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Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies

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Abstract

Previous studies concerning the association between physical activity (PA) and mortality in breast cancer yielded mixed results. We investigated the association by performing a meta-analysis of all available studies. Relevant studies were identified by searching PubMed and EMBASE to January 2014. We calculated the summary relative risk (RR) and 95 % confidence intervals (CIs) using random-effects models. The dose–response relationship was assessed by restricted cubic spline model and multivariate random-effect meta-regression. Sixteen cohort studies involving 42,602 patients of breast cancer were selected for meta-analysis. The analyses showed that patients who participated in any amount of PA before diagnosis had a RR of 0.82 (95 % CI 0.74–0.91) for breast cancer-specific mortality (vs. low PA). Those who participated in high PA and moderate PA before diagnosis had a RR of breast cancer-specific mortality of 0.81 (95 % CI 0.72–0.90) and 0.83 (95 % CI 0.73–0.94), respectively. Similar inverse associations of prediagnosis PA were found for all-cause mortality. Postdiagnosis PA on breast cancer-specific and all-cause mortality also showed the same results. Stratifying by body mass index (<25 vs. ≥25) or menopausal status, all the subgroups experienced benefits with PA, with a stronger mortality reduction among overweight women than normal weight women and among postmenopausal women than premenopausal women. A linear and significant dose–response association was only found for breast cancer-specific or all-cause mortality and prediagnosis PA (P for nonlinearity = 0.07 and 0.10, respectively). In conclusion, both prediagnosis and postdiagnosis PA were associated with reduced breast cancer-specific mortality and all-cause mortality.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30. doi:10.3322/caac.21166.

    Article  PubMed  Google Scholar 

  2. Keegan TH, Milne RL, Andrulis IL, et al. Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the Breast Cancer Family Registry. Breast Cancer Res Treat. 2010;123(2):531–42. doi:10.1007/s10549-010-0774-6.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Monninkhof EM, Elias SG, Vlems FA, et al. Physical activity and breast cancer: a systematic review. Epidemiology (Cambridge, Mass.). 2007;18(1):137–57. doi:10.1097/01.ede.0000251167.75581.98.

    Article  Google Scholar 

  4. Friedenreich CM. The role of physical activity in breast cancer etiology. Semin Oncol. 2010;37(3):297–302. doi:10.1053/j.seminoncol.2010.05.008.

    Article  PubMed  Google Scholar 

  5. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753–65. doi:10.1007/s12032-010-9536-x.

    Article  PubMed  Google Scholar 

  6. Dal Maso L, Zucchetto A, Talamini R, et al. Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer. 2008;123(9):2188–94. doi:10.1002/ijc.23747.

    Article  CAS  PubMed  Google Scholar 

  7. Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer. 2009;124(8):1954–62. doi:10.1002/ijc.24155.

    Article  CAS  PubMed  Google Scholar 

  8. West-Wright CN, Henderson KD, Sullivan-Halley J, et al. Long-term and recent recreational physical activity and survival after breast cancer: the California Teachers Study. Cancer Epidemiol Biomarkers Prev. 2009;18(11):2851–9. doi:10.1158/1055-9965.epi-09-0538.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Emaus A, Veierod MB, Tretli S, et al. Metabolic profile, physical activity, and mortality in breast cancer patients. Breast Cancer Res Treat. 2010;121(3):651–60. doi:10.1007/s10549-009-0603-y.

    Article  PubMed  Google Scholar 

  10. Hellmann SS, Thygesen LC, Tolstrup JS, Gronbaek M. Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study. Eur J Cancer Prev. 2010;19(5):366–73. doi:10.1097/CEJ.0b013e32833b4828.

    Article  PubMed  Google Scholar 

  11. Irwin ML, McTiernan A, Manson JE, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the women’s health initiative. Cancer Prev Res (Phila). 2011;4(4):522–9. doi:10.1158/1940-6207.capr-10-0295.

    Article  Google Scholar 

  12. Beasley JM, Kwan ML, Chen WY, et al. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 2012;131(2):637–43. doi:10.1007/s10549-011-1770-1.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Cleveland RJ, Eng SM, Stevens J, et al. Influence of prediagnostic recreational physical activity on survival from breast cancer. Eur J Cancer Prev. 2012;21(1):46–54. doi:10.1097/CEJ.0b013e3283498dd4.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Schmidt ME, Chang-Claude J, Vrieling A, et al. Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer. Int J Cancer. 2013;133(6):1431–40. doi:10.1002/ijc.28130.

    Article  CAS  PubMed  Google Scholar 

  15. Rohan TE, Fu W, Hiller JE. Physical activity and survival from breast cancer. Eur J Cancer Prev. 1995;4(5):419–24.

    Article  CAS  PubMed  Google Scholar 

  16. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010 www.ohri.ca/programs/clinical_epidemiology/oxford_web.ppt.

  17. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293(20):2479–86. doi:10.1001/jama.293.20.2479.

    Article  CAS  PubMed  Google Scholar 

  18. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  19. Abrahamson PE, Gammon MD, Lund MJ, et al. Recreational physical activity and survival among young women with breast cancer. Cancer. 2006;107(8):1777–85. doi:10.1002/cncr.22201.

    Article  PubMed  Google Scholar 

  20. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2008;17(2):379–86. doi:10.1158/1055-9965.epi-07-0771.

