Breast Cancer Research and Treatment

, Volume 145, Issue 3, pp 715–724 | Cite as

Adolescent physical activity in relation to breast cancer risk

  • Caroline E. BoekeEmail author
  • A. Heather  Eliassen
  • Hannah Oh
  • Donna Spiegelman
  • Walter C. Willett
  • Rulla M. Tamimi


Adolescent physical activity may protect against premenopausal breast cancer. Whether it also prevents postmenopausal breast cancer, and whether associations are independent of adult activity, is unclear. We evaluated this association among 75,669 women in the Nurses’ Health Study II. In 1997, participants reported strenuous, moderate, and walking activity (hours/week) at ages 12–13, 14–17, 18–22, and 23–29 years. We estimated metabolic equivalent task hours (MET-h)/week. Participants also reported current physical activity over follow-up. Breast cancer diagnoses (n = 2,697; premenopausal = 1,351; postmenopausal = 965) through 2011 were reported by participants and confirmed with medical records. We additionally stratified analyses by median age at diagnosis. In Cox proportional hazards models adjusted for adolescent characteristics, physical activity from ages 14–22 was modestly inversely associated with premenopausal breast cancer [e.g., hazard ratio (HR) comparing 72+ to <21 MET-h/week 0.81 (95 % confidence interval (CI) 0.69–0.95; p-trend = 0.10) for ages 14–17 and 0.85 (95 % CI 0.71–1.02; p-trend = 0.06 for ages 18–22]. However, adjustment for adult activity and additional breast cancer risk factors attenuated the associations [ages 14–17: 0.85 (95 % CI 0.73–1.00; p-trend = 0.33)]. Associations were stronger among women diagnosed at younger ages [e.g., ages 18–22, HR 0.77 (95 % CI 0.60–0.99; p-trend = 0.05) for women diagnosed before 46.9 years; HR 1.02 (95 % CI 0.79–1.32; p-trend = 0.94) for those diagnosed at/after 46.9 years]. Early life physical activity was not associated with postmenopausal breast cancer. Overall, adolescent physical activity was not associated with breast cancer risk. However, we observed a suggestive inverse association of physical activity at ages 14–22 years with premenopausal breast cancer.


Adolescence Physical activity Exercise Breast cancer Early life 



Nurses’ Health Study II


Metabolic equivalent task hours


Hazard ratio


Confidence interval


Estrogen receptor


Oral contraceptive


Body mass index



We would like to thank the participants and staff of the Nurses’ Health Study II for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. In addition, this study was approved by the Connecticut Department of Public Health (DPH) Human Investigations Committee. Certain data used in this publication were obtained from the DPH. The authors assume full responsibility for analyses and interpretation of these data. This work was supported by the Breast Cancer Research Foundation and the National Institutes of Health (grant numbers UM1 CA 176726, CA 050385). Caroline Boeke and Hannah Oh were funded by T32 CA 09001.




