Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: World Cancer Research Fund and the American Institute for Cancer Research; 2007.
Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.
Suzuki R, Orsini N, Saji S, et al. Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status: a meta-analysis. Int J Cancer. 2009;124(3):698–712.
Niraula S, Ocana A, Ennis M, Goodwin PJ. Body size and breast cancer prognosis in relation to hormone receptor and menopausal status: a meta-analysis. Breast Cancer Res Treat. 2012;134(2):769–81.
Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66(1):5–15.
Ballard-Barbash R, Hunsberger S, Alciati MH, et al. Physical activity, weight control, and breast cancer risk and survival: clinical trial rationale and design considerations. J Natl Cancer Inst. 2009;101(9):630–43.
Kushi LH, Byers T, Doyle C, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity. CA Cancer J Clin. 2006;56(5):254–81.
Lynch BM, Neilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Recent Results Cancer Res. 2011;186:13–42. A comprehensive literature review that we conducted in December 2009, relating physical activity to breast cancer risk. Our currently proposed biologic model was updated from this earlier review.
Wu Y, Zhang D, Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat. 2013;137(3):869–82.
Rundle A. Molecular epidemiology of physical activity and cancer. Cancer Epidemiol Biomarkers Prev. 2005;14(1):227–36.
Neilson HK, Friedenreich CM, Brockton NT, Millikan RC. Physical activity and postmenopausal breast cancer: proposed biologic mechanisms and areas for future research. Cancer Epidemiol Biomarkers Prev. 2009;18(1):11–27.
Ballard-Barbash R, Friedenreich CM, Courneya KS, et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40. The effects of exercise in breast cancer survivors was beyond the scope of our review. However, this systematic review by Ballard-Barbash et al. is recommended for a review of exercise trials in cancer survivors.
Lof M, Bergstrom K, Weiderpass E. Physical activity and biomarkers in breast cancer survivors: A systematic review. Maturitas. 2012.
Patterson RE, Rock CL, Kerr J, et al. Metabolism and breast cancer risk: frontiers in research and practice. J Acad Nutr Diet. 2013;113(2):288–96. This article reviews hypothesized mechanisms mediating the relation between obesity and breast cancer risk/progression, with parallels to our own biologic model of physical activity effects. Unlike Patterson et al. our review focuses only on postmenopausal breast cancer risk.
Rose DP, Vona-Davis L. Biochemical and molecular mechanisms for the association between obesity, chronic Inflammation, and breast cancer. Biofactors. 2013. doi:10.1002/biof.1109.
John EM, Phipps AI, Sangaramoorthy M. Body size, modifying factors, and postmenopausal breast cancer risk in a multiethnic population: the San Francisco Bay Area Breast Cancer Study. SpringerPlus. 2013;2(1):239.
Liedtke S, Schmidt ME, Vrieling A, et al. Postmenopausal sex hormones in relation to body fat distribution. Obesity (Silver Spring). 2012;20(5):1088–95. Findings support the hypothesis that exercise interventions may need to target abdominal fat in order to reduce postmenopausal breast cancer risk.
Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.
Lau DC, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8):S1–S13.
Sims ST, Larson JC, Lamonte MJ, et al. Physical activity and body mass: changes in younger versus older postmenopausal women. Med Sci Sports Exerc. 2012;44(1):89–97.
Slentz CA, Bateman LA, Willis LH, et al. Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT. Am J Physiol Endocrinol Metab. 2011;301(5):E1033–9. This randomized trial in 155 men and women age 18–79 years suggested that aerobic exercise was more beneficial than resistance exercise for lowering central body fat and improving insulin sensitivity. A similar trial in postmenopausal women that examines additional biomarkers for breast cancer would be informative.
Friedenreich CM, Woolcott CG, McTiernan A, et al. Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial. Int J Obes (Lond). 2010;35:427–35.
Irwin ML, Yasui Y, Ulrich CM, et al. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial. JAMA. 2003;289(3):323–30.
