1
|
Coelingh Bennink HJT, Schultz IJ, Schmidt M, Jordan VC, Briggs P, Egberts JFM, Gemzell-Danielsson K, Kiesel L, Kluivers K, Krijgh J, Simoncini T, Stanczyk FZ, Langer RD. Progesterone from ovulatory menstrual cycles is an important cause of breast cancer. Breast Cancer Res 2023; 25:60. [PMID: 37254150 DOI: 10.1186/s13058-023-01661-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
Many factors, including reproductive hormones, have been linked to a woman's risk of developing breast cancer (BC). We reviewed the literature regarding the relationship between ovulatory menstrual cycles (MCs) and BC risk. Physiological variations in the frequency of MCs and interference with MCs through genetic variations, pathological conditions and or pharmaceutical interventions revealed a strong link between BC risk and the lifetime number of MCs. A substantial reduction in BC risk is observed in situations without MCs. In genetic or transgender situations with normal female breasts and estrogens, but no progesterone (P4), the incidence of BC is very low, suggesting an essential role of P4. During the MC, P4 has a strong proliferative effect on normal breast epithelium, whereas estradiol (E2) has only a minimal effect. The origin of BC has been strongly linked to proliferation associated DNA replication errors, and the repeated stimulation of the breast epithelium by P4 with each MC is likely to impact the epithelial mutational burden. Long-lived cells, such as stem cells, present in the breast epithelium, can carry mutations forward for an extended period of time, and studies show that breast tumors tend to take decades to develop before detection. We therefore postulate that P4 is an important factor in a woman's lifetime risk of developing BC, and that breast tumors arising during hormonal contraception or after menopause, with or without menopausal hormone therapy, are the consequence of the outgrowth of pre-existing neoplastic lesions, eventually stimulated by estrogens and some progestins.
Collapse
Affiliation(s)
| | - Iman J Schultz
- Pantarhei Bioscience BV, P.O. Box 464, 3700 AL, Zeist, The Netherlands
| | - Marcus Schmidt
- Department of Obstetrics and Gynaecology, University Medical Center Mainz, Mainz, Germany
| | - V Craig Jordan
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paula Briggs
- Sexual and Reproductive Health, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | | | | | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Münster, Münster, Germany
| | - Kirsten Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan Krijgh
- Pantarhei Bioscience BV, P.O. Box 464, 3700 AL, Zeist, The Netherlands
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynaecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Robert D Langer
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA, USA
| |
Collapse
|
2
|
Pérez-Bilbao T, Alonso M, San Juan AF, Bezares S, Gil L, Pollán M, González-Frutos P, Peinado AB, Casla-Barrio S. Case studies in physiology: Training adaptation in an elite athlete after breast cancer diagnosis. J Appl Physiol (1985) 2022; 133:443-448. [PMID: 35861518 DOI: 10.1152/japplphysiol.00504.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the capacity to return to competition of a 28-year-old female 400m hurdle elite athlete after a diagnosis of breast cancer. The study lasted 14 months after diagnosis. She was tested four times (T1-T4) to measure body mass (BM), body mass index (BMI), percentage of total fat mass (TFM%), total fat-free mass (TFFM%), bone mineral density (BMD), one-repetition maximum (1RM) and maximal power (MP) in bench-press and half-squat, maximum oxygen uptake, 400m dash and hurdles. T0 (baseline time) was established with values prior to diagnosis. BM and BMI increased from T0 to T1 (5.3% and 5.2%) and remained stable. BMD experienced no change. TFM% values decreased from T1 to T4 (3.5%). TFFM% values increased from T1 to T3 (0.9%). During T1-T2, the athlete presented a global decline from T0 in 1RMSquat, 1RMBench, MPSquat and MPBench (32.6%, 27.2%, 37.5%, 27.6%, respectively). Results during T3-T4 were also lower for these parameters from T0 (23.3%, 20.6%, 23.4%, 11%). During T1-T2, the VO2max declined, compared to T0 (1.8% and 6.4%), showing a small increase at T3 (+1%) and reaching the lowest level at T4 (9%). During T1-T2, the time record of 400 m dash (8.3%) and hurdles (7.4%) increased. However, a slight improvement was found at T3 (1.3% and 0.6%, respectively). that exercise training improved body composition, maintained BMD and TFFM, but could not completely reverse the worsening of the cardiorespiratory, muscle strength and power, and running performance levels.
