Running and breast cancer survival

Jacob Schor ND, FABNO

March 7, 2014

www.DenverNaturopathic.com

 

 

A recent paper by Paul Williams that appeared in a January issue of the International Journal of Cancer will force me to change what I’ve been telling patients. For the past half dozen years, I have strongly encouraged breast cancer patients to walk daily based on data from Irwin et al’s 2007 paper that suggested a possible 45% reduction in death rate. [1] When patients have asked whether more exercise would be better, all I could do was shrug, we didn’t know and more of something that’s good for you is not necessarily better. Williams’ paper clears this up. It’s better for breast cancer patients to run than to walk for exercise.

 

Williams PT. Significantly greater reduction in breast cancer mortality from post-diagnosis running than walking. Int J Cancer. 2014 Jan 27. doi: 10.1002/ijc.28740.

 

Williams used Cox proportional hazard analyses to prospectively compare breast cancer mortality to baseline exercise energy expenditures and to test whether post-diagnosis running and walking differ significantly in their association with breast cancer mortality.

 

He analyzed data from 272 runners and 714 walkers from the National Runners' and Walkers' Health Studies who were previously diagnosed with breast cancer. Forty-six women (13 runners and 33 walkers) died from breast cancer during 9.1-years of the study. The survey data allowed the calculation of Metabolic Equivalent (METs) per hour per day and these were compared with risk of dying.

 

When data from runners and walkers were looked at together, the risk of dying from breast cancer decreased an average of 24% per metabolic equivalent (MET) hours per day of exercise, where one MET hour equals a little less than a mile of brisk walking or about two-thirds of a mile of running.

 

When the runners and walkers were analyzed separately, there was significantly lower mortality in the runners.              The runners’ risk for breast cancer mortality decreased over 40% per MET hour per day. Runners that averaged over 2.25 miles running per day were at 95% lower risk for breast cancer mortality than those that did not meet current exercise recommendations. In contrast, the walkers’ risk for breast cancer mortality decreased only a non-significant 5% per MET hour per day, much less than Irwin had reported in 2007.

 

 

Physical activity may improve survival in women diagnosed with breast cancer, yet the evidence is not consistent. While a number of other studies have already shown physical activity significantly reduces breast cancer mortality [2-7], several other studies have not demonstrated a significant reduction [8-12]. Still, when data is combined via meta-analyses, there is stronger evidence for improved survival with greater physical activity. For example data from 13,302 breast cancer survivors of the After Breast Cancer Pooling Project suggest that meeting the current physical activity recommendations is associated with a 25% reduction in breast cancer mortality [13].

 

Meta-analyses that combine study results provide stronger evidence for improved survival. For example, Haskell et al reported that meeting the current physical activity recommendations has been associated with a 25% reduction in breast cancer mortality in 13,302 breast cancer survivors of the After Breast Cancer Pooling Project [14] .

 

(These recommendations for physical activity suggest that, “…all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week” [15] .)

 

Two other meta-analyses reached similar conclusions. Patterson et al found 29% (including lifetime and at diagnosis physical activity) [16] and Ibrahim et al found 34% reductions [17] in breast cancer mortality with post-diagnosis physical activity when various study results were combined.

 

There are aspects of this study that will be criticized, in particular the self-reporting by the participants, lack of information on cancer stage at diagnosis, type of breast cancer it was and what treatment the women underwent.

 

There is low risk of harm from encouraging more physical activity and encouraging greater exercise intensity in women who have been diagnosed with breast cancer. The possibility that such a simple intervention as running might prove useful as Williams’ study suggests is certainly intriguing. We now have reason, at least for the moment, to encourage certain patients, at least those who have been diagnosed with breast cancer, to take up running.

 

 

Citation:

Reference: Williams PT. Significantly greater reduction in breast cancer mortality from post-diagnosis running than walking. Int J Cancer. 2014 Jan 27. doi: 10.1002/ijc.28740. [Epub ahead of print]

 

References:

 

1. Irwin ML1, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, Baumgartner RN, Baumgartner KB,Bernstein L. Influence of pre- and postdiagnosis physical activity on mortality in breastcancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008 Aug 20;26(24):3958-64. doi: 10.1200/JCO.2007.15.9822.

 

2. Holick CN, Newcomb PA, Trentham-Dietz A, Titus-Ernstoff L, Bersch AJ, Stampfer MJ, Baron JA, Egan KM, Willett WC. Physical activity and survival after diagnosis of

invasive breast cancer. Cancer epidemiology, biomarkers & prevention : a publication of

the American Association for Cancer Research, cosponsored by the American Society of

Preventive Oncology. 2008;17:379–386.

 

3. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical Activity and Survival After Breast Cancer Diagnosis. JAMA: The Journal of the American Medical Association. 2005;293:2479–2486.

 

4. Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD,

Baumgartner RN, Baumgartner KB, Bernstein L. Influence of pre- and postdiagnosis

physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol 2008;26:3958–64.

 

5. Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML,

Wactawski-Wende J, Craft L, Lane D, Martin LW, Chlebowski R. Physical activity and

survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res (Phila) 2011;4:522–529.

 

6. Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer

2009;124:1954–62.

 

7. Abrahamson PE, Gammon MD, Lund MJ, Britton JA, Marshall SW, Flagg EW, PorterPL, Brinton LA, Eley JW, Coates RJ. Recreational physical activity and survival among young women with breast cancer. Cancer. 2006;107:1777-85.

 

8. Sternfeld B, Weltzien E, Quesenberry Jr CP Jr, Castillo AL, Kwan M, Slattery ML, Caan BJ. Physical activity and risk of recurrence and mortality in breast cancer survivors:

findings from the LACE study. Cancer Epidemiol Biomarkers Prev 2009;18:87–95.

 

9. Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-DelaimyWK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. Journal of Clinical Oncology: official journal of the American Society of Clinical Oncology. 2007;25:2345–51

 

10. Borugian MJ, Sheps SB, Kim-Sing C, Van Patten C, Potter JD, Dunn B, Gallagher RP, Hislop TG. Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev 2004;13:1163–72.

 

12. Enger SM, Bernstein L. Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer 2004;90:2138–41.

 

13. Dal Maso L, Zucchetto A, Talamini R, Serraino D, Stocco CF, Vercelli M, Falcini F,

Franceschi S. Prospective Analysis of Case-control studies on Environmental factors and

health (PACE) study group. Effect of obesity and other lifestyle factors on mortality in

women with breast cancer. Int J Cancer. 2008;123:2188-94.

 

14. Cadmus-Bertram L, Patterson RE, Sternfeld B, Shu XO, Pierce JP, Caan BJ. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 2012;131:637-43.

 

15. Beasley JM, Kwan ML, Chen WY, Weltzien EK, Kroenke CH, Lu W, Nechuta SJ, Cadmus-Bertram L, Patterson RE, Sternfeld B, Shu XO, Pierce JP, Caan BJ. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 2012;131:637-43.

 

16. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.

 

17. Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66:5–15.

 

18. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28:753-65.

 

 

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