Foster-Schubert KE, Alfano CM, Duggan CR, et al. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity. 2012;20(8):1628–38. This article reports on adiposity changes in the Nutrition and Exercise in Women (NEW) trial. The study population is directly relevant to postmenopausal breast cancer risk.
Velthuis MJ, Schuit AJ, Peeters PH, Monninkhof EM. Exercise program affects body composition but not weight in postmenopausal women. Menopause. 2009;16(4):777–84.
Bergstrom I, Lombardo C, Brinck J. Physical training decreases waist circumference in postmenopausal borderline overweight women. Acta Obstet Gynecol Scand. 2009;88(3):308–13.
Key T, Appleby P, Barnes I, Reeves G. Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst. 2002;94(8):606–16.
Chlebowski RT, Kuller LH, Prentice RL, et al. Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 2009;360(6):573–87.
Uray IP, Brown PH. Prevention of breast cancer: current state of the science and future opportunities. Expert Opin Investig Drugs. 2006;15(12):1583–600.
Yager JD, Davidson NE. Estrogen carcinogenesis in breast cancer. N Engl J Med. 2006;354(3):270–82.
Copeland JL, Tremblay MS. Effect of HRT on hormone responses to resistance exercise in post-menopausal women. Maturitas. 2004;48(4):360–71.
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.
Yoo EJ, Jun TW, Hawkins S. The effects of a walking exercise program on fall-related fitness, bone metabolism, and fall-related psychological factors in elderly women. Res Sports Med. 2010;18(4):236–50.
Monninkhof EM, Velthuis MJ, Peeters PH, et al. Effect of exercise on postmenopausal sex hormone levels and role of body fat: a randomized controlled trial. J Clin Oncol. 2009;27(27):4492–9.
McTiernan A, Tworoger SS, Ulrich CM, et al. Effect of exercise on serum estrogens in postmenopausal women: a 12-month randomized clinical trial. Cancer Res. 2004;64(8):2923–8.
Campbell KL, Foster-Schubert KE, Alfano CM, et al. Reduced-calorie dietary weight loss, exercise, and sex hormones in postmenopausal women: randomized controlled trial. J Clin Oncol. 2012;30(19):2314–26. This article reports on primary outcomes from the Nutrition and Exercise in Women (NEW) trial. This trial provides the strongest evidence to-date to distinguish the effects of exercise from those of weight loss on sex hormone levels in healthy postmenopausal women.
Figueroa A, Going SB, Milliken LA, et al. Effects of exercise training and hormone replacement therapy on lean and fat mass in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2003;58(3):M266–70.
Kim JW, Kim DY. Effects of aerobic exercise training on serum sex hormone binding globulin, body fat index, and metabolic syndrome factors in obese postmenopausal women. Metab Syndr Relat Disord. 2012;10(6):452–7.
Orsatti FL, Nahas EA, Maesta N, et al. Plasma hormones, muscle mass and strength in resistance-trained postmenopausal women. Maturitas. 2008;59(4):394–404.
Atkinson C, Lampe JW, Tworoger SS, et al. Effects of a moderate intensity exercise intervention on estrogen metabolism in postmenopausal women. Cancer Epidemiol Biomarkers Prev. 2004;13(5):868–74.
Campbell KL, Foster-Schubert KE, Makar KW, et al. Gene Expression Changes in Adipose Tissue with Diet- and/or Exercise-Induced Weight Loss. Cancer Prev Res. 2013;6(3):217–31.
McTiernan A, Tworoger SS, Rajan KB, et al. Effect of exercise on serum androgens in postmenopausal women: a 12-month randomized clinical trial. Cancer Epidemiol Biomarkers Prev. 2004;13(7):1099–105.
Carpenter CL, Duvall K, Jardack P, et al. Weight loss reduces breast ductal fluid estrogens in obese postmenopausal women: a single arm intervention pilot study. Nutr J. 2012;11:102. This study demonstrated weight loss-associated decreased estrogens levels in the breast, whereas most other studies describe changes in circulating, whole-body estrogen levels.
