Journal of Cancer Survivorship

, Volume 7, Issue 2, pp 247–252 | Cite as

The association between television watching time and all-cause mortality after breast cancer

  • Stephanie M. George
  • Ashley W. Smith
  • Catherine M. Alfano
  • Heather R. Bowles
  • Melinda L. Irwin
  • Anne McTiernan
  • Leslie Bernstein
  • Kathy B. Baumgartner
  • Rachel Ballard-Barbash



Sedentary time is a rapidly emerging independent risk factor for mortality in the general population, but its prognostic effect among cancer survivors is unknown. In a multiethnic, prospective cohort of breast cancer survivors, we hypothesized that television watching time would be independently associated with an increased risk of death from any cause.


The Health, Eating, Activity, and Lifestyle Study cohort included 687 women diagnosed with local or regional breast cancer. On average 30 (±4) months postdiagnosis, women completed self-report assessments on time spent sitting watching television/videos in a typical day in the previous year. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for death from any cause (n = 89) during the 7 years of follow-up.


Television time (top tertile vs. bottom tertile) was positively related to risk of death (HR, 1.94; 95 % CI, 1.02, 3.66, ptrend = 0.024), but the association was attenuated and not statistically significant after adjustment for aerobic moderate-vigorous intensity physical activity (HR, 1.70; 95 % CI, 0.89, 3.22, ptrend = 0.14) and all covariates (HR, 1.39; 95 % CI, 0.69, 2.82, ptrend = 0.48).


In this first published investigation on this topic, we did not observe a statistically significant multivariate-adjusted association between television watching time and risk of death among women diagnosed with breast cancer.

Implications for cancer survivors

These results begin an evidence base on this topic that can be built upon to inform lifestyle recommendations for this expanding, aging population.


