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Cancer Epidemiology, Biomarkers & Prevention
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Research Articles

Physical Activity and Risk of Recurrence and Mortality in Breast Cancer Survivors: Findings from the LACE Study

Barbara Sternfeld, Erin Weltzien, Charles P. Quesenberry Jr., Adrienne L. Castillo, Marilyn Kwan, Martha L. Slattery and Bette J. Caan
Barbara Sternfeld
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Erin Weltzien
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Charles P. Quesenberry Jr.
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Adrienne L. Castillo
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Marilyn Kwan
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Martha L. Slattery
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Bette J. Caan
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DOI: 10.1158/1055-9965.EPI-08-0595 Published January 2009
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Article Figures & Data

Tables

  • Table 1.

    Characteristics of LACE cohort at study entry by outcome

    Recurrence*
    Deceased, breast cancer
    Deceased, all causes
    No (n = 1,745)Yes (n = 225)P†No (n = 1,868)Yes (n = 102)P†No (n = 1,783)Yes (n = 187)P†
    Person-years of follow-up6019,788-34510,478-69710,125-
    Age at enrollment, mean y (SD)60.6 (10.8)60.4 (10.9)0.8060.4 (10.8)62.5 (10.7)0.0660.0 (10.7)65.3 (10.5)<0.0001
    Race, n (%)0.930.570.77
        White1,421 (81.5)184 (81.8)1,524 (81.7)81 (79.4)1,451 (81.5)154 (82.4)
        Other322 (18.5)41 (18.2)342 (18.3)21(20.6)330 (18.5)33 (17.6)
    Education, n (%)0.870.270.0003
        High school graduate or less464 (26.7)63 (28.0)494 (26.5)33 (32.4)459 (25.8)68 (36.4)
        Some college646 (37.1)84 (37.3)691 (37.1)39 (38.2)655 (36.8)75 (40.1)
        College graduate or more631 (36.2)78 (34.7)679 (36.4)30 (29.4)665 (37.4)44 (23.5)
    Smoking status, n (%)0.270.380.0003
        Never940 (54.2)112 (49.8)1,003 (54.0)49 (48.0)973 (54.9)79 (42.3)
        Past676 (39.0)92 (40.9)725 (39.0)43 (42.2)684 (38.6)84 (44.9)
        Current119 (6.8)21 (9.3)130 (7.0)10 (9.8)116 (6.5)24 (12.8)
    BMI at enrollment, mean kg/m2 (SD)27.4 (5.8)27.9 (6.1)0.3127.4 (5.8)28.3 (6.1)0.1427.3 (5.7)28.6 (6.5)0.01
    Weight at 18 y, mean lbs (SD)120.8 (17.0)123.7 (17.6)0.02120.9 (16.9)125.6 (19.2)0.02120.8 (17.0)123.9 (17.9)0.03
