Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the breast cancer family registry
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Few studies have considered the joint association of body mass index (BMI) and physical activity, two modifiable factors, with all-cause mortality after breast cancer diagnosis. Women diagnosed with invasive breast cancer (n = 4,153) between 1991 and 2000 were enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. During a median follow-up of 7.8 years, 725 deaths occurred. Baseline questionnaires assessed moderate and vigorous recreational physical activity and BMI prior to diagnosis. Associations with all-cause mortality were assessed using Cox proportional hazards regression, adjusting for established prognostic factors. Compared with no physical activity, any recreational activity during the 3 years prior to diagnosis was associated with a 34% lower risk of death [hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.51–0.85] for women with estrogen receptor (ER)-positive tumors, but not those with ER-negative tumors; this association did not appear to differ by race/ethnicity or BMI. Lifetime physical activity was not associated with all-cause mortality. BMI was positively associated with all-cause mortality for women diagnosed at age ≥50 years with ER-positive tumors (compared with normal-weight women, HR for overweight = 1.39, 95% CI: 0.90–2.15; HR for obese = 1.77, 95% CI: 1.11–2.82). BMI associations did not appear to differ by race/ethnicity. Our findings suggest that physical activity and BMI exert independent effects on overall mortality after breast cancer.
KeywordsBreast cancer Physical activity Body mass index Obesity Mortality
The authors thank Enid Satariano and Jocelyn Koo (Northern California Cancer Center), Elaine Maloney and Nayana Weerasooriya (Cancer Care Ontario), and Maggie Angelakos, Judi Maskiell and Gillian Dite (University of Melbourne) for their assistance. The Breast Cancer Family Registry (Breast CFR) was supported by the National Cancer Institute, National Institutes of Health under RFA CA-95-011 and CA-06-503, and through cooperative agreements with members of the Breast CFR and Principal Investigators. The three registries contributing data to this analysis were supported by U01 CA69417 (Northern California Cancer Center), U01 CA69467 (Cancer Care Ontario), and U01 CA69638 (University of Melbourne). Kelly-Anne Phillips was supported by the Cancer Council Victoria Colebatch Clinical Research Fellowship. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the Breast CFR, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the Breast CFR.
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