Sedentary behavior Exercise Breast neoplasm Mortality Physical activity 


  1. 1.
    Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomark Prev. 2008;17(2):379–86. doi:10.1158/1055-9965.epi-07-0771.CrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res. 2011;4(4):522–9. doi:10.1158/1940-6207.capr-10-0295.CrossRefGoogle Scholar
  4. 4.
    Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, 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.PubMedCrossRefGoogle Scholar
  5. 5.
    Sternfeld B, Weltzien E, Quesenberry Jr CP, Castillo AL, Kwan M, Slattery ML, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomark Prev. 2009;18(1):87–95. doi:10.1158/1055-9965.EPI-08-0595.CrossRefGoogle Scholar
  6. 6.
    Beasley J, Kwan M, Chen W, Weltzien E, Kroenke C, Lu W, 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults: a systematic review of longitudinal studies, 1996–2011. Am J Prev Med. 2011;41(2):207–15.PubMedCrossRefGoogle Scholar
  8. 8.
    Dunstan DW, Barr EL, Healy GN, Salmon J, Shaw JE, Balkau B, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010;121(3):384–91. doi:10.1161/CIRCULATIONAHA.109.894824.PubMedCrossRefGoogle Scholar
  9. 9.
    Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998–1005.PubMedCrossRefGoogle Scholar
  10. 10.
    Matthews CE, George SM, Moore SC, Bowles HR, Blair A, Park Y, et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr. 2012;95(2):437–45. doi:10.3945/ajcn.111.019620.PubMedCrossRefGoogle Scholar
  11. 11.
    Patel AV, Bernstein L, Deka A, Feigelson HS, Campbell PT, Gapstur SM, et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010;172(4):419–29. doi:10.1093/aje/kwq155.PubMedCrossRefGoogle Scholar
  12. 12.
    Stamatakis E, Hamer M, Dunstan DW. Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol. 2011;57(3):292–9. doi:10.1016/j.jacc.2010.05.065.PubMedCrossRefGoogle Scholar
  13. 13.
    Ford ES. Combined television viewing and computer use and mortality from all-causes and diseases of the circulatory system among adults in the United States. BMC Publ Health. 2012;12:70. doi:10.1186/1471-2458-12-70.CrossRefGoogle Scholar
  14. 14.
    van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch Intern Med. 2012;172(6):494–500. doi:10.1001/archinternmed.2011.2174.PubMedCrossRefGoogle Scholar
  15. 15.
    Owen N, Sugiyama T, Eakin EE, Gardiner PA, Tremblay MS, Sallis JF. Adults' sedentary behavior determinants and interventions. Am J Prev Med. 2011;41(2):189–96. doi:10.1016/j.amepre.2011.05.013.PubMedCrossRefGoogle Scholar
  16. 16.
    Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population. Cancer Epidemiol Biomark Prev. 2011;20(10):1996–2005. doi:10.1158/1055-9965.EPI-11-0729.CrossRefGoogle Scholar
  17. 17.
    Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, et al. Physical activity levels among breast cancer survivors. Med Sci Sports Exerc. 2004;36(9):1484–91.PubMedGoogle Scholar
  18. 18.
    George SM, Irwin ML, Smith AW, Neuhouser ML, Reedy J, McTiernan A, et al. Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancer. Cancer Causes Control. 2011;22(4):589–98. doi:10.1007/s10552-011-9732-9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160(7):953–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Smith AW, Alfano CM, Reeve BB, Irwin ML, Bernstein L, Baumgartner K, et al. Race/ethnicity, physical activity, and quality of life in breast cancer survivors. Cancer Epidemiol Biomark Prev. 2009;18(2):656–63. doi:10.1158/1055-9965.EPI-08-0352.CrossRefGoogle Scholar
  21. 21.
    Lynch BM, Friedenreich CM, Winkler EA, Healy GN, Vallance JK, Eakin EG, et al. Associations of objectively assessed physical activity and sedentary time with biomarkers of breast cancer risk in postmenopausal women: findings from NHANES (2003–2006). Breast Cancer Res Treat. 2011;130(1):183–94. doi:10.1007/s10549-011-1559-2.PubMedCrossRefGoogle Scholar
  22. 22.
    Lynch BM. Sedentary behavior and cancer: a systematic review of the literature and proposed biologic mechanisms. Cancer Epidemiol Biomark Prev. 2010;19(11):2691–709. doi:10.1158/1055-9965.epi-10-0815.CrossRefGoogle Scholar
  23. 23.
    U.S. Department of Health and Human Services. Physical activity guidelines for Americans: be active, healthy, and happy. Washington, DC; 2008.Google Scholar
  24. 24.
    Clark BK, Sugiyama T, Healy GN, Salmon J, Dunstan DW, Owen N. Validity and reliability of measures of television viewing time and other non-occupational sedentary behaviour of adults: a review. Obes Rev. 2009;10(1):7–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Warren TY, Barry V, Hooker SP, Sui X, Church TS, Blair SN. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc. 2010;42(5):879–85. doi:10.1249/MSS.0b013e3181c3aa7e.PubMedCrossRefGoogle Scholar
  26. 26.
    Wijndaele K, Brage S, Besson H, Khaw KT, Sharp SJ, Luben R, et al. Television viewing time independently predicts all-cause and cardiovascular mortality: the EPIC Norfolk study. Int J Epidemiol. 2011;40(1):150–9. doi:10.1093/ije/dyq105.PubMedCrossRefGoogle Scholar
  27. 27.
    Kriska A. Modifiable activity questionnaire. Med Sci Sports Exerc. 1997;29:73–8. No. 6 Supplement.Google Scholar
  28. 28.
    Nechuta S, Caan B, Chen W, Flatt S, Lu W, Patterson R, et al. The After Breast Cancer Pooling Project: rationale, methodology, and breast cancer survivor characteristics. Cancer Causes Control. 2011;22(9):1319–31. doi:10.1007/s10552-011-9805-9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA)  2013

Authors and Affiliations

  • Stephanie M. George
    • 1
    • 7
  • Ashley W. Smith
    • 1
  • Catherine M. Alfano
    • 2
  • Heather R. Bowles
    • 1
  • Melinda L. Irwin
    • 3
  • Anne McTiernan
    • 4
  • Leslie Bernstein
    • 5
  • Kathy B. Baumgartner
    • 6
  • Rachel Ballard-Barbash
    • 1
  1. 1.Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  2. 2.Office of Cancer Survivorship, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  3. 3.Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenUSA
  4. 4.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  5. 5.Department of Population SciencesCity of Hope Medical Center and Beckman Research CenterDuarteUSA
  6. 6.Department of Epidemiology and Population HealthUniversity of LouisvilleLouisvilleUSA
  7. 7.BethesdaUSA

Personalised recommendations