    Menopausal status, n (%)0.760.510.0004
        Postmenopausal1,139 (65.3)142 (63.1)1,211 (64.8)70 (68.6)1,136 (63.7)145 (77.5)
        Premenopausal370 (21.2)49 (21.8)402 (21.5)17 (16.7)398 (22.3)21 (11.2)
        Undetermined236 (13.5)34 (15.1)255 (13.7)15 (14.7)249 (14.0)21 (11.2)
    Family history of breast cancer, n (%)0.980.960.69
        No1,388 (79.6)179 (79.6)1,486 (79.6)81 (79.4)1,416 (79.5)151 (80.7)
        Yes355 (20.4)46 (20.4)380 (20.4)21 (20.6)365 (20.5)36 (19.3)
    Stage, n (%)<0.0001<0.0001<0.0001
        I867 (49.8)73 (32.6)915 (49.1)25 (24.5)878 (49.3)62 (33.3)
        IIa582 (33.4)73 (32.6)623 (33.4)32 (31.4)593 (33.3)62 (33.3)
        IIb256 (14.7)58 (25.9)282 (15.1)32 (31.4)266 (14.9)48 (25.8)
        IIIa37 (2.1)20 (8.9)44 (2.4)13 (12.7)43 (2.4)14 (7.5)
    Type of surgery, n (%)0.0010.020.01
        Conserving902 (51.7)91 (40.4)953 (51.0)40 (39.2)915 (51.3)78 (41.7)
        Mastectomy842 (48.3)134 (59.6)914 (49.0)62 (60.8)867 (48.7)109 (58.3)
    Chemotherapy, n (%)<0.00010.010.62
        No786 (45.4)70 (31.5)825 (44.5)31 (31.3)773 (43.7)83 (45.6)
        Yes944 (54.6)152 (68.5)1,028 (55.5)68 (68.7)997 (56.3)99 (54.4)
    Radiation therapy, n (%)0.330.060.38
        No639 (37.5)75 (34.1)686 (37.6)28 (28.3)653 (37.4)61 (34.1)
        Yes1,066 (62.5)145 (65.9)1,140 (62.4)71 (71.7)1,093 (62.6)118 (65.9)
    Number of positive nodes, n (%)<0.0001<0.0001<0.0001
        Node negative1,097 (66.9)90 (43.7)1,154 (66.0)33 (34.0)1,105 (66.2)82 (46.1)
        1-3409 (24.9)60 (29.1)435 (24.9)34 (35.1)418 (25.1)51 (28.6)
        ≥3134 (8.2)56 (27.2)160 (9.1)30 (30.9)145 (8.7)45 (25.3)
    Tamoxifen use, n (%)0.310.790.09
        No389 (22.3)57 (25.3)424 (22.7)22 (21.6)413 (23.2)33 (17.6)
        Yes1,356 (77.7)168 (74.7)1,444 (77.3)80 (78.4)1,370 (76.8)154 (82.4)
    ER/PR receptor status, n (%)0.010.060.03
        ER+, PR+1,196 (69.4)131 (59.8)1,268 (68.8)59 (59.6)1,212 (68.9)115 (62.8)
        ER+, PR−239 (13.9)36 (16.4)256 (13.9)19 (19.2)238 (13.5)37 (20.2)
        ER−, PR+27 (1.6)8 (3.7)31 (1.7)4 (4.0)29 (1.7)6 (3.3)
        ER−, PR−260 (15.1)44 (20.1)288 (15.6)17 (17.2)279 (15.9)25 (13.7)
    Time from diagnosis to enrollment, mean y (SD)1.9 (0.6)1.9 (0.6)0.541.9 (0.6)1.9 (0.6)0.871.9 (0.6)1.9 (0.5)0.50
    • Abbreviations: ER+, estrogen receptor positive; ER−, estrogen receptor negative; PR+, progesterone receptor positive; PR−, progesterone receptor negative.