Collapse
Affiliation(s)
- Txomin Pérez-Bilbao
- Health and Performance Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain.,Department of Education, Investigation Methods and Evaluation, Faculty of Human and Social Sciences, Comillas Pontifical University, Madrid, Spain
| | - María Alonso
- Health and Performance Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain.,GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | - Alejandro F San Juan
- Health and Performance Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain.,GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - Lucía Gil
- Asociación Española Contra el Cáncer, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Ana B Peinado
- Health and Performance Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain.,LFE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
| | - Soraya Casla-Barrio
- GEICAM Spanish Breast Cancer Group, Madrid, Spain.,Unidad de Ejercicio Oncológico en Tigers Running Club
| |
Collapse
|
3
|
Cathcart-Rake EJ, Ruddy KJ, Bleyer A, Johnson RH. Breast Cancer in Adolescent and Young Adult Women Under the Age of 40 Years. JCO Oncol Pract 2021; 17:305-313. [PMID: 33449828 DOI: 10.1200/op.20.00793] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the United States, one in 196 women is diagnosed with breast cancer under the age of 40 years. Adolescents and young adults (AYAs), of age 15-39 years at diagnosis, experience a number of unique challenges when confronting breast cancer. The incidence of invasive breast cancer has increased among AYA women in the United States since 2004, and most of this change is due to an increase in young women diagnosed with distant disease. AYAs are more likely than older women to present with aggressive subtypes and advanced disease, and they often require systemic staging at diagnosis. Clinical trials should be considered whenever possible, particularly in AYAs with locally advanced or metastatic disease at diagnosis and those with disease progression or recurrence. A significant proportion of AYAs carry germline cancer predisposition mutations, which necessitates prompt genetic testing for all AYAs at diagnosis and may influence choice of local therapy. Suppression of ovarian function, as an adjunct to chemotherapy, may improve breast cancer survival in AYAs. To provide optimal care for AYAs with breast cancer, clinicians should engage multidisciplinary teams that offer fertility preservation, genetic counseling, physical and occupational therapy, nutrition, and psychosocial support, along with medical expertise in tailoring cancer-directed therapy and symptom management toward young women.
Collapse
Affiliation(s)
| | | | - Archie Bleyer
- St Charles Health System, Central Oregon Health and Science University, Portland, OR
| | | |
Collapse
|
4
|
Hidayat K, Zhou HJ, Shi BM. Influence of physical activity at a young age and lifetime physical activity on the risks of 3 obesity-related cancers: systematic review and meta-analysis of observational studies. Nutr Rev 2020; 78:1-18. [PMID: 31393566 DOI: 10.1093/nutrit/nuz024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Excess weight has been linked to increased risks of 13 types of cancers. Physical activity is a non-nutritional modifiable lifestyle factor that is not only crucial for weight control but is also known to regulate hormones and metabolic pathways that may contribute to carcinogenesis. There is solid evidence that being physically active during middle and late adulthood lowers the risks of 3 obesity-related cancers, namely breast cancer, colon cancer, and endometrial cancer. However, the associations between physical activity at a young age (childhood, adolescence, and young adulthood; age 5 to ≤30 yr) and lifetime physical activity and the risks of breast cancer, colon cancer, and endometrial cancer are less defined. OBJECTIVE The present systematic review and meta-analysis of observational studies was performed in accordance with the MOOSE guidelines to determine whether physical activity at a young age and lifetime physical activity may lower the risks of breast cancer, colon cancer, and endometrial cancer. DATA SOURCES The PubMed and Web of Science databases were searched for relevant observational studies published from inception to July 2018. STUDY SELECTION Observational studies (prospective cohort, case-cohort, nested case-control, historical cohort, and case-control) were considered relevant if they investigated the association between physical activity at a young age or lifetime physical activity and the risks of developing selected cancers. DATA EXTRACTION A random-effects meta-analysis was performed to generate the summary relative risk (RR) with 95%CI for the highest vs the lowest category of physical activity of any type. RESULTS Eighty publications were included in the present meta-analysis. Higher physical activity at a young age was associated with lower risks of breast cancer (RR 0.81, 95%CI 0.76, 0.87) and colon cancer (RR 0.67, 95%CI 0.50, 0.88). Similarly, lifetime physical activity was inversely associated with the risks of breast cancer (RR 0.79, 95%CI 0.72, 0.86) and colon cancer (RR 0.75, 95%CI 0.69, 0.82). For breast cancer, menopausal status did not appear to modify the observed inverse association. The benefit with respect to endometrial cancer risk reduction was only observed with higher lifetime physical activity (RR 0.77, 95%CI 0.67, 0.88), not with higher physical activity at a young age (RR 0.89, 95%CI 0.73, 1.07). CONCLUSIONS Being physically active over a lifetime, starting from early childhood, may lower the risks of developing breast cancer, colon cancer, and endometrial cancer.