Jones ME, Schoemaker M, Rae M, et al. Changes in estradiol and testosterone levels in postmenopausal women after changes in body mass index. J Clin Endocrinol Metab. 2013;98(7):2967–74.
Autier P, Koechlin A, Boniol M, et al. Serum insulin and C-peptide concentration and breast cancer: a meta-analysis. Cancer Causes Control. 2013;24(5):873–83.
Ahern TP, Hankinson SE, Willett WC, et al. Plasma C-peptide, mammographic breast density, and risk of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(10):1786–96.
Rose DP, Vona-Davis L. The cellular and molecular mechanisms by which insulin influences breast cancer risk and progression. Endocr Relat Cancer. 2012;19(6):R225–41.
Goodwin PJ, Stambolic V. Obesity and insulin resistance in breast cancer–chemoprevention strategies with a focus on metformin. Breast. 2011;20 Suppl 3:S31–5.
Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and Type 2 Diabetes: The American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33(12):2692–6.
Friedenreich CM, Neilson HK, Woolcott CG, et al. Changes in insulin resistance indicators, insulin-like growth factors, and adipokines in a year-long trial of aerobic exercise in postmenopausal women. Endocr Relat Cancer. 2011;18(3):357–69.
Frank LL, Sorensen BE, Yasui Y, et al. Effects of exercise on metabolic risk variables in overweight postmenopausal women: a randomized clinical trial. Obes Res. 2005;13(3):615–25.
Mason C, Foster-Schubert KE, Imayama I, et al. Dietary weight loss and exercise effects on insulin resistance in postmenopausal women. Am J Prev Med. 2011;41(4):366–75. This article reports on the Nutrition and Exercise in Women (NEW) trial. This trial provides the strongest evidence to-date to distinguish the effects of exercise from those of weight loss on insulin resistance indicators in a study population that is directly relevant to postmenopausal breast cancer.
Arsenault BJ, Cote M, Cartier A, et al. Effect of exercise training on cardiometabolic risk markers among sedentary, but metabolically healthy overweight or obese post-menopausal women with elevated blood pressure. Atherosclerosis. 2009;207(2):530–3.
Friedenreich CM, Neilson HK, Woolcott CG, et al. Mediators and moderators of the effects of a year-long exercise intervention on endogenous sex hormones in postmenopausal women. Cancer Causes Control. 2011;22(10):1365–73. A novel analytical approach is used to identify potential mediators of exercise-induced sex hormone changes. Formal definitions of mediators and moderators are drawn from the psychology literature.
Brochu M, Tchernof A, Dionne IJ, et al. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab. 2001;86(3):1020–5.
Tresierras MA, Balady GJ. Resistance training in the treatment of diabetes and obesity: mechanisms and outcomes. J Cardiopulm Rehabil Prev. 2009;29(2):67–75.
Figueroa A, Vicil F, Sanchez-Gonzalez MA, et al. Effects of diet and/or low-intensity resistance exercise training on arterial stiffness, adiposity, and lean mass in obese postmenopausal women. Am J Hypertens. 2013;26(3):416–23.
Waki H, Tontonoz P. Endocrine functions of adipose tissue. Annu Rev Pathol. 2007;2:31–56.
You T, Arsenis NC, Disanzo BL, LaMonte MJ. Effects of exercise training on chronic inflammation in obesity. Sports Med. 2013;43(4):243–56.
Jarde T, Perrier S, Vasson MP, Caldefie-Chezet F. Molecular mechanisms of leptin and adiponectin in breast cancer. Eur J Cancer. 2011;47(1):33–43.
He B, Niu J, Jiang L, et al. The association between leptin level and breast cancer: a meta-analysis. PLoS ONE. 2013;8(6):e67349.
