Cancer Causes & Control

, Volume 9, Issue 4, pp 433–439 | Cite as

Physical activity and breast cancer risk in the College Alumni Health Study (United States)

  • Howard D. Sesso
  • I-Min Lee
  • Ralph S. PaffenbargerJr.


Objectives: It is unclear whether physical activity is associated with a reduced risk of breast cancer. Some studies also suggest different effects between pre- and postmenopausal women, and lean and heavy women.

Methods: We followed 1,566 University of Pennsylvania alumnae (mean age, 45.5 years), initially free of breast cancer, from 1962 until 1993. Physical activity at baseline was assessed by asking women about stairs climbed, blocks walked, and sports played. We estimated energy expenditure and categorized women into approximate thirds (< 500, 500-999, 1,000+ kcal/wk). We identified 109 breast cancer cases during 35,365 person-years from follow-up questionnaires or from death certificates.

Results: After adjustment for age and body mass index (BMI) (kg/m2), the relative risk (RR) of breast cancer was 0.92 (95 percent confidence interval [CI]=0.58-1.45) among women expending 500-999 kcal/wk and 0.73 (CI=0.46-1.14) for those expending 1,000+ kcal/wk, compared with women expending < 500 kcal/wk (P trend=0.17). This association was modified by menopausal status, but not BMI. For postmenopausal women, corresponding RRs were 0.95 (CI=0.58-1.57) and 0.49 (CI=0.28-0.86), respectively (P trend=0.015). Increased physical activity in premenopausal women was not significantly associated with decreased risk of breast cancer.

Conclusions: These data support an inverse association between physical activity and breast cancer among postmenopausal women. Cancer Causes and Control 1998, 9, 433–439

