Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, Baron JA, Egan KM, Willett WCPhysical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev 17: 379-386

Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 02/2008; 17(2):379-86. DOI: 10.1158/1055-9965.EPI-07-0771
Source: PubMed


Previous studies suggest that increased physical activity may lower the risk of breast cancer incidence, but less is known about whether levels of physical activity after breast cancer diagnosis can influence survival. We prospectively examined the relation between postdiagnosis recreational physical activity and risk of breast cancer death in women who had a previous invasive breast cancer diagnosed between 1988 and 2001 (at ages 20-79 years). All women completed a questionnaire on recent postdiagnosis physical activity and other lifestyle factors. Among 4,482 women without history of recurrence at the time of completing the questionnaire, 109 died from breast cancer within 6 years of enrollment. Physical activity was expressed as metabolic equivalent task-hours per week (MET-h/wk); hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards regression. After adjusting for age at diagnosis, stage of disease, state of residence, interval between diagnosis and physical activity assessment, body mass index, menopausal status, hormone therapy use, energy intake, education, family history of breast cancer, and treatment modality compared with women expending <2.8 MET-h/wk in physical activity, women who engaged in greater levels of activity had a significantly lower risk of dying from breast cancer (HR, 0.65; 95% CI, 0.39-1.08 for 2.8-7.9 MET-h/wk; HR, 0.59; 95% CI, 0.35-1.01 for 8.0-20.9 MET-h/wk; and HR, 0.51; 95% CI, 0.29-0.89 for > or =21.0 MET-h/wk; P for trend = 0.05). Results were similar for overall survival (HR, 0.44; 95% CI, 0.32-0.60 for > or =21.0 versus <2.8 MET-h/wk; P for trend <0.001) and were similar regardless of a woman's age, stage of disease, and body mass index. This study provides support for reduced overall mortality and mortality from breast cancer among women who engage in physical activity after breast cancer diagnosis.

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    • "Women with stage I-III breast cancer who participated in more than 9 metabolic of breast cancer recurrence and mortality [4]. Moderate physical exercise, including brisk walking, reduced postmenopausal breast cancer risk suggesting that increases in activity follow up of women diagnosed with local or regional breast cancer, any recreational physidiets was associated with a 91% reduced risk of death from breast cancer [5]. However, not all studies have shown positive associations. "
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    ABSTRACT: Epidemiological evidence supports a protective effect of physical activity for breast cancer but pre-clinical studies are needed to help define the underlying mechanisms in an age-related manner. We utilized 18-month old BALB/c mice injected in the mammary fat pad with syngeneic 4T1 tumor cells as a model of invasive breast cancer. A negative correlation was observed between daily distance ran, prior to tumor injection, and absolute tumor mass measured at necropsy (Pearson's r = -0.89, P = 0.0066, R(2) = 0.80). A correlation was also observed between distance ran before tumor implant and the histological score for mitotic index (Pearson's r = -0.85, P = 0.034, R(2) = 0.72). Runners showed an increased respiratory exchange ratio during the light cycle (P = 0.029) suggesting that voluntary running shifted resting substrate metabolism toward glucose oxidation, relative to lipid oxidation. The shift in substrate metabolism was significantly different from baseline for both groups of animals, indicating that the tumor burden might have been responsible. The observations from this study indicate that running longer distances is associated with decreased breast tumor burden in old mice, suggesting that physiological factors generated by exercising before tumor onset are protective against tumor progression. The mechanisms for this protective effect are not known but the data show that older mice are useful models to address specific questions in cancer research and support further studies on the ability of exercise training to protect older women at risk for breast cancer.
    American Journal of Cancer Research 07/2014; 4(4):378-84. · 4.17 Impact Factor
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    • "Pre-diagnosis behaviors can impact survival from breast cancer and medical conditions, such as cardiovascular disease [2-5]. For example, higher levels of physical activity and lower body mass index (BMI) prior to breast cancer diagnosis are associated with improved all-cause and cause-specific survival [3,6-8]. A beneficial effect of pre-diagnosis bilateral oophorectomy on breast cancer-specific mortality has been reported in some [9], but not all [10], studies of women in the general population and among patient populations of women at high risk of developing breast cancer due to BRCA1/2 mutation status [11]. "
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    ABSTRACT: Pre-diagnosis oophorectomy and estrogen therapy could impact mortality due to breast cancer and cardiovascular disease (CVD) among breast cancer survivors. Elective bilateral oophorectomy at the time of hysterectomy for benign conditions is not uncommon among US women. We examined the association between pre-diagnosis total abdominal hysterectomy with bilateral salpingo oophorectomy (TAHBSO) and both overall and cause-specific mortality in the Collaborative Breast Cancer Studies cohort. Medical history and prior estrogen use were collected during standardized telephone interviews. Vital status, including date and cause of death, was obtained by linkage with the National Death Index. Multivariate hazard ratios (HR) and 95% confidence intervals (CI) for cause-specific mortality were calculated using Cox proportional hazards regression. Seventeen percent (N=1,778) of breast cancer survivors (mean age at diagnosis = 63.5) reported pre-diagnosis TAHBSO. During follow-up (mean = 9.5 years), 2,856 deaths occurred, including 1,060 breast cancer deaths and 459 CVD deaths. Breast cancer deaths occurred a median of 5.1 years after diagnosis; CVD deaths occurred further from diagnosis (median = 9.7 years). Women who reported pre-diagnosis TAHBSO had a 16% decrease in all-cause mortality (HR = 0.84; 95% CI: 0.76, 0.92) compared to those with an intact uterus and ovaries. This overall decrease reflected a 27% lower breast cancer mortality among women who never used postmenopausal hormones (HR = 0.73; CI: 0.55, 0.96) and 43% lower CVD risk among women who reported using estrogen (HR = 0.57; CI: 0.39, 0.83) after TAHBSO. Information on prior TAHBSO and estrogen use can inform risk of death from both breast cancer and cardiovascular disease among breast cancer survivors.
    Breast cancer research: BCR 10/2013; 15(5):R99. DOI:10.1186/bcr3560 · 5.49 Impact Factor
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    • "Evidence from dozens of health outcome trials suggests that regular physical activity can address both the psychological and physiological burdens presented after breast cancer diagnosis and treatment [4–6]. Furthermore, observational research suggests that regular physical activity may also have an impact on survival, with breast cancer survivors who are active after treatment having a lower risk of cancer recurrence, co-morbidities and death from all causes compared with those who are less active, regardless of cancer stage [7–9]. In recognition of these benefits, detailed exercise prescription guidelines for cancer survivors have been published by professional bodies internationally [10–14]. "
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    ABSTRACT: Health outcome trials have provided strong evidence that participating in regular physical activity can improve the quality of life and health of post-treatment breast cancer survivors. Focus is now needed on how to promote changes in physical activity behaviour among this group. This systematic review examines the efficacy of behavioural interventions for promoting physical activity among post-treatment breast cancer survivors. Behavioural intervention studies published up until July 2012 were identified through a systematic search of two databases: MEDLINE and CINAHL, and by searching reference lists of relevant publications and scanning citation libraries of project staff. Eight out of the ten identified studies reported positive intervention effects on aerobic physical activity behaviour, ranging from during the intervention period to 6 months post-intervention. Only two studies reported intervention effect sizes. The identification of factors related to efficacy was not possible because of the limited number and heterogeneity of studies included, as well as the lack of effect sizes reported. Nonetheless, an examination of the eight studies that did yield significant intervention effects suggests that 12-week interventions employing behaviour change techniques (e.g., self-monitoring and goal setting) derived from a variety of theories and delivered in a variety of settings (i.e., one-on-one, group or home) can be effective at changing the aerobic physical activity behaviour of breast cancer survivors in the mid- to long terms. Behavioural interventions do hold promise for effectively changing physical activity behaviour among breast cancer survivors. However, future research is needed to address the lack of studies exploring long-term intervention effects, mediators of intervention effects and interventions promoting resistance-training activity, and to address issues impacting on validity, such as the limited use of objective physical activity measures and the use of convenience samples. Identifying effective ways of assisting breast cancer survivors to adopt and maintain physical activity is important for enhancing the well-being and health outcomes of this group.
    Journal of Cancer Survivorship 07/2013; 7(4). DOI:10.1007/s11764-013-0296-4 · 3.30 Impact Factor
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