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Abstract
Background
Recreational physical activity (RPA) is associated with improved survival after breast cancer (BC) in average-risk women, but evidence is limited for women who are at increased familial risk because of a BC family history or BRCA1 and BRCA2 pathogenic variants (BRCA1/2 PVs).
Methods
We estimated associations of RPA (self-reported average hours per week within 3 years of BC diagnosis) with all-cause mortality and second BC events (recurrence or new primary) after first invasive BC in women in the Prospective Family Study Cohort (n = 4610, diagnosed 1993-2011, aged 22-79 years at diagnosis). We fitted Cox proportional hazards regression models adjusted for age at diagnosis, demographics, and lifestyle factors. We tested for multiplicative interactions (Wald test statistic for cross-product terms) and additive interactions (relative excess risk due to interaction) by age at diagnosis, body mass index, estrogen receptor status, stage at diagnosis, BRCA1/2 PVs, and familial risk score estimated from multigenerational pedigree data. Statistical tests were 2-sided.
Results
We observed 1212 deaths and 473 second BC events over a median follow-up from study enrollment of 11.0 and 10.5 years, respectively. After adjusting for covariates, RPA (any vs none) was associated with lower all-cause mortality of 16.1% (95% confidence interval [CI] = 2.4% to 27.9%) overall, 11.8% (95% CI = -3.6% to 24.9%) in women without BRCA1/2 PVs, and 47.5% (95% CI = 17.4% to 66.6%) in women with BRCA1/2 PVs (RPA*BRCA1/2 multiplicative interaction P = .005; relative excess risk due to interaction = 0.87, 95% CI = 0.01 to 1.74). RPA was not associated with risk of second BC events.
Conclusion
Findings support that RPA is associated with lower all-cause mortality in women with BC, particularly in women with BRCA1/2 PVs.
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Details
1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
2 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
3 Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
4 Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
5 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
6 Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
7 Division of Medical Oncology, Huntsman Cancer Institute, Salt Lake City, UT, USA
8 Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
9 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
10 Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
11 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
12 Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
13 Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia; Department of Medical Oncology, St Vincent’s Hospital, Fitzroy, Melbourne, Victoria, Australia
14 Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
15 Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
16 Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
17 Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
18 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
19 Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada; Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
20 Department of Medicine and Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA