Skip to main content

Advertisement

Log in

Post-diagnosis physical activity and survival after breast cancer diagnosis: the Long Island Breast Cancer Study

Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Physical activity (PA) is associated with physiological responses thought to beneficially affect survival after breast cancer diagnosis, yet few studies have considered the entire survivorship experience. Effects of post-diagnosis activity on survival were examined in a cohort of 1,423 women diagnosed with in situ or invasive breast cancer in 1996–1997. Subjects were interviewed soon after diagnosis and again after approximately 5 years to assess breast cancer-related factors, including recreational PA before and after diagnosis. Date and cause of death through 2009 were determined from the National Death Index. Adjusted estimates were obtained using proportional hazards regression and a selection model to account for missing data. Survival was improved among women who were highly active after diagnosis (>9.0 MET h/week) compared to inactive women (0 MET h/week) for all-cause [hazard ratio (HR) (95 % credible interval): 0.33 (0.22, 0.48)] and breast cancer-specific mortality [HR: 0.27 (0.15, 0.46)]. The association of PA with overall mortality appeared stronger in the first 2 years after diagnosis [HR: 0.14 (0.03, 0.44)] compared to 2+ years since diagnosis [HR: 0.37 (0.25, 0.55)]. These findings show that post-diagnosis PA is associated with improved survival among women with breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Monninkhof EM, Elias SG, Vlems FA, van der Tweel I, Schuit AJ, Voskuil DW, van Leeuwen FE (2007) Physical activity and breast cancer: a systematic review. Epidemiology 18(1):137–157

    Article  PubMed  Google Scholar 

  2. Patel AV, Bernstein L (2005) Physical activity and cancer incidence: breast cancer. In: McTiernan A (ed) Cancer prevention and management through exercise and weight control. CRC Press, Boca Raton, pp 49–74

    Chapter  Google Scholar 

  3. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM (2012) Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 104(11):815–840. doi:10.1093/jnci/djs207

    Article  PubMed Central  PubMed  Google Scholar 

  4. Patterson RE, Cadmus LA, Emond JA, Pierce JP (2010) Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas 66(1):5–15. doi:10.1016/j.maturitas.2010.01.004

    Article  PubMed  Google Scholar 

  5. Chen X, Lu W, Zheng W, Gu K, Matthews CE, Chen Z, Zheng Y, Shu XO (2011) Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res (Phila) 4(9):1409–1418. doi:10.1158/1940-6207.CAPR-10-0355

    Article  Google Scholar 

  6. Gammon MD, Neugut AI, Santella RM, Teitelbaum SL, Britton JA, Terry MB, Eng SM, Wolff MS, Stellman SD, Kabat GC, Levin B, Bradlow HL, Hatch M, Beyea J, Camann D, Trent M, Senie RT, Garbowski GC, Maffeo C, Montalvan P, Berkowitz GS, Kemeny M, Citron M, Schnabe F, Schuss A, Hajdu S, Vincguerra V, Collman GW, Obrams GI (2002) The Long Island Breast Cancer Study Project: description of a multi-institutional collaboration to identify environmental risk factors for breast cancer. Breast Cancer Res Treat 74(3):235–254

    Article  CAS  PubMed  Google Scholar 

  7. Fink BN, Gaudet MM, Britton JA, Abrahamson PE, Teitelbaum SL, Jacobson J, Bell P, Thomas JA, Kabat GC, Neugut AI, Gammon MD (2006) Fruits, vegetables, and micronutrient intake in relation to breast cancer survival. Breast Cancer Res Treat 98(2):199–208

    Article  CAS  PubMed  Google Scholar 

  8. Centers for Disease Control and Prevention (2006) What is the National Death Index? http://www.cdc.gov/nchs/r&d/ndi/what_is_ndi.htm. Accessed 7 Feb 2006

  9. Cowper DC, Kubal JD, Maynard C, Hynes DM (2002) A primer and comparative review of major US mortality databases. Ann Epidemiol 12(7):462–468

    Article  PubMed  Google Scholar 

  10. Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J, Ross RK (1994) Physical exercise and reduced risk of breast cancer in young women. J Natl Cancer Inst 86(18):1403–1408

    Article  CAS  PubMed  Google Scholar 

  11. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80

    Article  CAS  PubMed  Google Scholar 

  12. Cleveland RJ, Eng SM, Abrahamson PE, Britton JA, Teitelbaum SL, Neugut AI, Gammon MD (2007) Weight gain prior to diagnosis and survival from breast cancer. Cancer Epidemiol Biomark Prev 16(9):1803–1811

    Article  Google Scholar 

  13. Bradshaw PT, Ibrahim JG, Gammon MD (2010) A Bayesian proportional hazards regression model with non-ignorably missing time-varying covariates. Stat Med 29(29):3017–3029. doi:10.1002/sim.4076

    Article  PubMed Central  PubMed  Google Scholar 

  14. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093

    Article  PubMed  Google Scholar 

  15. Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, Baumgartner RN, Baumgartner KB, Bernstein L (2008) Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 26(24):3958–3964

    Article  PubMed Central  PubMed  Google Scholar 

  16. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard-Barbash R (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer 97(7):1746–1757

    Article  PubMed Central  PubMed  Google Scholar 

  17. Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, Ballard-Barbash R (2004) Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 36(9):1484–1491

    PubMed Central  PubMed  Google Scholar 

  18. Greenland S, Finkle WD (1995) A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol 142(12):1255–1264

    CAS  PubMed  Google Scholar 

  19. Lunn DJ, Thomas A, Best N, Spiegelhalter D (2000) WinBUGS–a Bayesian modelling framework: concepts, structure and extensibility. Stat Comput 10:325–337