Ollberding NJ, Kim Y, Shvetsov YB, et al. Prediagnostic Leptin, Adiponectin, C-Reactive Protein, and the Risk of Postmenopausal Breast Cancer. Cancer Prev Res. 2013;6(3):188–95.
Gross AL, Newschaffer CJ, Hoffman-Bolton J, et al. Adipocytokines, inflammation, and breast cancer risk in postmenopausal women: a prospective study. Cancer Epidemiol Biomarkers Prev. 2013;22(7):1319–24.
Singh S, Liu L-Y, Wang M, et al. The role of adiponectin in breast cancer: a meta-analysis. PLoS ONE. 2013;8(8):e73183.
Heikkila K, Harris R, Lowe G, et al. Associations of circulating C-reactive protein and interleukin-6 with cancer risk: findings from two prospective cohorts and a meta-analysis. Cancer Causes Control. 2009;20(1):15–26.
Shen C, Sun H, Sun D, et al. Polymorphisms of tumor necrosis factor-alpha and breast cancer risk: a meta-analysis. Breast Cancer Res Treat. 2010;126(3):763–70.
Abbenhardt C, McTiernan A, Alfano CM, et al. Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels. J Intern Med. 2013;274(2):163–75. This article reports on the Nutrition and Exercise in Women (NEW) trial. This trial provides the strongest evidence to-date to distinguish the effects of exercise from those of weight loss on adiponectin and leptin levels in a study population that is directly relevant to postmenopausal breast cancer.
Imayama I, Ulrich CM, Alfano CM, et al. Effects of a caloric restriction weight loss diet and exercise on inflammatory biomarkers in overweight/obese postmenopausal women: a randomized controlled trial. Cancer Res. 2012;72(9):2314–26. This article reports on the Nutrition and Exercise in Women (NEW) trial. This trial provides the strongest evidence to-date to distinguish the effects of exercise from those of weight loss on inflammatory markers in a study population that is directly relevant to postmenopausal breast cancer.
Giannopoulou I, Fernhall B, Carhart R, et al. Effects of diet and/or exercise on the adipocytokine and inflammatory cytokine levels of postmenopausal women with type 2 diabetes. Metabolism. 2005;54(7):866–75.
Friedenreich CM, Neilson HK, Woolcott CG, et al. Inflammatory marker changes in a year-long randomized exercise intervention trial among postmenopausal women. Cancer Prev Res. 2012;5(1):98–108.
Campbell PT, Campbell KL, Wener MH, et al. A yearlong exercise intervention decreases CRP among obese postmenopausal women. Med Sci Sports Exerc. 2009;41(8):1533–9.
Stewart LK, Earnest CP, Blair SN, Church TS. Effects of different doses of physical activity on C-reactive protein among women. Med Sci Sports Exerc. 2010;42(4):701–7.
Phillips MD, Patrizi RM, Cheek DJ, et al. Resistance training reduces subclinical inflammation in obese, postmenopausal women. Med Sci Sports Exerc. 2012;44(11):2099–110.
Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74.
Standish LJ, Sweet ES, Novack J, et al. Breast cancer and the immune system. J Soc Integr Oncol. 2008;6(4):158–68.
Walsh NP, Gleeson M, Shephard RJ, et al. Position statement Part one: Immune function and exercise. ExercImmunol Rev. 2011;17:6–63.
Simpson RJ, Lowder TW, Spielmann G, et al. Exercise and the aging immune system. Ageing Res Rev. 2012;11(3):404–20.
Haaland DA, Sabljic TF, Baribeau DA, et al. Is regular exercise a friend or foe of the aging immune system? A systematic review. Clin J Sport Med. 2008;18(6):539–48.
Campbell PT, Wener MH, Sorensen B, et al. Effect of exercise on in vitro immune function: a 12-month randomized, controlled trial among postmenopausal women. J Appl Physiol. 2008;104(6):1648–55.
