Increased Physical Activity Reduces Breast Cancer Risk, International Study Suggests

Increasing physical activity and reducing time spent sedentary is likely to decrease the risk of breast cancer, a study of more than 100,000 women suggests. An international team including researchers from Australia, the UK and US have used genetic analysis to establish a causal relationship between overall activity levels and cancer risk.

The study, published in the British Journal of Sports Medicine, included data from 130,957 women, 76,505 of whom had breast cancer. While previous research has shown a correlation between physical activity and lowered risk of breast cancer, proving causation has been difficult.

“There has always been a little bit of uncertainty as to whether physical activity truly causes a lower rate of breast cancer or whether that relationship is confounded by other factors,” said Associate Prof Brigid Lynch of Cancer Council Victoria, the study’s senior author.

“For example, women who tend to be more physically active might have healthier lifestyles in other ways as well.”Lynch said the new study “suggests that it is certainly a causal effect: physical activity does reduce your risk of developing breast cancer”.“We saw a risk reduction across all breast cancer types,” she said.

The researchers used a technique known as Mendelian randomisation to establish causality, which uses genetic variants as proxies for particular traits – in this case, physical activity and time spent sitting or reclining.They found that a higher level of physical activity, or general movement, was associated with a 41% reduction in invasive breast cancer risk.

In pre- and perimenopausal women, vigorous physical activity at least three days per week was linked to a 38% lower risk of breast cancer compared to no vigorous activity.“For every 100 odd minutes [of sedentary time] per day we observed a 20% risk increase in breast cancer overall, and a doubling of risk for triple-negative breast cancer [which is more aggressive and difficult to treat],” Lynch said.

Physical activity is thought to lower breast cancer risk because it decreases the amount of both oestrogen and androgen hormones circulating in the bloodstream. A reduction in inflammation may also be a factor.“There’s always been a lot of focus on other health behaviours like healthy eating, maintaining a healthy weight, reducing alcohol intake,” Lynch said. “There’s a big role for physical activity in preventing cancer.”

The research drew data from the UK Biobank as well as 76 other studies conducted as part of the Breast Cancer Association Consortium.One limitation of the study was that it only included data from women of European ancestry.“We can’t say for sure that these genetic instruments are applicable across different racial backgrounds,” Lynch said.

But she added that large observational studies in Asia and for women of different ethnicities in the US have found correlations between physical activity and reduced risk.“We do already recommend that physical activity is one of things you can do to reduce your breast cancer risk,” said Associate Prof Wendy Ingman of the University of Adelaide, who was not involved in the study.

Other factors associated with a reduced risk of breast cancer include minimising alcohol intake, and breastfeeding. “The longer a woman breastfeeds for, the less breast cancer risk she has,” Ingman said.

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Source: Increased physical activity reduces breast cancer risk, international study suggests | Australia news | The Guardian

Critics by Vanessa B. Sheppard, PhD, Kepher Makambi, PhD, Teletia Taylor, PhD, Sherrie Flynt Wallington, PhD, Jennifer Sween, MS, and Lucile Adams-Campbell, PhD

A population-based case-control study was conducted with 199 women (97 cases and 102 controls) from the Washington, DC metro area. A self-report physical activity questionnaire elicited responses on walking for exercise and vigorous physical activity (e.g., running, aerobics, etc.) in the past year. Responses were used to calculate a metabolic equivalent (MET) score [MET-hours/week = hours/week vigorous activity×7+ hours/week walking ×3]. The MET score was categorized into low, medium and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer.

African American women who engaged in vigorous physical activity (> 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = 0.36; 95% confidence interval, CI = 0.17–0.75). We also found a 64% reduced breast cancer risk in women with a high versus low tertile of total activity (OR = 0.36; 95% CI = 0.16–0.79). For postmenopausal women, vigorous physical activity and total activity (high versus low tertile) also had an inverse relationship with breast cancer (p<.05).

Data regarding the association of physical activity and breast cancer has been equivocal and lacking for African American women. This study found that modest levels of physical activity reduced breast cancer risk in this group. Targeted efforts are needed to encourage more African American women to engage in physical activity.

Breast cancer is the leading cancer diagnosed in US women. With more than 190,000 cases diagnosed each year, there are few prevention strategies. Known risk factors, such as genetic mutations and family history of cancer, account for only 30% of a woman’s risk for being diagnosed with breast cancer. Thus, lifestyle changes may reduce a woman’s breast cancer risk.

Research suggests that an increase in physical activity, in particular, among sedentary, post-menopausal women changes their hormone levels to reflect a lower risk of breast cancer diagnosis. Therefore, physical activity may be one of the best approaches towards the primary prevention of breast cancer.

The relationship between physical activity and breast risk is complex and may be explained by certain molecular mechanisms. It is plausible that physical activity could affect breast cancer risk because it also affects other risk factors, such as menstrual cycle, body mass, immune system, and hormones such as IGF. It is well accepted that physical inactivity increases one’s risk of obesity. Obesity has separately been considered a breast cancer risk factor and there is an inverse relationship between obesity and physical activity.

How physical activity and obesity might confound each other is unknown; obesity is positively associated with breast cancer risk in postmenopausal women but inversely associated with risk in premenopausal women. Further, some data suggests that adult weight gain, rather than BMI, affects breast cancer risk, especially among non users of hormonal replacement therapy.

Studies have shown a relationship between obesity and risk of breast cancer but in samples of mostly Caucasian women.Research, although equivocal, suggest that physical activity is inversely related to breast cancer risk in both pre- and postmenopausal women. Considering African American women have higher rates of being overweight or obese, limited physical activity may be a significant breast cancer risk factor in this population. Some data in African American women suggests that breast cancer risk is reduced with increased physical activity.

In a study by Adams-Campbell et al, strenuous physical activity was associated with a reduced risk of breast cancer in African American women. This study, however, focused only on strenuous physical activity levels. Bernstein et al also found that increased physical activity reduces breast cancer risk in African-American women. However, this study also lacked data on the effect of moderate intensity exercise in this population. More research is needed to determine whether moderate levels of physical activity can also reduce breast cancer risk in this population.

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