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Neighborhood influences on recreational physical activity and survival after breast cancer

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Abstract

Purpose

Higher levels of physical activity have been associated with improved survival after breast cancer diagnosis. However, no previous studies have considered the influence of the social and built environment on physical activity and survival among breast cancer patients.

Methods

Our study included 4,345 women diagnosed with breast cancer (1995–2008) from two population-based studies conducted in the San Francisco Bay Area. We examined questionnaire-based moderate/strenuous recreational physical activity during the 3 years before diagnosis. Neighborhood characteristics were based on data from the 2000 US Census, business listings, parks, farmers’ markets, and Department of Transportation. Survival was evaluated using multivariable Cox proportional hazards models, with follow-up through 2009.

Results

Women residing in neighborhoods with no fast-food restaurants (vs. fewer fast-food restaurants) to other restaurants, high traffic density, and a high percentage of foreign-born residents were less likely to meet physical activity recommendations set by the American Cancer Society. Women who were not recreationally physically active had a 22 % higher risk of death from any cause than women that were the most active. Poorer overall survival was associated with lower neighborhood socioeconomic status (SES) (p trend = 0.02), whereas better breast cancer-specific survival was associated with a lack of parks, especially among women in high-SES neighborhoods.

Conclusion

Certain aspects of the neighborhood have independent associations with recreational physical activity among breast cancer patients and their survival. Considering neighborhood factors may aide in the design of more effective, tailored physical activity programs for breast cancer survivors.

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Acknowledgments

The authors thank David Nelson, Sarah Shema, and Kristine Winters for their contributions to these analyses. This work was supported by National Cancer Institute funds from R21CA133255 (T.H.M.K.) and R01CA140058 (S.L.G.). The Breast Cancer Family Registry (BCFR) was supported by Grant UM1 CA164920 from the National Cancer Institute. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the BCFR, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the BCFR. The San Francisco Bay Area Breast Cancer Study was supported by National Cancer Institute Grants R01 CA63446 and R01 CA77305; by the U.S. Department of Defense (DOD) Grant DAMD17-96-1-6071; and by the California Breast Cancer Research Program (CBCRP) Grants 4JB-1106 and 7PB-0068. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under Contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, Contract HHSN261201000035C awarded to the University of Southern California, and Contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under Agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA

    Theresa H. M. Keegan, Salma Shariff-Marco, Meera Sangaramoorthy, Jocelyn Koo, Andrew Hertz, Clayton W. Schupp, Juan Yang, Esther M. John & Scarlett L. Gomez

  2. Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA

    Theresa H. M. Keegan, Esther M. John & Scarlett L. Gomez

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  1. Theresa H. M. Keegan
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  2. Salma Shariff-Marco
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  3. Meera Sangaramoorthy
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  4. Jocelyn Koo
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  5. Andrew Hertz
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  6. Clayton W. Schupp
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  7. Juan Yang
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  8. Esther M. John
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  9. Scarlett L. Gomez
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Correspondence to Theresa H. M. Keegan.

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Keegan, T.H.M., Shariff-Marco, S., Sangaramoorthy, M. et al. Neighborhood influences on recreational physical activity and survival after breast cancer. Cancer Causes Control 25, 1295–1308 (2014). https://doi.org/10.1007/s10552-014-0431-1

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