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Senior Citizen Health & Medicine
Reduced Risk of Breast Cancer Noted in Older Women
with Higher Physical Activity
Physical activity reduces body fat, the major
source of estrogen in postmenopausal women
December 12, 2006 Older women post menopause -
with higher levels of physical activity may have a reduced risk of
breast cancer, according to a report in the December 11/25 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals. The
association appears to be stronger for estrogen receptor
positive/progesterone receptor negative tumors (which are typically more
aggressive) than for other types of breast cancer tumors.
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Breast cancer may be biologically heterogeneous,
meaning that not all cases have the same causes or disease processes,
according to background information in the article. One way cancers
differ is by hormone receptor status.
Tumors are classified as estrogen- and
progesterone-receptor (ER/PR) positive or negative based on whether
these hormones bind to the surface of the tumor. Recent studies have
found that various well-established risk factors for breast cancer vary
by the ER/PR profile of the tumor, including age, menopausal status,
parity, age at menarche, age at first pregnancy, hormonal use, family
history, body mass index (BMI), waist-hip ratio, alcohol consumption,
dietary fat intake and folate level, the authors write.
Aditya Bardia, M.D., M.P.H., of the Mayo Clinic
College of Medicine, Rochester, Minn., and colleagues reported findings
from the Iowa Womens Health Study, which includes 41,836 postmenopausal
women who were age 55 to 69 in 1986. The women filled out a 16-page
questionnaire at the beginning of the study that included information
about how often and with what intensity they participated in physical
activity during free time.
High physical activity (9,111 women) was defined as
vigorous activity (such as jogging, swimming or racket sports) two or
more times per week or moderate activity (such as bowling, golf,
gardening or walking) more than four times per week; medium physical
activity (10,030 women) was defined as participation in vigorous
activity once per week or moderate activity one to four times per week;
and low physical activity included the rest of the women (17,222).
Follow-up questionnaires were completed in 1987,
1989, 1992, 1997 and 2002. Information about breast cancer cases,
including ER/PR status, was identified through the Iowa Cancer Registry.
Through 2003, 2,548 cases of breast cancer were
observed in the 36,363 women who were included in this analysis. Women
with high physical activity levels based on the original survey had a 14
percent lower risk of developing breast cancer than those with low
physical activity levels.
After the researchers adjusted for body mass index
(BMI), those with high physical activity levels had a 9 percent lower
risk of breast cancer, suggesting that some but not all of the
association was due to the effect of exercise on body weight.
The inverse association between high physical
activity levels and lower risk of breast cancer was strongest for women
with ER+/PR- tumors; after adjusting for BMI, women with high physical
activity levels had a 34 percent lower risk of developing this type of
cancer.
Physical activity reduces body fat, the major
source of estrogen in postmenopausal women, the authors write. Lowering
estrogen levels could lead to a decreased ER+/PR+ tumors, the opposite
of which is seen in obesity, in which increased circulating estrogens
are associated with increased ER+/PR+ tumors.
Consistent with this mechanism, the association of
physical activity with ER+/PR+ tumors attenuated after adjustment for
BMI. Because adjusting for BMI did not change the risk of ER+/PR-
tumors, it is possible that a different mechanismsuch as certain growth
factors that become more prevalent with exercisemay be involved in the
association between physical activity and these tumors.
Further studies are needed to confirm these novel
findings, and to evaluate similar relationships among premenopausal
women, the authors conclude.
If found to be causally related to breast cancer,
physical activity would have a substantial public health effect on the
prevention of this disease, along with its other positive health
benefits.
Editor's Note: This study was supported in part by
a grant from the National Cancer Institute.
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