Journal
INTERNATIONAL JOURNAL OF CANCER
Volume 132, Issue 7, Pages 1667-1678Publisher
WILEY-BLACKWELL
DOI: 10.1002/ijc.27778
Keywords
physical activity; breast cancer; etiology; estrogen receptor; progesterone receptor; cohort study
Categories
Funding
- European Commission (DG-SANCO) (Denmark)
- International Agency for Research on Cancer (Denmark)
- Danish Cancer Society (Denmark)
- Ligue contre le Cancer, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (France)
- Deutsche Krebshilfe (Germany)
- Deutsches Krebsforschungszentrum (Germany)
- Federal Ministry of Education and Research (Germany)
- Hellenic Health Foundation (Italy)
- Stavros Niarchos Foundation (Greece) (Italy)
- Italian Association for Research on Cancer (AIRC) (Italy)
- National Research Council (Italy)
- Dutch Ministry of Public Health, Welfare and Sports (VWS) (The Netherlands)
- Netherlands Cancer Registry (NKR) (The Netherlands)
- LK Research Funds (The Netherlands)
- Dutch Prevention Funds (The Netherlands)
- Dutch ZON (Zorg Onderzoek Nederland) (The Netherlands)
- World Cancer Research Fund (WCRF) (The Netherlands)
- Statistics Netherlands (The Netherlands)
- Nordforsk, Nordic Center of Excellence programme on Food, Nutrition and Health. (Norway)
- Health Research Fund (FIS) (Spain)
- Regional Government of Andalucia (Spain)
- Regional Government Asturias (Spain)
- Regional Government Basque Country (Spain)
- Regional Government Murcia (Spain) [6236]
- Navarra, ISCIII RTICC 'Red Tematica de Investigacion Cooperativa en Cancer (Spain) [R06/0020]
- Swedish Cancer Society (Sweden)
- Swedish Scientific Council (Sweden)
- Regional Government of Skane and Vasterbotten (Sweden)
- Cancer Research UK
- Medical Research Council (United Kingdom)
- [ERC-2009-AdG 232997]
- MRC [MC_UU_12015/1] Funding Source: UKRI
- Medical Research Council [MC_UU_12015/1, MC_U106179471, G0401527, G1000143] Funding Source: researchfish
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Physical activity is associated with reduced risks of invasive breast cancer. However, whether this holds true for breast cancer subtypes defined by the estrogen receptor (ER) and the progesterone receptor (PR) status is controversial. The study included 257,805 women from the multinational EPIC-cohort study with detailed information on occupational, recreational and household physical activity and important cofactors assessed at baseline. During 11.6 years of median follow-up, 8,034 incident invasive breast cancer cases were identified. Data on ER, PR and combined ER/PR expression were available for 6,007 (67.6%), 4,814 (54.2%) and 4,798 (53.9%) cases, respectively. Adjusted hazard ratios (HR) were estimated by proportional hazards models. Breast cancer risk was inversely associated with moderate and high levels of total physical activity (HR = 0.92, 95% confidence interval (CI): 0.860.99, HR = 0.87, 95%-CI: 0.790.97, respectively; p-trend = 0.002), compared to the lowest quartile. Among women diagnosed with breast cancer after age 50, the largest risk reduction was found with highest activity (HR = 0.86, 95%-CI: 0.770.97), whereas for cancers diagnosed before age 50 strongest associations were found for moderate total physical activity (HR = 0.78, 95%-CI: 0.640.94). Analyses by hormone receptor status suggested differential associations for total physical activity (p-heterogeneity = 0.04), with a somewhat stronger inverse relationship for ER+/PR+ breast tumors, primarily driven by PR+ tumors (p-heterogeneity < 0.01). Household physical activity was inversely associated with ER/PR tumors. The results of this largest prospective study on the protective effects of physical activity indicate that moderate and high physical activity are associated with modest decreased breast cancer risk. Heterogeneities by receptor status indicate hormone-related mechanisms.
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