    Article  PubMed  Google Scholar 

  21. Enger SM, Bernstein L. Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer. 2004;90(11):2138–41. doi:10.1038/sj.bjc.6601820.

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26(24):3958–64. doi:10.1200/jco.2007.15.9822.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. doi:10.1002/sim.1186.

    Article  PubMed  Google Scholar 

  24. Hedges LV, Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods. 2001;6(3):203–17.

    Article  CAS  PubMed  Google Scholar 

  25. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73. doi:10.1093/aje/kwr265.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6:40–57.

    Google Scholar 

  28. Jackson D, White IR, Thompson SG. Extending DerSimonian and Laird’s methodology to perform multivariate random effects meta-analyses. Stat Med. 2010;29(12):1282–97. doi:10.1002/sim.3602.

    Article  PubMed  Google Scholar 

  29. Pierce JP, Stefanick ML, Flatt SW, et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 2007;25(17):2345–51. doi:10.1200/jco.2006.08.6819.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Borugian MJ, Sheps SB, Kim-Sing C, et al. Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev. 2004;13(7):1163–72.

    CAS  PubMed  Google Scholar 

  31. Sternfeld B, Weltzien E, Quesenberry CP Jr, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev. 2009;18(1):87–95. doi:10.1158/1055-9965.epi-08-0595.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Bertram LA, Stefanick ML, Saquib N, et al. Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study. Cancer Causes Control. 2011;22(3):427–35. doi:10.1007/s10552-010-9714-3.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Chen X, Lu W, Zheng W, et al. Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res (Phila). 2011;4(9):1409–18. doi:10.1158/1940-6207.capr-10-0355.

    Article  Google Scholar 

  34. Rodriguez San Felipe MJ, Aguilar Martinez A, Manuel YKB. Influence of body weight on the prognosis of breast cancer survivors. Nutritional approach after diagnosis. Nutr Hosp. 2013;28(6):1829–41. doi:10.3305/nutrhosp.v28in06.6981.

    PubMed  Google Scholar 

  35. Etemadi A, Abnet CC, Kamangar F, et al. Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran. Eur J Epidemiol. 2014;. doi:10.1007/s10654-014-9883-6.

    PubMed  Google Scholar 

  36. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4(8):579–91. doi:10.1038/nrc1408.

    Article  CAS  PubMed  Google Scholar 

  37. Fontein DB, de Glas NA, Duijm M, et al. Age and the effect of physical activity on breast cancer survival: a systematic review. Cancer Treat Rev. 2013;39(8):958–65. doi:10.1016/j.ctrv.2013.03.008.

    Article  CAS  PubMed  Google Scholar 

  38. Ligibel JA, Campbell N, Partridge A, et al. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. J Clin Oncol. 2008;26(6):907–12. doi:10.1200/JCO.2007.12.7357.

    Article  CAS  PubMed  Google Scholar 

  39. Autenrieth C, Schneider A, Doring A, et al. Association between different domains of physical activity and markers of inflammation. Med Sci Sports Exerc. 2009;41(9):1706–13. doi:10.1249/MSS.0b013e3181a15512.

    Article  CAS  PubMed  Google Scholar 

  40. Friedenreich CM, Neilson HK, Woolcott CG, et al. Inflammatory marker changes in a yearlong randomized exercise intervention trial among postmenopausal women. Cancer Prev Res (Phila). 2012;5(1):98–108. doi:10.1158/1940-6207.CAPR-11-0369.

    Article  CAS  Google Scholar 

  41. Morris PG, Hudis CA, Giri D, et al. Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila). 2011;4(7):1021–9. doi:10.1158/1940-6207.CAPR-11-0110.

    Article  CAS  Google Scholar 

  42. Cher MD, Louise AB, Charles EM, et al. Is accelerometer-measured physical activity associated with urinary estrogens and estrogen metabolites among postmenopausal women? Cancer Res. 2013;73(8 Suppl). doi:10.1158/1538-7445.AM2013-2519.

  43. Friedenreich CM, Woolcott CG, McTiernan A, et al. Alberta physical activity and breast cancer prevention trial: sex hormone changes in a year-long exercise intervention among postmenopausal women. J Clin Oncol. 2010;28(9):1458–66. doi:10.1200/JCO.2009.24.9557.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Folkerd E, Dowsett M. Sex hormones and breast cancer risk and prognosis. Breast. 2013;22(Suppl 2):S38–43. doi:10.1016/j.breast.2013.07.007.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the National Natural Science Foundation of China (81272470).

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Baiziting 42, Nanjing, 210009, China

    Shanliang Zhong, Tengfei Ma, Xiaohui Zhang & Jianhua Zhao

  2. Clinical College of Nanjing Medical University, Nanjing, 210029, China

    Tianchi Jiang

  3. Department of General Surgery, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing, 210009, China

    Jinhai Tang

  4. The Fourth Clinical College of Nanjing Medical University, Nanjing, 210009, China

    Weixian Chen & Mengmeng Lv

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  1. Shanliang Zhong
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Correspondence to Jianhua Zhao.

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Zhong, S., Jiang, T., Ma, T. et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol 29, 391–404 (2014). https://doi.org/10.1007/s10654-014-9916-1

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