Recreational physical activity and breast cancer risk by menopausal status and tumor hormone receptor status: results from the Nurses’ Health Studies
Renée T. Fortner, Kristen D. Brantley, Shelley S. Tworoger, Rulla M. Tamimi, Bernard Rosner, Michelle D. Holmes, Walter C. Willett, A. Heather Eliassen
Abstract
Abstract Purpose Physical activity is associated with lower breast cancer risk, especially in postmenopausal women. Associations in premenopausal women are less well established. Methods We evaluated recreational physical activity and breast cancer risk in the Nurses’ Health Study (NHS) and NHSII (187,278 women; n = 12,785 breast cancers; follow-up: NHS = 1986–2016, NHSII = 1989–2017) by menopausal status and estrogen (ER) and progesterone (PR) receptor status. Physical activity was evaluated as updated cumulative average of metabolic equivalent of task (MET)-h/week. Cox proportional hazards models were used to estimate multivariable hazard ratios (HR) and 95% confidence intervals (CI). Results Recreational physical activity was inversely associated with breast cancer risk in pre- and postmenopausal women. Higher activity levels were associated with lower risk of ER+/PR + breast cancer in both pre- and postmenopausal women (e.g., total recreational activity, ≥ 27 vs < 3 MET-h/week, premenopausal HR = 0.83, 95%CI = (0.70–0.99), postmenopausal HR = 0.86 (0.78–0.95); p heterogeneity = 0.97). Results were attenuated with adjustment for current body mass index (BMI) among postmenopausal, but not premenopausal, women (e.g., ≥ 27 vs < 3 MET-h/week, premenopausal HR = 0.83 (0.69–0.98); postmenopausal HR = 0.95 (0.85–1.05); p heterogeneity = 0.99). In analyses of moderate-vigorous activity and breast cancer risk, no heterogeneity by menopausal status was observed (p het ≥ 0.53; e.g., ≥ 27 vs < 3 MET-h/week, ER+/PR+, premenopausal HR = 0.88 (0.69–1.11); postmenopausal HR = 0.71 (0.58–0.88). No associations were observed for ER−/PR− disease. Conclusions Recreational physical activity was associated with lower breast cancer risk in both pre- and postmenopausal women, supporting recreational physical activity as an accessible, modifiable exposure associated with reduced breast cancer risk regardless of menopausal status.