Breast Cancer Mortality vs. Exercise and Breast Size in Runners and Walkers

Purpose: Identify predictors of breast cancer mortality in women who exercised below (<7.5 metabolic equivalent hours/week, MET-hours/wk), at (7.5 to 12.5 MET-hours/wk), or above (>= 12.5 MET-hours/wk) recommended levels. Methods: Cox proportional hazard analyses of baseline pre-diagnosis MET-hours/wk vs. breast cancer mortality adjusted for follow-up age, race, baseline menopause, and estrogen and oral contraceptive use in 79,124 women (32,872 walkers, 46,252 runners) from the National Walkers' and Runners' Health Studies. Results: One-hundred eleven women (57 walkers, 54 runners) died from breast cancer during the 11-year follow-up. The decline in mortality in women who exercised >= 7.5 MET-hours/wk was not different for walking and running (P = 0.34), so running and walking energy expenditures were combined. The risk for breast cancer mortality was 41.5% lower for >= 7.5 vs. <7.5 MET-hours/wk (HR: 0.585, 95%Cl: 0.382 to 0.924, P = 0.02), which persisted when adjusted for BMI (HR: 0.584, 95%Cl: 0.368 to 0.956, P = 0.03). Other than age and menopause, baseline bra cup size was the strongest predictor of breast cancer mortality, i.e., 57.9% risk increase per cup size when adjusted for MET-hours/wk and the other covariates (HR: 1.579, 95%Cl: 1.268 to 1.966, P<0.0001), and 70.4% greater when further adjusted for BMI (HR: 1.704, 95%Cl: 1.344 to 2.156, P = 10(-5)). Breast cancer mortality was 4.0-fold greater (HR: 3.980, 95%Cl: 1.894 to 9.412, P = 0.0001) for C-cup, and 4.7-fold greater (HR: 4.668, 95%Cl: 1.963 to 11.980, P = 0.0004) for >= D-cup vs. A-cup when adjusted for BMI and other covariates. Adjustment for cup size and BM I did not eliminate the association between breast cancer mortality and >= 7.5 MET-hour/wk walked or run (HR: 0.615, 95%Cl: 0.389 to 1.004, P = 0.05). Conclusion: Breast cancer mortality decreased in association with both meeting the exercise recommendations and smaller breast volume.