Body mass breast cancer menopause physical activity United States women 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bernstein L, Ross RK, Henderson BE. Prospects for the primary prevention of breast cancer. Am J Epidemiol 1992; 135: 142–52.Google Scholar
  2. 2.
    Friedenreich CM, Rohan TE. A review of physical activity and breast cancer. Epidemiology 1995; 6: 311–7.Google Scholar
  3. 3.
    Kramer MM, Wells CL. Does physical activity reduce risk of estrogen-dependent cancer in women? Med Sci Sports Exerc 1996; 28: 322–34.Google Scholar
  4. 4.
    Henderson BE, Ross RK, Judd HL, Krailo MD, Pike MC. Do regular ovulatory cycles increase breast cancer risk? Cancer 1985; 56: 1206–8.Google Scholar
  5. 5.
    La Vecchia C, Decarli A, di Pietro S, Fransceschi S, Negri E, Parazzini F. Menstrual cycle patterns and the risk of breast disease. Eur J Cancer Clin Oncol 1985; 21: 417–22.Google Scholar
  6. 6.
    MacMahon B, Trichopoulos D, Brown J, et al. Age at menarche, probability of ovulation and breast cancer risk. Int J Cancer 1982; 29: 13–6.Google Scholar
  7. 7.
    Frisch RE, Wyshak G, Vincent L. Delayed menarche and amenorrhea in ballet dancers. N Engl J Med 1980; 303: 17–9.Google Scholar
  8. 8.
    Frisch RE, Gotz-Welbergen AV, McArthur JW, et al. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. JAMA 1981; 246: 1559–63.Google Scholar
  9. 9.
    Loucks AB, Vaitukaitis J, Cameron JL, et al. The reproductive system and exercise in women. Med Sci Sports Exerc 1992; 24: S288–93.Google Scholar
  10. 10.
    Prior JC, Vigna YM, Schechter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990; 323: 1221–7.Google Scholar
  11. 11.
    Greene JW. Exercise-induced menstrual irregularities. Compr Ther 1993; 19: 116–20.Google Scholar
  12. 12.
    Keizer HA, Rogol AD. Physical exercise and menstrual cycle alterations. What are the mechanisms? Sports Med 1990; 10: 218–35.Google Scholar
  13. 13.
    Loucks AB. Effects of exercise training on the menstrual cycle: existence and mechanisms. Med Sci Sports Exerc 1990; 22: 275–80.Google Scholar
  14. 14.
    Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J, Ross RK. Physical exercise and reduced risk of breast cancer in young women. J Natl Cancer Inst 1994; 86: 1403–8.Google Scholar
  15. 15.
    Thompson HJ. Effect of exercise intensity and duration on the induction of mammary carcinogenesis. Cancer Res 1994; 54: 1960s–3s.Google Scholar
  16. 16.
    Albanes D, Blair A, Taylor PR. Physical activity and risk of cancer in the NHANES I population. Am J Public Health 1989; 79: 744–50.Google Scholar
  17. 17.
    Dorgan JF, Brown C, Barrett M, et al. Physical activity and risk of breast cancer in the Framingham Heart Study. Am J Epidemiol 1994; 139: 662–9.Google Scholar
  18. 18.
    Paffenbarger RS Jr, Lee IM, Wing AL. The influence of physical activity on the incidence of site-specific cancers in college alumni. Adv Exp Med Biol 1992; 322: 7–15.Google Scholar
  19. 19.
    Vena JE, Graham S, Zielezny M, Brasure J, Swanson MK. Occupational exercise and risk of cancer. Am J Clin Nutr 1987; 45: 318–27.Google Scholar
  20. 20.
    Vihko VJ, Apter DL, Pukkala EI, Oinonen MT, Hakulinen TR, Vihko RK. Risk of breast cancer among female teachers of physical education and languages. Acta Oncol 1992; 31: 201–4.Google Scholar
  21. 21.
    Thune I, Brenn T, Lund E, Gaard M. Physical activity and the risk of breast cancer. N Engl J Med 1997; 336: 1269–75.Google Scholar
  22. 22.
    D’Avanzo B, Nanni O, La Vecchia C, Franceschi S, Negri E, Giacosa A. Physical activity and breast cancer risk. Cancer Epidemiol Biomark Prev 1996; 5: 155–60.Google Scholar
  23. 23.
    Dosemeci M, Hayes RB, Vetter R, et al. Occupational physical activity, socioeconomic status, and risks of 15 cancer sites in Turkey. Cancer Causes Control 1993; 4: 313–21.Google Scholar
  24. 24.
    Friedenreich CM, Rohan TE. Physical activity and risk of breast cancer. Eur J Cancer Prev 1995; 4: 145–51.Google Scholar
  25. 25.
    Taioli E, Barone J, Wynder EL. A case-control study on breast cancer and body mass. The American Health Foundation-Division of Epidemiology. Eur J Cancer 1995; 31A: 723–8.Google Scholar
  26. 26.
    Sternfeld B, Williams CS, Quesenberry CP, Satariano WA, Sidney S. Lifetime physical activity and incidence of breast cancer [Abstract]. Med Sci Sports Exerc 1993; 25: S148.Google Scholar
