Association between pre-diagnosis recreational physical activity and risk of breast cancer recurrence: the California Teachers Study

Dan Lin; Cheryl L Thompson; Alaina Demalis; Rebecca Derbes; Laila Al-Shaar; Emma S Spielfogel; Kathleen M Sturgeon

doi:10.1007/s10552-024-01870-8

Association between pre-diagnosis recreational physical activity and risk of breast cancer recurrence: the California Teachers Study

Cancer Causes Control. 2024 Apr 13. doi: 10.1007/s10552-024-01870-8. Online ahead of print.

Authors

Dan Lin¹, Cheryl L Thompson¹, Alaina Demalis², Rebecca Derbes¹, Laila Al-Shaar¹, Emma S Spielfogel³, Kathleen M Sturgeon⁴

Affiliations

¹ Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA.
² Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA.
³ Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA, 91010, USA.
⁴ Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA. sturgeon.katie@gmail.com.

PMID: 38613744
DOI: 10.1007/s10552-024-01870-8

Abstract

Purpose: Studies have reported inverse associations of pre-diagnosis recreational physical activity (RPA) level with all-cause and breast cancer (BCa)-specific mortality among BCa patients. However, the association between pre-diagnosis RPA level and BCa recurrence is unclear. We investigated the association between pre-diagnosis RPA level and risk of BCa recurrence in the California Teachers Study (CTS).

Methods: Stage I-IIIb BCa survivors (n = 6,479) were followed with median of 7.4 years, and 474 BCa recurrence cases were identified. Long-term (from high school to age at baseline questionnaire, or, age 55 years, whichever was younger) and baseline (past 3 years reported at baseline questionnaire) pre-diagnosis RPA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of BCa recurrence overall and by estrogen receptor (ER)/progesterone receptor (PR) status.

Results: Long-term RPA was not associated with BCa recurrence risk (p_trend = 0.99). The inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was marginally significant (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.79, 95% CI = 0.60-1.03; p_trend = 0.07). However, the association became non-significant after adjusting for post-diagnosis RPA (p_trend = 0.65). An inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was observed in ER-PR- cases (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.31, 95% CI = 0.13-0.72; p_trend = 0.04), but not in ER+ or PR+ cases (p_trend = 0.97).

Conclusions: Our data indicates that the benefit of baseline RPA on BCa recurrence may differ by tumor characteristics. This information may be particularly important for populations at higher risk of ER-PR- BCa.

Keywords: Breast neoplasms; Estrogen receptor; Exercise; Progesterone receptor; Recurrence.