Cancer Causes & Control

, Volume 20, Issue 3, pp 323–333 | Cite as

Physical activity and breast cancer risk among pre- and postmenopausal women in the U.S. Radiologic Technologists cohort

  • Regan A. Howard
  • Michael F. Leitzmann
  • Martha S. Linet
  • D. Michal Freedman
Original Paper


To clarify aspects of the association between physical activity and breast cancer, such as activity intensity required, and possible effect modification by factors such as menopausal hormone therapy (MHT) use. We prospectively examined physical activity in relation to breast cancer risk among 45,631 women participating in the U.S. Radiologic Technologists cohort. Participants provided information at baseline regarding hours spent per week engaging in strenuous activity, walking/hiking for exercise, and walking at home or work. We estimated multivariable relative risks (RR) and 95% confidence intervals (CI) of breast cancer using Cox regression. We identified 864 incident-invasive breast cancers. Greatest risk reduction was observed among women who reported walking/hiking for exercise 10 or more hours per week (RR, 0.57; 95% CI, 0.34–0.95) compared with those reporting no walking/hiking. The association between walking/hiking for exercise and breast cancer was modified by MHT use (p for interaction = 0.039). Postmenopausal women who never used MHT had reduced risks of breast cancer associated with physical activity whereas no relation was observed among ever users of MHT. Our study suggests moderate intensity physical activity, such as walking, may protect against breast cancer. Further, the relation between physical activity and breast cancer may be modified by MHT use.


Breast cancer Physical activity Cohort studies Hormones 



We are indebted to Jeremy Miller, Information Management Services, Rockville, MD, for expert computer support and data management. This research was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics.


  1. 1.
    American Cancer Society (2008) Cancer facts and figures 2008. American Cancer Society, Atlanta, GAGoogle Scholar
  2. 2.
    Mittendorf R, Longnecker MP, Newcomb PA et al (1995) Strenuous physical activity in young adulthood and risk of breast cancer. Cancer Causes Control 6:347–353. doi: 10.1007/BF00051410 PubMedCrossRefGoogle Scholar
  3. 3.
    Thune I, Brenn T, Lund E et al (1997) Physical activity and the risk of breast cancer. N Engl J Med 336:1269–1275. doi: 10.1056/NEJM199705013361801 PubMedCrossRefGoogle Scholar
  4. 4.
    Gammon MD, Schoenberg JB, Britton JA et al (1998) Recreational physical activity and breast cancer risk among women under age 45 years. Am J Epidemiol 147:273–280PubMedGoogle Scholar
  5. 5.
    McTiernan A, Kooperberg C, White E et al (2003) Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA 290:1331–1336. doi: 10.1001/jama.290.10.1331 PubMedCrossRefGoogle Scholar
  6. 6.
    Monninkhof EM, Elias SG, Vlems FA et al (2007) Physical activity and breast cancer: a systematic review. Epidemiology 18:137–157. doi: 10.1097/01.ede.0000251167.75581.98 PubMedCrossRefGoogle Scholar
  7. 7.
    IARC (2002) IARC handbooks on cancer prevention, vol 6, Weight control and physical activity. IARC Press, Lyon (France) Google Scholar
  8. 8.
    Hoffman-Goetz L, Apter D, Demark-Wahnefried W, Goran MI, McTiernan A, Reichman ME (1998) Possible mechanisms mediating an association between physical activity and breast cancer. Cancer 83:621–628. doi:10.1002/(SICI)1097-0142(19980801)83:3+<621::AID-CNCR4>3.0.CO;2-APubMedCrossRefGoogle Scholar
  9. 9.
    McTiernan A, Ulrich C, Slate S, Potter J (1998) Physical activity and cancer etiology: associations and mechanisms. Cancer Causes Control 9:487–509. doi: 10.1023/A:1008853601471 PubMedCrossRefGoogle Scholar
  10. 10.
    Friedenreich CM, Orenstein MR (2002) Physical activity and cancer prevention: etiologic evidence and biological mechanisms. J Nutr 32:180–184Google Scholar
  11. 11.
    McTiernan A (2008) Mechanisms linking physical activity with cancer. Nat Rev Cancer 8:205–211. doi: 10.1038/nrc2325 PubMedCrossRefGoogle Scholar
  12. 12.
    Rockhill B, Willett WC, Hunter DJ, Manson JE, Hankinson SE, Colditz GA (1999) A prospective study of recreational physical activity and breast cancer risk. Arch Intern Med 159:2290–2296. doi: 10.1001/archinte.159.19.2290 PubMedCrossRefGoogle Scholar
  13. 13.
    Tehard B, Friedenreich CM, Oppert JM et al (2006) Effect of physical activity on women at increased risk of breast cancer: results from the E3 N cohort study. Cancer Epidemiol Biomarkers Prev 15:57–64. doi: 10.1158/1055-9965.EPI-05-0603 PubMedCrossRefGoogle Scholar
  14. 14.
    Dorn J, Vena J, Brasure J, Freudenheim J, Graham S (2003) Lifetime physical activity and breast cancer risk in pre- and postmenopausal women. Med Sci Sports Exerc 35:278–285. doi: 10.1249/01.MSS.0000048835.59454.8D PubMedCrossRefGoogle Scholar
  15. 15.
    Dallal CM, Sullivan-Halley J, Ross RK et al (2007) Long-term recreational physical activity and risk of invasive and in situ breast cancer. Arch Intern Med 167:408–415. doi: 10.1001/archinte.167.4.408 PubMedCrossRefGoogle Scholar
  16. 16.
    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 42:636–647. doi: 10.1136/bjsm.2006.029132 PubMedCrossRefGoogle Scholar
  17. 17.
    Friedenreich CM (2004) Physical activity and breast cancer risk: the effect of menopausal status. Exerc Sport Sci Rev 32:180–184. doi: 10.1097/00003677-200410000-00010 PubMedCrossRefGoogle Scholar
  18. 18.
    Margolis KL, Mucci L, Braaten T et al (2005) Physical activity in different periods of life and the risk of breast cancer: the Norwegian-Swedish women’s lifestyle and health cohort study. Cancer Epidemiol Biomarkers Prev 14:27–32PubMedGoogle Scholar
  19. 19.
    Lahmann PH, Friedenreich C, Schuit AJ (2007) Physical activity and breast cancer risk: The European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 16(1):OF1–OF7. doi: 10.1158/1055-9965.EPI-06-0582 CrossRefGoogle Scholar
  20. 20.
    Moore DB, Folsom AR, Mink PJ et al (2000) Physical activity and incidence of postmenopausal breast cancer. Epidemiology 11:292–296. doi: 10.1097/00001648-200005000-00011 PubMedCrossRefGoogle Scholar
  21. 21.
    Friedenreich CM, Bryant HE, Courneya KS (2001) Case–control study of lifetime physical activity and breast cancer risk. Am J Epidemiol 154:336–347. doi: 10.1093/aje/154.4.336 PubMedCrossRefGoogle Scholar
  22. 22.
    Patel AV, Callel EE, Bernstein L et al (2003) Recreational physical activity and risk of postmenopausal breast cancer in a large cohort of US women. Cancer Causes Control 14:519–529. doi: 10.1023/A:1024895613663 PubMedCrossRefGoogle Scholar
  23. 23.
    Bernstein L, Patel AV, Ursin G et al (2005) Lifetime physical recreational exercise activity and breast cancer risk among black women and white women. J Natl Cancer Inst 97:1671–1679PubMedCrossRefGoogle Scholar
  24. 24.
    Boice JD Jr, Mandel JS, Doody MM, Yoder RC, McGowan R (1992) A health survey of radiologic technologists. Cancer 69:586–598. doi:10.1002/1097-0142(19920115)69:2<586::AID-CNCR2820690251>3.0.CO;2-3PubMedCrossRefGoogle Scholar