Vera-Ramirez L, Sanchez-Rovira P, Ramirez-Tortosa MC, et al. Free radicals in breast carcinogenesis, breast cancer progression and cancer stem cells Biological bases to develop oxidative-based therapies. Crit Rev Oncol Hematol. 2011;80(3):347–68.
Crujeiras AB, Diaz-Lagares A, Carreira MC, et al. Oxidative stress associated to dysfunctional adipose tissue: a potential link between obesity, type 2 diabetes mellitus and breast cancer. Free Radic Res. 2013;47(4):243–56.
Ziech D, Franco R, Pappa A, Panayiotidis MI. Reactive oxygen species (ROS)–induced genetic and epigenetic alterations in human carcinogenesis. Mutat Res. 2011;711(1–2):167–73.
Prescott J, Wentzensen IM, Savage SA, De Vivo I. Epidemiologic evidence for a role of telomere dysfunction in cancer etiology. Mutat Res. 2012;730(1–2):75–84.
Radak Z, Chung HY, Goto S. Systemic adaptation to oxidative challenge induced by regular exercise. Free Radic Biol Med. 2008;44(2):153–9.
Campbell PT, Gross MD, Potter JD, et al. Effect of exercise on oxidative stress: a 12-month randomized, controlled trial. Med Sci Sports Exerc. 2010;42(8):1448–53.
Qian G, Xue K, Tang L, et al. Mitigation of oxidative damage by green tea polyphenols and Tai Chi exercise in postmenopausal women with osteopenia. PLoS One. 2012;7(10):e48090.
Vincent HK, Bourguignon C, Vincent KR. Resistance training lowers exercise-induced oxidative stress and homocysteine levels in overweight and obese older adults. Obesity (Silver Spring). 2006;14(11):1921–30.
Mason C, Risques R-A, Xiao L, et al. Independent and combined effects of dietary weight loss and exercise on leukocyte telomere length in postmenopausal women. Obesity. 2013. doi:10.1002/oby.20509. This article reports on the Nutrition and Exercise in Women (NEW) trial. This article presents novel findings surrounding the effects of exercise-alone versus weight loss on leukocytle telomere length in a study population that is directly relevant to postmenopausal breast cancer.
Hovatta I, de Mello VD, Kananen L, et al. Leukocyte telomere length in the Finnish Diabetes Prevention Study. PLoS ONE. 2012;7(4):e34948.
Woo HD, Kim J. Global DNA hypomethylation in peripheral blood leukocytes as a biomarker for cancer risk: a meta-analysis. PLoS One. 2012;7(4):e34615.
Delgado-Cruzata L, Wu HC, Perrin M, et al. Global DNA methylation levels in white blood cell DNA from sisters discordant for breast cancer from the New York site of the Breast Cancer Family Registry. Epigenetics. 2012;7(8):868–74.
Deroo LA, Bolick SC, Xu Z et al. Global DNA methylation and one-carbon metabolism gene polymorphisms and the risk of breast cancer in the Sister Study. Carcinogenesis. 2013
Ntanasis-Stathopoulos J, Tzanninis JG, Philippou A, Koutsilieris M. Epigenetic regulation on gene expression induced by physical exercise. J Musculoskelet Neuronal Interact. 2013;13(2):133–46. While our review focuses on global DNA hypomethylation as a potentially modifiable epigenetic biomarker of breast cancer risk, this article comprehensively reviews a variety of epigenetic changes induced by exercise. Mechanisms related to carcinogenesis, aging, neurophysiological disorders, metabolic syndrome, and cardiovascular disease are described.
Yang AS, Estecio MR, Doshi K, et al. A simple method for estimating global DNA methylation using bisulfite PCR of repetitive DNA elements. Nucleic Acids Res. 2004;32(3):e38.
White AJ, Sandler DP, Bolick SCE, et al. Recreational and household physical activity at different time points and DNA global methylation. Eur J Cancer. 2013;49(9):2199–206.