  1. 1.
    Wu Y, Zhang D, Kang S (2013) Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat 137(3):869–882. doi: 10.1007/s10549-012-2396-7 PubMedCrossRefGoogle Scholar
  2. 2.
    Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380(9838):219–229. doi: 10.1016/S0140-6736(12)61031-9 PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Friedenreich CM (2011) Physical activity and breast cancer: review of the epidemiologic evidence and biologic mechanisms. Recent Results Cancer Res 188:125–139. doi: 10.1007/978-3-642-10858-7_11 PubMedCrossRefGoogle Scholar
  4. 4.
    Peters TM, Schatzkin A, Gierach GL, Moore SC, Lacey JV Jr, Wareham NJ, Ekelund U, Hollenbeck AR, Leitzmann MF (2009) Physical activity and postmenopausal breast cancer risk in the NIH-AARP diet and health study. Cancer Epidemiol Biomarkers Prev 18(1):289–296. doi: 10.1158/1055-9965.EPI-08-0768 PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Friedenreich CM, Cust AE (2008) Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br J Sports Med 42(8):636–647. doi: 10.1136/bjsm.2006.029132 PubMedCrossRefGoogle Scholar
  6. 6.
    Pike MC, Krailo MD, Henderson BE, Casagrande JT, Hoel DG (1983) ‘Hormonal’ risk factors, ‘breast tissue age’ and the age-incidence of breast cancer. Nature 303(5920):767–770PubMedCrossRefGoogle Scholar
  7. 7.
    Colditz GA, Frazier AL (1995) Models of breast cancer show that risk is set by events of early life: prevention efforts must shift focus. Cancer Epidemiol Biomarkers Prev 4(5):567–571PubMedGoogle Scholar
  8. 8.
    Maruti SS, Willett WC, Feskanich D, Rosner B, Colditz GA (2008) A prospective study of age-specific physical activity and premenopausal breast cancer. J Natl Cancer Inst 100(10):728–737. doi: 10.1093/jnci/djn135 PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    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):71–80PubMedCrossRefGoogle Scholar
  10. 10.
    Eliassen AH, Hankinson SE, Rosner B, Holmes MD, Willett WC (2010) Physical activity and risk of breast cancer among postmenopausal women. Arch Intern Med 170(19):1758–1764. doi: 10.1001/archinternmed.2010.363 PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA, Rosner B, Kriska A, Willett WC (1994) Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 23(5):991–999PubMedCrossRefGoogle Scholar
  12. 12.
    Stunkard AJ, Sørensen T, Schulsinger F (eds) (1983) Use of the Danish Adoption Register for the study of obesity and thinness. The genetics of neurological and psychiatric disorders. Raven Press, New YorkGoogle Scholar
  13. 13.
    Baer HJ, Schnitt SJ, Connolly JL, Byrne C, Willett WC, Rosner B, Colditz GA (2005) Early life factors and incidence of proliferative benign breast disease. Cancer Epidemiol Biomarkers Prev 14(12):2889–2897. doi: 10.1158/1055-9965.EPI-05-0525 PubMedCrossRefGoogle Scholar
  14. 14.
    Rosner B, Glynn RJ, Tamimi RM, Chen WY, Colditz GA, Willett WC, Hankinson SE (2013) Breast cancer risk prediction with heterogeneous risk profiles according to breast cancer tumor markers. Am J Epidemiol. doi: 10.1093/aje/kws457 Google Scholar
  15. 15.
    Glynn RJ, Rosner B (2005) Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol 162(10):975–982. doi: 10.1093/aje/kwi309 PubMedCrossRefGoogle Scholar
  16. 16.
    Lunn M, McNeil D (1995) Applying Cox regression to competing risks. Biometrics 51(2):524–532PubMedCrossRefGoogle Scholar
  17. 17.
    Mekary RA, Willett WC, Hu FB, Ding EL (2009) Isotemporal substitution paradigm for physical activity epidemiology and weight change. Am J Epidemiol 170(4):519–527. doi: 10.1093/aje/kwp163 PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Shoff SM, Newcomb PA, Trentham-Dietz A, Remington PL, Mittendorf R, Greenberg ER, Willett WC (2000) Early-life physical activity and postmenopausal breast cancer: effect of body size and weight change. Cancer Epidemiol Biomarkers Prev 9(6):591–595PubMedGoogle Scholar
  19. 19.
    McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, Woods N, Ockene J (2003) Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA 290(10):1331–1336. doi: 10.1001/jama.290.10.1331 PubMedCrossRefGoogle Scholar
  20. 20.
    Pronk A, Ji BT, Shu XO, Chow WH, Xue S, Yang G, Li HL, Rothman N, Gao YT, Zheng W, Matthews CE (2011) Physical activity and breast cancer risk in Chinese women. Br J Cancer 105(9):1443–1450. doi: 10.1038/bjc.2011.370 PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Peters TM, Moore SC, Gierach GL, Wareham NJ, Ekelund U, Hollenbeck AR, Schatzkin A, Leitzmann MF (2009) Intensity and timing of physical activity in relation to postmenopausal breast cancer risk: the prospective NIH-AARP diet and health study. BMC Cancer 9:349. doi: 10.1186/1471-2407-9-349 PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Goncalves AK, Florencio G, Maisonnette MJ, Cobucci R, Giraldo P, Cote N (2013) Effects of physical activity on breast cancer prevention: a systematic review. J Phys Act Health 11(2):445–454PubMedCrossRefGoogle Scholar
  23. 23.
    Tworoger SS, Rosner BA, Willett WC, Hankinson SE (2011) The combined influence of multiple sex and growth hormones on risk of postmenopausal breast cancer: a nested case-control study. Breast Cancer Res 13(5):R99. doi: 10.1186/bcr3040 PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Harris HR, Tamimi RM, Willett WC, Hankinson SE, Michels KB (2011) Body size across the life course, mammographic density, and risk of breast cancer. Am J Epidemiol 174(8):909–918. doi: 10.1093/aje/kwr225 PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Samimi G, Colditz GA, Baer HJ, Tamimi RM (2008) Measures of energy balance and mammographic density in the Nurses’ Health Study. Breast Cancer Res Treat 109(1):113–122. doi: 10.1007/s10549-007-9631-7 PubMedCrossRefGoogle Scholar
  26. 26.
    Neilson HK, Friedenreich CM, Brockton NT, Millikan RC (2009) Physical activity and postmenopausal breast cancer: proposed biologic mechanisms and areas for future research. Cancer Epidemiol Biomarkers Prev 18(1):11–27. doi: 10.1158/1055-9965.EPI-08-0756 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Caroline E. Boeke
    • 1
    • 2
    Email author
  • A. Heather  Eliassen
    • 1
    • 2
    • 3
  • Hannah Oh
    • 1
    • 2
    • 4
  • Donna Spiegelman
    • 1
    • 4
    • 5
  • Walter C. Willett
    • 1
    • 2
    • 3
    • 4
  • Rulla M. Tamimi
    • 1
    • 2
    • 3
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Channing Division of Network MedicineBrigham and Women’s HospitalBostonUSA
  3. 3.Department of MedicineHarvard Medical SchoolBostonUSA
  4. 4.Department of NutritionHarvard School of Public HealthBostonUSA
  5. 5.Department of BiostatisticsHarvard School of Public HealthBostonUSA

Personalised recommendations