirós16,
- Carmen Navarro17,
- Carmen Martinez18,
- Franco Berrino19,
- Domenico Palli5,
- Rosario Tumino20,
- Salvatore Panico21,
- Paolo Vineis22,
- Antonia Trichopoulou23,
- Christina Bamia23,
- Dimitrios Trichopoulos24,
- Heiner Boeing1,
- Mandy Schulz1,
- Jakob Linseisen25,
- Jenny Chang-Claude25,
- Francoise Clavel Chapelon26,
- Agnès Fournier26,
- Marie-Christine Boutron-Ruault26,
- Anne Tjønneland27,
- Nina Føns Johnson27,
- Kim Overvad28,
- Rudolf Kaaks29,30 and
- Elio Riboli31
- 1Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany; 2Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada; 3National Institute of Public Health and the Environment, Bilthoven, the Netherlands; 4Institute of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands; 5Molecular and Nutritional Epidemiology Unit, Centro per lo Studio e la Prevenzione Oncologica, Scientific Institute of Tuscany, Florence, Italy; 6Cancer Research UK, Epidemiology Unit, University of Oxford, Oxford, United Kingdom; 7Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, United Kingdom; 8MRC Dunn Human Nutrition Unit, Cambridge, United Kingdom; 9MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, United Kingdom; 10Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands; 11Department of Clinical Sciences in Malmö, Clinical Research Center, Lund University, Lund, Sweden; 12Department of Surgery, Malmö University Hospital, Malmö, Sweden; 13Department of Epidemiology, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; 14Public Health Institute of Navarra, Pamplona, Spain; 15Department of Public Health of Gipuzkoa, San Sebastian, Spain; 16Health Information Unit, Public Health and Planning Directorate, Health and Health Services Council, Principality of Asturias, Oviedo, Spain; 17Epidemiology Department, Murcia Health Council, Murcia, Spain; 18Andalusian School of Public Health, Granada, Spain; 19Epidemiology Unit, National Cancer Institute, Milan, Italy; 20Cancer Registry, Azienda Ospedaliera “Civile-M.P. Arezzo,” Ragusa, Italy; 21Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy; 22Imperial College London, and University of Torino, Turin, Italy; 23Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece; 24Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; 25Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany; 26Institut National de la Santé et de la Recherche Médicale, ERI20, Institut Gustave Roussy, Villejuif, France; 27Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; 28Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, Aalborg, Denmark; 29Nutrition and Hormones Group, IARC (WHO), Lyon, France; 30Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany; and 31Department 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
Abstract
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 (Ptrend = 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; Ptrend = 0.001) and premenopausal (HR, 0.71; 95% confidence interval, 0.55-0.90, highest versus lowest quartile; Ptrend = 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)
Footnotes
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Grant support: “Europe Against Cancer” Programme of the European Commission; Deutsche Krebshilfe; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Greek Ministry of Education; Associazione Italiana per la Ricerca sul Cancro; Compagnia di San Paolo, Italy; Health Research Fund (FIS) of the Spanish Ministry of Health; the ISCIII Network RCESP (C03/09) and RETICC C03/10; Spanish Regional Governments of Andalusia, Asturias, Basque Country, Murcia, and Navarra and the Catalan Institute of Oncology; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skåne, Sweden.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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Note: Part of this work was done while C. Friedenreich was a Visiting Scientist at the IARC, Lyon, France.
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- Accepted October 27, 2006.
- Received July 14, 2006.
- Revision received October 24, 2006.