  27. 27.
    Mittendorf R, Longnecker MP, Newcomb PA, et al. Strenuous physical activity in young adulthood and risk of breast cancer (United States). Cancer Causes Control 1995; 6: 347–53.Google Scholar
  28. 28.
    McTiernan A, Stanford JL, Weiss NS, Daling JR, Voigt LF. Occurrence of breast cancer in relation to recreational exercise in women age 50-64 years. Epidemiology 1996; 7: 598–604.Google Scholar
  29. 29.
    Coogan PF, Newcomb PA, Clapp RW, Trentham-Dietz A, Baron JA, Longnecker MP. Physical activity in usual occupation and risk of breast cancer (United States). Cancer Causes Control 1997; 8: 626–31.Google Scholar
  30. 30.
    Zheng W, Shu XO, McLaughlin JK, Chow WH, Gao YT, Blot WJ. Occupational physical activity and the incidence of cancer of the breast, corpus uteri, and ovary in Shanghai. Cancer 1993; 71: 3620–4.Google Scholar
  31. 31.
    Frisch RE, Wyshak G, Albright NL, Albright TE, Schiff I, Witschi J. Former athletes have a lower lifetime occurrence of breast cancer and cancers of the reproductive system. Adv Exp Med Biol 1992; 322: 29–39.Google Scholar
  32. 32.
    Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71–80.Google Scholar
  33. 33.
    LaPorte RE, Cauley JA, Kinsey CM, et al. The epidemiology of physical activity in children, college students, middle-aged men, menopausal females and monkeys. J Chronic Dis 1982; 35: 787–95.Google Scholar
  34. 34.
    Siconolfi SF, Lasater TM, Snow RC, Carleton RA. Self-reported physical activity compared with maximal oxygen uptake. Am J Epidemiol 1985; 122: 101–5.Google Scholar
  35. 35.
    Washburn RA, Goldfield SR, Smith KW, McKinlay JB. The validity of self-reported exercise-induced sweating as a measure of physical activity. Am J Epidemiol 1990; 132: 107–13.Google Scholar
  36. 36.
    Albanes D, Conway JM, Taylor PR, Moe PW, Judd J. Validation and comparison of eight physical activity questionnaires. Epidemiology 1990; 1: 65–71.Google Scholar
  37. 37.
    LaPorte RE, Black-Sandler R, Cauley JA, Link M, Bayles C, Marks B. The assessment of physical activity in older women: analysis of the interrelationship and reliability of activity monitoring, activity surveys, and caloric intake. J Gerontol 1983; 38: 394–7.Google Scholar
  38. 38.
    Cauley JA, LaPorte RE, Sandler RB, Schramm MM, Kriska AM. Comparison of methods to measure physical activity in postmenopausal women. Am J Clin Nutr 1987; 45: 14–22.Google Scholar
  39. 39.
    Ainsworth BE, Leon AS, Richardson MT, Jacobs DR, Paffenbarger RS Jr. Accuracy of the College Alumnus Physical Activity Questionnaire. J Clin Epidemiol 1993; 46: 1403–11.Google Scholar
  40. 40.
    Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol 1986; 123: 894–900.Google Scholar
  41. 41.
    Ries LAG, Kosary CL, Hankey BF, Harras A, Miller BA, Edwards BK, eds. SEER Cancer Statistics Review, 1973-1993: Tables and Graphs. Bethesda, MD (USA): National Cancer Institute, 1996.Google Scholar
  42. 42.
    Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–7.Google Scholar
  43. 43.
    Bonen A, Belcastro AN, Ling WY, Simpson AA. Profiles of selected hormones during menstrual cycles of teenage athletes. J Appl Physiol 1981; 50: 545–51.Google Scholar
  44. 44.
    Boyden TW, Pamenter RW, Stanforth P, Rotkis T, Wilmore JH. Sex steroids and endurance running in women. Fertil Steril 1983; 39: 629–32.Google Scholar
  45. 45.
    Cauley JA, Gutai JP, Kuller LH, LeDonne D, Powell JG. The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 1989; 129: 1120–31.Google Scholar
  46. 46.
    Haffner SM, Katz MS, Dunn JF. Increased upper body and overall adiposity is associated with decreased sex hormone binding globulin in post-menopausal women. Int J Obes 1991; 15: 471–8.Google Scholar
  47. 47.
    Broocks A, Pirke KM, Schweiger U, et al. Cyclic ovarian function in recreational athletes. J Appl Physiol 1990; 68: 2083–6.Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Howard D. Sesso
    • 1
    • 2
  • I-Min Lee
    • 1
    • 2
  • Ralph S. PaffenbargerJr.
    • 1
    • 3
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Division of Preventive Medicine, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Division of EpidemiologyStanford University School of MedicineStanfordUSA

Personalised recommendations