    • ↵* Recurrence includes local, regional, or distant recurrence or metastasis or death from breast cancer if no recurrence was previously reported.

    • ↵† P value for t test for difference in means, or χ2 test for difference in proportions between women with and without the event.

  • Table 2.

    Level of physical activity in LACE cohort at study entry

    Total activity, median MET-h/wk (I-Q range)44.3 (29.3-62.3)
    Moderate-vigorous activity, median MET-h/wk (I-Q range)14.8 (5.3-27.2)
    Moderate activity, median h/wk(I-Q range)2.9 (1.0-5.6)
    Categorized in h/wk, n (%)
        <1490 (25%)
        1-<3502 (26%)
        3-<6524 (27%)
        ≥6434 (22%)
    Vigorous activity, median h/wk (I-Q range)0.0 (0-1.1)
    Categorized in h/wk, n (%)
        01,102 (56%)
        >0-<1356 (18%)
        ≥1505 (26%)
    Selected activities, median MET-h/wk (I-Q range)5.9 (0-16.5)
    Categorized in h/wk, n (%)
        <91,099 (58%)
        ≥9804 (42%)
  • Table 3.

    Characteristics of LACE cohort by hours/week of moderate intensity physical activity

    Hours per week of moderate activity
    P*
    <1 h (n = 490)1-<3 h (n = 502)3-<6 h (n = 523)≥6 h (n = 433)
    Age at enrollment, mean y (SD)62.8 (11.1)60.0 (11.2)59.9 (10.3)59.6 (10.2)<0.0001
    Race, n (%)0.15
        White383 (78.2)409 (81.5)432 (82.6)362 (83.6)
        Other107 (21.8)93 (18.5)91 (17.4)71 (16.4)
    Education, n (%)0.0001
        High school graduate or less167 (34.1)125 (24.9)116 (22.2)116 (26.9)
        Some college178 (36.3)201 (40.0)198 (37.9)143 (33.2)
        College graduate or more145 (29.6)176 (35.1)209 (40.0)172 (39.9)
    Smoking status, n (%)0.40
        Never263 (53.8)279 (55.8)269 (51.6)234 (54.3)
        Past184 (37.6)187 (37.4)222 (42.6)165 (38.3)
        Current42 (8.6)34 (6.8)30 (5.8)32 (7.4)
    BMI at enrollment, mean kg/m2 (SD)28.9 (6.3)27.9 (5.8)26.9 (5.6)26.2 (5.1)<0.0001
    Weight at 18 y, mean lbs (SD)120.5 (17.6)120.4 (16.2)122.5 (17.3)120.6 (16.9)0.16
    Menopausal status, n (%)0.03
        Postmenopausal340 (69.4)315 (62.8)333 (63.5)286 (65.9)
        Premenopausal95 (19.4)117 (23.3)100 (19.1)97 (22.4)
        Undetermined55 (11.2)70 (13.9)91 (17.4)51 (11.7)
    Family history of breast cancer, n (%)0.74
        No389 (79.4)408 (81.3)411 (78.6)343 (79.2)
        Yes101 (20.6)94 (18.7)112 (21.4)90 (20.8)
    Stage, n (%)0.21
        I218 (44.7)233 (46.5)257 (49.1)219 (50.6)
        IIa163 (33.4)180 (35.9)160 (30.5)147 (34.0)
        IIb94 (19.3)72 (14.4)90 (17.2)56 (12.9)
        IIIa13 (2.7)16 (3.2)17 (3.2)11 (2.5)
    Type of surgery, n (%)0.60
        Conserving244 (49.8)265 (52.8)255 (48.7)218 (50.3)
        Mastectomy246 (50.2)237 (47.2)269 (51.3)215 (49.7)
    Chemotherapy, n (%)0.03
        No232 (48.2)195 (39.0)230 (44.3)188 (43.5)
        Yes249 (51.8)305 (61.0)289 (55.7)244 (56.5)
    Radiation therapy, n (%)0.83
        No179 (38.2)176 (35.6)197 (37.9)155 (36.8)
        Yes290 (61.8)319 (64.4)323 (62.1)266 (63.2)
    Number of positive nodes, n (%)0.06
        Node negative282 (60.6)291 (62.1)319 (65.8)283 (68.9)
        1-3125 (26.9)121 (25.8)121 (24.9)99 (24.1)
        ≥358 (12.5)57 (12.1)45 (9.3)29 (7.1)
    Tamoxifen use, n (%).69
        No116 (23.7)121 (24.1)113 (21.6)94 (21.7)
        Yes374 (76.3)381 (75.9)411 (78.4)340 (78.3)
    ER/PR receptor status, n (%)0.33
        ER+, PR+330 (68.6)319 (64.4)366 (70.8)296 (69.0)
        ER+, PR-62 (12.9)73 (14.8)71 (13.7)67 (15.6)
        ER-, PR+6 (1.2)12 (2.4)9 (1.7)7 (1.6)
        ER-, PR-83 (17.3)91 (18.4)71 (13.7)59 (13.8)
    Time from diagnosis to enrollment, mean y (SD)1.9 (0.5)1.9 (0.6)1.9 (0.6)1.9 (0.6)0.91
    Follow-up time, mean y (SD)
        To recurrence7.0 (1.6)7.2 (1.6)7.2 (1.5)7.2 (1.5)0.08
        To death7.2 (1.3)7.4 (1.3)7.4 (1.2)7.4 (1.3)0.08
    • ↵* ANOVA to test for differences in means of continuous variables; chi-square tests to evaluate differences in proportions for categorical variables.

  • Table 4.

    Risk of breast cancer recurrence, breast cancer mortality and all-cause mortality associated with physical activity