Collapse
Affiliation(s)
- Khemayanto Hidayat
- K. Hidayat, H.-J. Zhou, and B.-M. Shi are with the Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui-Juan Zhou
- K. Hidayat, H.-J. Zhou, and B.-M. Shi are with the Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bi-Min Shi
- K. Hidayat, H.-J. Zhou, and B.-M. Shi are with the Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
5
|
Luo H, Galvão DA, Newton RU, Fairman CM, Taaffe DR. Sport Medicine in the Prevention and Management of Cancer. Integr Cancer Ther 2020; 18:1534735419894063. [PMID: 31838880 PMCID: PMC6913064 DOI: 10.1177/1534735419894063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Physical inactivity is a major concern in cancer patients despite the established preventative and therapeutic effects of regular physical exercise for this patient group. Sport not only plays an important role in supporting the development and maintenance of a physically active lifestyle but also is increasingly used as a health promotion activity in various populations. Nevertheless, the potential of sport as an effective strategy in the prevention and management of cancer has gained little attention. Based on the scant evidence to date, participation of cancer patients in supervised, well-tailored sport programs appears to be safe and feasible and is associated with an array of physical and psychological benefits. We propose that sport participation may serve as an alternative strategy in the prevention of cancer and sport medicine in the management of cancer. As with the traditional exercise modes, benefits derived from sport participation will be dependent on the sport undertaken and the physical/physiological, motor, and cognitive demands required. To this end, further work is required to develop a solid evidence base in this field so that targeted sport participation can be recommended for cancer patients.
Collapse
Affiliation(s)
- Hao Luo
- Guangdong Vocational Institute of Sport, Guangzhou, Guangdong, China.,Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia.,The University of Hong Kong, Hong Kong
| | | | - Dennis R Taaffe
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
6
|
Li F, Bai M, Xu J, Zhu L, Liu C, Duan R. Long-Term Exercise Alters the Profiles of Circulating Micro-RNAs in the Plasma of Young Women. Front Physiol 2020; 11:372. [PMID: 32477155 PMCID: PMC7233279 DOI: 10.3389/fphys.2020.00372] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/30/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: The objective of this paper was to study the effects of long-term exercise on circulating microRNAs (miRNAs) in human plasma. Methods: Whole blood was collected from 10 female elite athletes with at least 5 years of training experience in a Synchronized Swimming Group (S group) and 15 female college students without regular exercise training (C group). Plasma miRNAs were then isolated, sequenced, and semi-quantified by the second-generation sequencing technology, and the results were analyzed by bioinformatics methods. Results: We found 380 differentially expressed miRNAs in the S group compared with the C group, among which 238 miRNAs were upregulated and 142 were downregulated. The top five abundant miRNAs in the 380 miRNAs of the S group are hsa-miR-451a, hsa-miR-486, hsa-miR-21-5p, hsa-miR-423-5p, and hsa-let-7b-5p. Muscle-specific/enriched miRNAs were not significantly different, except for miR-206 and miR-486. According to the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, a large proportion of the differentially expressed miRNAs are targeted in cancer-related pathways, including proteoglycans in cancer and miRNAs in cancer and basal cell carcinoma. As the levels of circulating miRNAs (ci-miRNAs) are commonly known to be significantly deregulated in cancer patients, we further compared the levels of some well-studied miRNAs in different types of cancer patients with those in the S group and found that long-term exercise regulates the level of ci-miRNAs in an opposite direction to those in cancer patients. Conclusion: Long-term exercise significantly alters the profiles of plasma miRNAs in healthy young women. It may reduce the risk of certain types of cancers by regulating plasma miRNA levels.
