Download PDF
Methods Inf Med 2009; 48(05): 444-450
DOI: 10.3414/ME9239
Original Articles
Schattauer GmbH

Physical Activity and Postmenopausal Breast Cancer

Effect Modification by Other Breast Cancer Risk Factors
M. E. Schmidt
1   Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
,
J. Chang-Claude
2   Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
,
T. Slanger
2   Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
,
N. Obi
3   Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
,
D. Flesch-Janys
3   Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
,
K. Steindorf
1   Unit of Environmental Epidemiology, German Cancer Research Center, Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

20 August 2009

Publication Date:
20 January 2018 (online)

    Permissions and Reprints

Summary

Objectives: Epidemiological evidence suggests an inverse association between physical activity (PA) and postmenopausal breast cancer risk. Breast cancer is a heterogeneous disease, influenced by reproductive factors, lifestyle pattern, and predispositions. We investigated whether these risk factors modify the effect of PA on breast cancer risk.

Methods: We analyzed data from 2004 hormone-receptor-positive postmenopausal breast cancer cases and 6569 controls from the population-based MARIE study conducted 2002–2005 in Germany. Interaction was statistically tested using adjusted unconditional logistic regression models.

Results: The inverse association between leisure-time PA and risk of postmenopausal hormone-receptor-positive breast cancer was not heterogeneous by family history of breast cancer or by hormone therapy. PA showed a significant interaction with benign breast diseases (p = 0.023) and with breastfeeding (p = 0.045) but not with parity (p = 0.94), with clear risk reductions only for women who ever had breastfed or who ever had a benign breast disease (among ever breastfed: odds ratio = 0.63; 95% confidence interval = (0.52, 0.77), highest vs. lowest PA quartile). Interaction with BMI was weak (p = 0.053).

Conclusions: Breastfeeding and benign breast diseases modified the effect of PA on postmenopausal breast cancer risk. If other studies find similar modifications, increasing knowledge about these risk factors may contribute to a better understanding of the mode of action of PA on breast cancer risk. For women who are at higher risk for breast cancer due to family history or due to hormone therapy use, it is encouraging that they might lower their risk by being physically active.

Keywords

Postmenopausal breast cancer - physical activity - effect modification - case-control study
 