    Recurrence (n = 225)
    Breast cancer mortality (n = 102)
    All-cause mortality (n = 187)
    Model I*
    Model II†
    Model I*
    Model II‡
    Model I*
    Model II§
    HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)HR (95% CI)
    Total activity, MET-h/wk
        Q1 (<29)RefRefRefRefRefRef
        Q2 (29-<44)0.65 (0.44-0.97)0.76 (0.51-1.13)0.83 (0.49-1.40)1.01 (0.57-1.78)0.70 (0.47-1.04)0.89 (0.59-1.33)
        Q3 (44-<62)0.82 (0.57-1.19)0.87 (0.59-1.29)0.71 (0.41-1.24)0.70 (0.38-1.29)0.67 (0.45-1.00)0.82 (0.54-1.25)
        Q4 (≥62)0.79 (0.54-1.15)0.91 (0.61-1.36)0.68 (0.39-1.18)0.87 (0.48-1.59)0.58 (0.38-0.88)0.76 (0.48-1.19)
        P for trend0.400.780.140.410.010.20
    Moderate-vigorous activity, MET-h/wk
        Q1 (<5.3)RefRefRefRefRefRef
        Q2 (5.3-<15)0.67 (0.46-0.97)0.73 (0.49-1.09)0.68 (0.41-1.15)0.77 (0.44-1.34)0.63 (0.43-0.93)0.71 (0.48-1.07)
        Q3 (15-<27)0.62 (0.42-0.91)0.75 (0.50-1.12)0.47 (0.26-0.85)0.47 (0.24-0.91)0.49 (0.32-0.74)0.58 (0.37-0.90)
        Q4 (≥27)0.84 (0.59-1.20)1.00 (0.68-1.46)0.68 (0.41-1.15)0.90 (0.51-1.58)0.56 (0.38-0.83)0.74 (0.49-1.13)
        P for trend0.310.950.070.380.0010.06
    H/wk of moderate activity
        <1RefRefRefRefRefRef
        1-<30.76 (0.53-1.09)0.81 (0.55-1.18)0.51 (0.29-0.89)0.65 (0.36-1.16)0.59 (0.40-0.87)0.71 (0.48-1.06)
        3-<60.80 (0.56-1.13)0.86 (0.60-1.25)0.69 (0.42-1.13)0.69 (0.40-1.19)0.57 (0.39-0.84)0.66 (0.44-1.00)
        ≥60.66 (0.44-0.97)0.81 (0.54-1.22)0.56 (0.32-0.98)0.73 (0.40-1.33)0.51 (0.34-0.79)0.66 (0.42-1.03)
        P for trend0.050.360.070.260.0010.04
    Hours/wk of vigorous activity
        0RefRefRefRefRefRef
        >0-<10.88 (0.61-1.28)0.91 (0.62-1.36)0.72 (0.40-1.28)0.79 (0.42-1.48)0.74 (0.48-1.15)0.90 (0.57-1.41)
        ≥11.06 (0.78-1.44)1.12 (0.81-1.56)0.85 (0.53-1.36)1.10 (0.68-1.80)0.87 (0.61-1.23)1.02 (0.70-1.47)
        P for trend0.800.580.400.820.331.0
    Selected activities, MET-h/wk
        <9RefRefRefRefRefRef
        ≥91.00 (0.76-1.31)1.16 (0.87-1.55)0.91 (0.61-1.36)1.19 (0.78-1.84)0.78 (0.57-1.06)0.98 (0.71-1.35)
    • HR, hazard ratio; 95% CI, 95% confidence interval.

    • ↵* Adjusted for age.

    • ↵† Adjusted for age, number of positive nodes, stage and weight at 18 y.

    • ↵‡ Adjusted for age, number of positive nodes, stage, weight at 18 y, type of treatment (chemotherapy/radiation) and type of surgery (mastectomy or conserving).

    • ↵§ Adjusted for age, number of positive nodes, stage, weight at 18 y, education level and smoking status.

  • Table 5.

    Multivariable adjusted risk of all-cause mortality associated with moderate intensity physical activity stratified by baseline BMI and ER/PR receptor status

    BMI at enrollment, kg/m2
    <25 (n = 749)
    25-29.9 (n = 656)
    >30 (n = 518)
    HR (95% CI)HR (95% CI)HR (95% CI)
    H/wk of moderate activity
        <1RefRefRef
        1-<30.52 (0.25-1.10)0.73 (0.37-1.43)0.84 (0.42-1.70)
        3-<60.42 (0.20-0.90)0.74 (0.38-1.45)0.89 (0.42-1.85)
        >60.38 (0.17-0.85)0.95 (0.47-1.94)0.90 (0.38-2.16)
        P for trend0.010.780.76
    ER/PR receptor status
    ER and/or PR negative (n = 614)
    ER/PR positive (n = 1,327)

    HR (95% CI)
    HR (95% CI)
    H/wk of moderate activity
        <1RefRef
        1-<30.80 (0.41-1.54)0.64 (0.38-1.06)
        3-<61.06 (0.56-2.00)0.46 (0.26-0.79)
        >60.75 (0.36-1.59)0.59 (0.34-1.04)
        P for trend0.690.01
    • NOTE: Adjusted for age at enrollment into cohort, number of positive nodes, stage, weight at 18 y, education level and smoking status.

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Cancer Epidemiology Biomarkers & Prevention: 18 (1)
January 2009
Volume 18, Issue 1
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Physical Activity and Risk of Recurrence and Mortality in Breast Cancer Survivors: Findings from the LACE Study
Barbara Sternfeld, Erin Weltzien, Charles P. Quesenberry Jr., Adrienne L. Castillo, Marilyn Kwan, Martha L. Slattery and Bette J. Caan
Cancer Epidemiol Biomarkers Prev January 1 2009 (18) (1) 87-95; DOI: 10.1158/1055-9965.EPI-08-0595

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Physical Activity and Risk of Recurrence and Mortality in Breast Cancer Survivors: Findings from the LACE Study
Barbara Sternfeld, Erin Weltzien, Charles P. Quesenberry Jr., Adrienne L. Castillo, Marilyn Kwan, Martha L. Slattery and Bette J. Caan
Cancer Epidemiol Biomarkers Prev January 1 2009 (18) (1) 87-95; DOI: 10.1158/1055-9965.EPI-08-0595
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