    Article  Google Scholar 

  20. Fogelholm M (2005) Energy balance and cancer prognosis, breast cancer. In: McTiernan A (ed) Cancer prevention and management through exercise and weight control. CRC Press, Boca Raton, pp 447–469

    Chapter  Google Scholar 

  21. Goris AH, Westerterp KR (2007) Physical activity, fat intake and body fat. Physiol Behav 94(2):164–168

    Article  PubMed  Google Scholar 

  22. Wardlaw GM, Hampl JS (2007) Perspectives in nutrition, 7th edn. McGraw-Hill, New York

    Google Scholar 

  23. McTiernan A, Ulrich C, Slate S, Potter J (1998) Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control 9(5):487–509

    Article  CAS  PubMed  Google Scholar 

  24. Perez-Martin A, Raynaud E, Mercier J (2001) Insulin resistance and associated metabolic abnormalities in muscle: effects of exercise. Obes Rev 2(1):47–59

    Article  CAS  PubMed  Google Scholar 

  25. Nieman DC (1994) Exercise, upper respiratory tract infection, and the immune system. Med Sci Sports Exerc 26(2):128–139

    Article  CAS  PubMed  Google Scholar 

  26. Shephard RJ, Rhind S, Shek PN (1995) The impact of exercise on the immune system: NK cells, interleukins 1 and 2, and related responses. Exerc Sport Sci Rev 23:215–241

    Article  CAS  PubMed  Google Scholar 

  27. Wetmore CM, Ulrich CM (2005) Mechanisms associating physical activity with cancer incidence: exercise and immune function. In: McTiernan A (ed) Cancer prevention and management through exercise and weight control. CRC Press, Boca Raton, pp 157–175

    Google Scholar 

  28. Covas MI, Elosua R, Fito M, Alcantara M, Coca L, Marrugat J (2002) Relationship between physical activity and oxidative stress biomarkers in women. Med Sci Sports Exerc 34(5):814–819

    Article  CAS  PubMed  Google Scholar 

  29. Cleveland RJ, Eng SM, Stevens J, Bradshaw PT, Teitelbaum SL, Neugut AI, Gammon MD (2012) Influence of prediagnostic recreational physical activity on survival from breast cancer. Eur J Cancer Prev 21(1):46–54. doi:10.1097/CEJ.0b013e3283498dd4

    Article  PubMed Central  PubMed  Google Scholar 

  30. Beasley JM, Kwan ML, Chen WY, Weltzien EK, Kroenke CH, Lu W, Nechuta SJ, Cadmus-Bertram L, Patterson RE, Sternfeld B, Shu XO, Pierce JP, Caan BJ (2012) Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat 131(2):637–643. doi:10.1007/s10549-011-1770-1

    Article  PubMed Central  PubMed  Google Scholar 

  31. Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-Delaimy WK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25(17):2345–2351

    Article  PubMed Central  PubMed  Google Scholar 

  32. Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, Baron JA, Egan KM, Willett WC (2008) Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomark Prev 17(2):379–386

    Article  Google Scholar 

  33. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, Newcomb PA (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomark Prev 18(5):1403–1409

    Article  Google Scholar 

  34. Delgado-Rodriguez M, Llorca J (2004) Bias. J Epidemiol Community Health 58(8):635–641

    Article  PubMed Central  PubMed  Google Scholar 

  35. McTiernan A, Wu L, Chen C, Chlebowski R, Mossavar-Rahmani Y, Modugno F, Perri MG, Stanczyk FZ, Van Horn L, Wang CY (2006) Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring) 14(9):1662–1677

    Article  CAS  Google Scholar 

  36. Herring AH, Ibrahim JG, Lipsitz SR (2004) Non-ignorable missing covariate data in survival analysis: a case-study of an International Breast Cancer Study Group trial. Appl Stat 53(2):293–310

    Google Scholar 

  37. Shephard RJ (2003) Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med 37(3):197–206 discussion 206

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Gammon MD, Schoenberg JB, Britton JA, Kelsey JL, Coates RJ, Brogan D, Potischman N, Swanson CA, Daling JR, Stanford JL, Brinton LA (1998) Recreational physical activity and breast cancer risk among women under age 45 years. Am J Epidemiol 147(3):273–280

    Article  CAS  PubMed  Google Scholar 

  39. Sprague BL, Trentham-Dietz A, Newcomb PA, Titus-Ernstoff L, Hampton JM, Egan KM (2007) Lifetime recreational and occupational physical activity and risk of in situ and invasive breast cancer. Cancer Epidemiol Biomark Prev 16(2):236–243

    Article  Google Scholar 

  40. Graham P, Jackson R (2000) A comparison of primary and proxy respondent reports of habitual physical activity, using kappa statistics and log-linear models. J Epidemiol Biostat 5(4):255–265

    CAS  PubMed  Google Scholar 

  41. Campbell PT, Sloan M, Kreiger N (2007) Utility of proxy versus index respondent information in a population-based case–control study of rapidly fatal cancers. Ann Epidemiol 17(4):253–257

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work supported in part by National Cancer Institute and the National Institutes of Environmental Health and Sciences Grant Nos. UO1CA/ES66572, P30ES10126, T32CA72319, and T32CA009330 and the Marilyn Gentry Fellowship from the American Institute for Cancer Research.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patrick T. Bradshaw.

Additional information

Jessie A. Satia—Deceased.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bradshaw, P.T., Ibrahim, J.G., Khankari, N. et al. Post-diagnosis physical activity and survival after breast cancer diagnosis: the Long Island Breast Cancer Study. Breast Cancer Res Treat 145, 735–742 (2014). https://doi.org/10.1007/s10549-014-2966-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-014-2966-y

Keywords

Navigation