  • References

  • 1 Monninkhof EM, Elias SG, Vlems FA, van der Tweel I, Schuit AJ, Voskuil DW, van Leeuwen FE. Physical activity and breast cancer, a systematic review of current evidence. Epidemiology 2007; 18: 137-157.
    CrossrefPubMedGoogle Scholar
  • 2 Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, Demeter J, Perou CM, Lonning PE, Brown PO, Borresen-Dale AL, Botstein D. Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 2003; 100 (14) 8418-8423.
    CrossrefPubMedGoogle Scholar
  • 3 Schmidt ME, Steindorf K, Mutschelknauss E, Slanger T, Obi N, Kropp S, Berger J, Braendle W, Flesch-Janys D, Chang-Claude J. Physical activity and postmenopausal breast cancer: effective periods in life and effect modification by different breast cancer characteristics. Cancer Epidemiol Biomarkers Prev 2008; 17: 3402-3410.
    CrossrefPubMedGoogle Scholar
  • 4 Flesch-Janys D, Slanger T, Mutschelknauss E, Kropp S, Obi N, Vettorazzi E, Braendle W, Bastert G, Hentschel S, Berger J, Chang-Claude J. Risk of different histological types of postmenopausal breast cancer by type and regimen of menopausal hormone therapy. Int J Cancer 2008; 123 (04) 933-941.
    CrossrefPubMedGoogle Scholar
  • 5 Schmidt ME, Slanger T, Chang-Claude J, Wahrendorf J, Steindorf K. Evaluation of a short retrospective questionnaire for physical activity in women. Eur J Epidemiol 2006; 21 (08) 575-585.
    CrossrefPubMedGoogle Scholar
  • 6 Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR, Schmitz KH, Emplaincourt PO, Jacobs DR, Leon AS. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32 (09) S498-504.
    CrossrefPubMedGoogle Scholar
  • 7 Ainsworth BE, Haskell WL, Leon AS, Jacobs DR, Montoye HJ, Sallis JF, Paffenbarger Jr RS. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25 (01) 71-80.
    CrossrefPubMedGoogle Scholar
  • 8 Royston P, Ambler G, Sauerbrei W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 1999; 28 (05) 964-974.
    CrossrefPubMedGoogle Scholar
  • 9 Tehard B, Friedenreich CM, Oppert JM, Clavel-Chapelon F. Effect of physical activity on women at increased risk of breast cancer: results from the E3N cohort study. Cancer Epidemiol Biomarkers Prev 2006; 15 (01) 57-64.
    CrossrefPubMedGoogle Scholar
  • 10 Friedenreich CM, Bryant HE, Courneya KS. Casecontrol study of lifetime physical activity and breast cancer risk. Am J Epidemiol 2001; 154 (04) 336-347.
    CrossrefPubMedGoogle Scholar
  • 11 Patel AV, Press MF, Meeske K, Calle EE, Bernstein L. Lifetime recreational exercise activity and risk of breast carcinoma in situ. Cancer 2003; 98 (10) 2161-2169.
    CrossrefPubMedGoogle Scholar
  • 12 Moore DB, Folsom AR, Mink PJ, Hong CP, Anderson KE, Kushi LH. Physical activity and incidence of postmenopausal breast cancer. Epidemiology 2000; 11 (03) 292-296.
    CrossrefPubMedGoogle Scholar
  • 13 Peplonska B, Lissowska J, Hartman TJ, Szeszenia-Dabrowska N, Blair A, Zatonski W, Sherman ME, Garcia-Closas M, Brinton LA. Adulthood lifetime physical activity and breast cancer. Epidemiology 2008; 19 (02) 226-236.
    CrossrefPubMedGoogle Scholar
  • 14 Carpenter CL, Ross RK, Paganini-Hill A, Bernstein L. Effect of family history, obesity and exercise on breast cancer risk among postmenopausal women. Int J Cancer 2003; 106 (01) 96-102.
    CrossrefPubMedGoogle Scholar
  • 15 Bernstein L, Patel AV, Ursin G, Sullivan-Halley J, Press MF, Deapen D, Berlin JA, Daling JR, McDonald JA, Norman SA, Malone KE, Strom BL, Liff J, Folger SG, Simon MS, Burkman RT, Marchbanks PA, Weiss LK, Spirtas R. Lifetime recreational exercise activity and breast cancer risk among black women and white women. J Natl Cancer Inst 2005; 97 (22) 1671-1679.
    CrossrefPubMedGoogle Scholar
  • 16 Sprague BL, Trentham-Dietz A, Newcomb PA, Titus-Ernstoff L, Hampton JM, Egan KM. Lifetime recreational and occupational physical activity and risk of in situ and invasive breast cancer. Cancer Epidemiol Biomarkers Prev 2007; 16 (02) 236-243.
    CrossrefPubMedGoogle Scholar
  • 17 Dallal CM, Sullivan-Halley J, Ross RK, Wang Y, Deapen D, Horn-Ross PL, Reynolds P, Stram DO, Clarke CA, Anton-Culver H, Ziogas A, Peel D, West DW, Wright W, Bernstein L. Long-term recreational physical activity and risk of invasive and in situ breast cancer: the California teachers study. Arch Intern Med 2007; 167 (04) 408-415.
    CrossrefPubMedGoogle Scholar
  • 18 McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, Woods N, Ockene J. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA 2003; 290 (10) 1331-1336.
    CrossrefPubMedGoogle Scholar
  • 19 Shoff SM, Newcomb PA, Trentham Dietz A, Remington PL, Mittendorf R, Greenberg ER, Willett WC. Early-life physical activity and postmenopausal breast cancer: effect of body size and weight change. Cancer Epidemiol Biomarkers Prev 2000; 9 (06) 591-595.
    PubMedGoogle Scholar
  • 20 D’Avanzo B, Nanni O, La Vecchia C, Franceschi S, Negri E, Giacosa A, Conti E, Montella M, Talamini R, Decarli A. Physical activity and breast cancer risk. Cancer Epidemiol Biomarkers Prev 1996; 5 (03) 155-160.
    PubMedGoogle Scholar
  • 21 Patel AV, Callel EE, Bernstein L, Wu AH, Thun MJ. Recreational physical activity and risk of postmenopausal breast cancer in a large cohort of US women. Cancer Causes Control 2003; 14 (06) 519-529.
    CrossrefPubMedGoogle Scholar
  • 22 Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K, Vierkant RA, Maloney SD, Pankratz VS, Hillman DW, Suman VJ, Johnson J, Blake C, Tlsty T, Vachon CM, Melton III LJ, Visscher DW. Benign breast disease and the risk of breast cancer. N Engl J Med 2005; 353 (03) 229-237.
    CrossrefPubMedGoogle Scholar
  • 23 Santen RJ, Mansel R. Benign breast disorders. N Engl J Med 2005; 353 (03) 275-285.
    CrossrefPubMedGoogle Scholar
  • 24 Gertig DM, Stillman IE, Byrne C, Spiegelman D, Schnitt SJ, Connolly JL, Colditz GA, Hunter DJ. Association of age and reproductive factors with benign breast tissue composition. Cancer Epidemiol Biomarkers Prev 1999; 8 (10) 873-879.
    PubMedGoogle Scholar
  • 25 Courtillot C, Plu-Bureau G, Binart N, Balleyguier C, Sigal-Zafrani B, Goffin V, Kuttenn F, Kelly PA, Touraine P. Benign breast diseases. J Mammary Gland Biol Neoplasia 2005; 10 (04) 325-335.
    CrossrefPubMedGoogle Scholar
  • 26 Friedenreich CM, Cust AE. Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br J Sports Med 2008; 42 (08) 636-647.
    CrossrefPubMedGoogle Scholar
  • 27 Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 2002; 360 9328 187-195.
    CrossrefPubMedGoogle Scholar
  • 28 Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME. Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomarkers Prev 2004; 13 (10) 1558-1568.
    PubMedGoogle Scholar
  • 29 Ma H, Bernstein L, Pike MC, Ursin G. Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a metaanalysis of epidemiological studies. Breast Cancer Res 2006; 8 (04) R43.
    CrossrefPubMedGoogle Scholar
  • 30 Lipworth L, Bailey LR, Trichopoulos D. History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature. J Natl Cancer Inst 2000; 92 (04) 302-312.
    CrossrefPubMedGoogle Scholar
  • 31 Russo J, Russo IH. Toward a physiological approach to breast cancer prevention. Cancer Epidemiol Biomarkers Prev 1994; 3 (04) 353-364.
    PubMedGoogle Scholar
  • 32 World Cancer Research Fund/American Institute for Cancer Research.. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Prospective. Washington, DC, AICR;; 2007
    Google Scholar