  25. 25.
    Sigurdson AJ, Doody MM, Rao RS et al (2003) Cancer incidence in the US radiologic technologists health study, 1983–1998. Cancer 97:3080–3089. doi: 10.1002/cncr.11444 PubMedCrossRefGoogle Scholar
  26. 26.
    Ainsworth BE, Haskell WL, Leon AS et al (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25:71–80. doi: 10.1249/00005768-199301000-00011 PubMedCrossRefGoogle Scholar
  27. 27.
    Bowles HR, FitzGerald SJ, Morrow JR Jr, Jackson AW, Blair SN (2004) Construct validity of self-reported historical physical activity. Am J Epidemiol 160:279–286. doi: 10.1093/aje/kwh209 PubMedCrossRefGoogle Scholar
  28. 28.
    Jackson AW, Morrow JR Jr, Bowles HR, FitzGerald SJ, Blair SN (2007) Construct validity evidence for single-response items to estimate physical activity levels in large sample studies. Res Q Exerc Sport 78:24–31PubMedGoogle Scholar
  29. 29.
    Cerhan J, Chiu B, Wallace R et al (1998) Physical activity, physical function, and the risk of breast cancer in a prospective study among elderly women. J Gerontol 53A:M251–M256Google Scholar
  30. 30.
    Steindorf K, Schmidt M, Kropp S et al (2003) Case–control study of physical activity and breast cancer risk among premenopausal women in Germany. Am J Epidemiol 157:121–130. doi: 10.1093/aje/kwf181 PubMedCrossRefGoogle Scholar
  31. 31.
    Shoff SM, Newcomb PA, Trentham-Dietz A et al (2000) Early-life physical activity and postmenopausal breast cancer: effect of body size and weight change. Cancer Epidemiol Biomarkers Prev 9:591–595PubMedGoogle Scholar
  32. 32.
    Yang D, Bernstein L, Wu AH (2003) Physical activity and breast cancer risk among Asian-American women in Los Angeles: a case–control study. Cancer 97:2565–2575. doi: 10.1002/cncr.11364 PubMedCrossRefGoogle Scholar
  33. 33.
    Verloop J, Rookus MA, van der Kooy K, van Leeuwen FE (2000) Physical activity and breast cancer risk in women aged 20–54 years. J Natl Cancer Inst 92:128–135. doi: 10.1093/jnci/92.2.128 PubMedCrossRefGoogle Scholar
  34. 34.
    John EM, Horn-Ross PL, Koo J (2003) Lifetime physical activity and breast cancer risk in a multiethnic population: the San Francisco Bay area breast cancer study. Cancer Epidemiol Biomarkers Prev 12:1143–1152PubMedGoogle Scholar
  35. 35.
    Colditz GA, Feskanich D, Chen WY et al (2003) Physical activity and risk of breast cancer in premenopausal women. Br J Cancer 89:847–851. doi: 10.1038/sj.bjc.6601175 PubMedCrossRefGoogle Scholar
  36. 36.
    Slattery ML, Jacobs DR Jr (1995) Assessment of ability to recall physical activity of several years ago. Ann Epidemiol 5:292–296. doi: 10.1016/1047-2797(94)00095-B PubMedCrossRefGoogle Scholar
  37. 37.
    Hagstromer M, Oja P, Sjostrom M (2006) The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr 9:755–762. doi: 10.1079/PHN2005898 PubMedCrossRefGoogle Scholar
  38. 38.
    Wyshak G, Frisch RE (2000) Breast cancer among former college athletes compared to non-athletes: a 15-year follow-up. Br J Cancer 82:726–730. doi: 10.1054/bjoc.1999.0987 PubMedCrossRefGoogle Scholar
  39. 39.
    Matthews CE, Shu XO, Jin F et al (2001) Lifetime physical activity and breast cancer risk in the Shanghai Breast Cancer Study. Br J Cancer 84:994–1001. doi: 10.1054/bjoc.2000.1671 PubMedCrossRefGoogle Scholar
  40. 40.
    Sesso HD, Paffenbarger RS Jr, Lee IM (1998) Physical activity and breast cancer risk in the College Alumni Health Study. Cancer Causes Control 9:433–439. doi: 10.1023/A:1008827903302 PubMedCrossRefGoogle Scholar
  41. 41.
    Breslow RA, Ballard-Barbash R, Munoz K et al (2001) Long-term recreational physical activity and breast cancer in the National Health and Nutrition Examination Survey I epidemiologic follow-up study. Cancer Epidemiol Biomarkers Prev 10:805–808PubMedGoogle Scholar
  42. 42.
    Luoto R, Latikka P, Pukkala E et al (2000) Physical activity on breast cancer risk: a cohort study of 30,548 women. Eur J Epidemiol 16:973–980. doi: 10.1023/A:1010847311422 PubMedCrossRefGoogle Scholar
  43. 43.
    Magnusson CMK, Roddam AW, Pike MC et al (2005) Body fatness and physical activity at young ages and the risk of breast cancer in premenopausal women. Br J Cancer 93:817–824. doi: 10.1038/sj.bjc.6602758 PubMedCrossRefGoogle Scholar
  44. 44.
    Slattery ML, Edwards S, Murtaugh MA et al (2007) Physical activity and breast cancer risk among women in the Southwestern United States. Ann Epidemiol 17:342–353. doi: 10.1016/j.annepidem.2006.10.017 PubMedCrossRefGoogle Scholar
  45. 45.
    Siiteri P (1987) Adipose tissue as a source of hormones. Am J Clin Nutr 45:277–282PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Regan A. Howard
    • 1
  • Michael F. Leitzmann
    • 2
  • Martha S. Linet
    • 1
  • D. Michal Freedman
    • 1
  1. 1.Division of Cancer Epidemiology and Genetics, Radiation Epidemiology BranchNational Cancer Institute, NIH, DHHSBethesdaUSA
  2. 2.Division of Cancer Epidemiology and Genetics, Nutritional Epidemiology BranchNational Cancer InstituteBethesdaUSA

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