Zhang FF, Cardarelli R, Carroll J, et al. Physical activity and global genomic DNA methylation in a cancer-free population. Epigenetics. 2011;6(3):293–9.
Bauer SR, Hankinson SE, Bertone-Johnson ER, Ding EL. Plasma vitamin D levels, menopause, and risk of breast cancer: dose–response meta-analysis of prospective studies. Medicine (Baltimore). 2013;92(3):123–31.
Wang D, Velez de-la-Paz OI, Zhai JX, Liu DW. Serum 25-hydroxyvitamin D and breast cancer risk: a meta-analysis of prospective studies. Tumour Biol. 2013.
Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690–3.
Mason C, Xiao L, Imayama I, et al. Effects of weight loss on serum vitamin D in postmenopausal women. Am J Clin Nutr. 2011;94(1):95–103. This article reports on the Nutrition and Exercise in Women (NEW) trial. This trial provides strong evidence to support the hypothesis that serum 25-hydroxyvitamin D levels are mediated by body fat in postmenopausal women.
Rock CL, Emond JA, Flatt SW, et al. Weight loss is associated with increased serum 25-hydroxyvitamin D in overweight or obese women. Obesity. 2012;20(11):2296–301.
Tamimi RM, Byrne C, Colditz GA, Hankinson SE. Endogenous hormone levels, mammographic density, and subsequent risk of breast cancer in postmenopausal women. J Natl Cancer Inst. 2007;99(15):1178–87.
Yaghjyan L, Colditz GA, Wolin K. Physical activity and mammographic breast density: a systematic review. Breast Cancer Res Treat. 2012;135(2):367–80.
Key TJ, Appleby PN, Reeves GK, Roddam AW. Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies. Lancet Oncol. 2010;11(6):530–42.
McTiernan A, Sorensen B, Yasui Y, et al. No effect of exercise on insulin-like growth factor 1 and insulin-like growth factor binding protein 3 in postmenopausal women: a 12-month randomized clinical trial. Cancer Epidemiol Biomarkers Prev. 2005;14(4):1020–1.
Mason C, Xiao L, Duggan C, et al. Effects of Dietary Weight Loss and Exercise on Insulin-Like Growth Factor-I and Insulin-Like Growth Factor-Binding Protein-3 in Postmenopausal Women: A Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev. 2013;22(8):1457–63. This article provides strong evidence from the four-armed Nutrition and Exercise in Women (NEW) trial that IGF-1 bioavailability is an unlikely mechanism through which weight loss mediates postmenopausal breast cancer risk, which refutes common theories surrounding IGF-1.
Liedtke S, Schmidt ME, Becker S, et al. Physical activity and endogenous sex hormones in postmenopausal women: to what extent are observed associations confounded or modified by BMI? Cancer Causes Control. 2011;22(1):81–9.
van Gemert WAM, Iestra JI, Schuit AJ, et al. Design of the SHAPE-2 study: the effect of physical activity, in addition to weight loss, on biomarkers of postmenopausal breast cancer risk. BMC Cancer. 2013;13(1):395. Results from the SHAPE-2 trial will help discern whether or not exercise contibutes to biomarker changes independently of weight loss in healthy postmenopausal women.
Joffe M, Gambhir M, Chadeau-Hyam M, Vineis P. Causal diagrams in systems epidemiology. Emerg Themes Epidemiol. 2012;9(1):1.
Friedenreich CM, Woolcott CG, McTiernan A, et al. Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: a randomized controlled trial. Int J Obes (Lond). 2011;35(3):427–35.
Hastert TA, Beresford SAA, Patterson RE, et al. Adherence to WCRF/AICR Cancer Prevention Recommendations and Risk of Postmenopausal Breast Cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(9):1498–508. Findings from this prospective study of 30,797 postmenopausal women in the U.S. imply that near-achievement of the minimum physical activity recommendation for cancer prevention does not significantly decrease the risk of postmenopausal invasive breast cancer.