Collapse
Affiliation(s)
- Fan Li
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Muwei Bai
- Laboratory of Laser Sports Medicine, School of Physical Education and Sports Science, South China Normal University, Guangzhou, China.,Department of Physical Education, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianfang Xu
- China Institute of Sport Science, Beijing, China
| | - Ling Zhu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Chengyi Liu
- Laboratory of Laser Sports Medicine, School of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Rui Duan
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| |
Collapse
|
7
|
Melo L, Hagar A. How to train a mouse-methodological issues in pre-clinical exercise oncology. Am J Cancer Res 2019; 9:1246-1253. [PMID: 31285956 PMCID: PMC6610064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 06/09/2023] Open
Abstract
We point at several challenges that current exercise oncology rodent models face, which call their human-relevance into question: the vast majority of pre-clinical studies in exercise oncology treat "physical exercise" as a primitive concept without further analysis or qualification, and their results are based on dosages that no human can endure. The lack of analysis and qualification together with the dosage mismatch conceal the fact that rodents do not run like humans. Consequently, while these pre-clinical studies may yield insights into potential biological mechanisms underlying the systemic effects of physical exercise on cancer, the applicability of this knowledge to preventive interventions in healthy humans and the ability to translate it to practical therapies in the critically ill remain limited. We propose an alternative exercise rodent model that has better chances of meeting these challenges.
Collapse
Affiliation(s)
- Luma Melo
- Department of Environmental Health, School of Public Health, Indiana UniversityBloomington, IN 47405, USA
- Department of History & Philosophy of Science & Medicine, Indiana UniversityBloomington, IN, USA
| | - Amit Hagar
- Department of Environmental Health, School of Public Health, Indiana UniversityBloomington, IN 47405, USA
- Department of Intelligent Systems Engineering, Indiana UniversityBloomington, IN, USA
- Department of History & Philosophy of Science & Medicine, Indiana UniversityBloomington, IN, USA
| |
Collapse
|
8
|
Chen X, Wang Q, Zhang Y, Xie Q, Tan X. Physical Activity and Risk of Breast Cancer: A Meta-Analysis of 38 Cohort Studies in 45 Study Reports. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:104-128. [PMID: 30661625 DOI: 10.1016/j.jval.2018.06.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate and quantify the association between physical activity (PA) and risk of breast cancer. METHODS A systematic review meta-analysis was conducted. The literature was independently and manually searched by 2 reviewers through 3 English databases (PubMed, Embase, and ISI Web of Science) for data till October 2017. The quality of included studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Fixed-effects models were used to estimate the pooled relative risk and 95% confidence intervals (95% CI). Dose-response analysis was chosen for quantifying the association between PA and risk of breast cancer. The Begg test and the Egger test were used to estimate potential publication bias. Heterogeneity between studies was evaluated with I2 statistics. RESULTS The meta-analysis included 38 cohort studies published between 1994 and 2017, which included 68 416 breast cancer cases. The overall relative risk (ORR) for breast cancer was 0.87 (95% CI 0.84-0.90). The inverse association was consistent among all subgroup analyses. In subgroup analysis by menopausal status, the ORR of breast cancer was 0.83 (95% CI 0.79-0.87) for premenopausal status and 0.91 (95% CI 0.85-0.97) for postmenopausal status. In subgroup analysis by PA type, the ORR for total activity was 0.87 (95% CI 0.81-0.93), for recreational activity 0.88 (95% CI 0.85-0.91), for occupational activity 0.91 (95% CI 0.84-0.99), and for nonoccupational activity 0.87 (95% CI 0.83-0.92). The risk of breast cancer was significantly lower in people with exposure periods longer than 1 year and less than 5 years (ORR 0.62; 95% CI 0.46-0.78), followed by those with lifetime activity (ORR 0.81; 95% CI 0.69-0.93). The ORR for subjects with body mass index of less than 25 kg/m2 (0.88; 95% CI 0.83-0.93) was close to that for subjects with body mass index of more than 25 kg/m2 (0.87; 95% CI 0.77-0.97). A linear relationship was found between breast cancer risk and PA (recreational activity and total activity), and the ORR was reduced by 3% (95% CI 0.95-0.99) for every 10 metabolic equivalent of energy hours per week increment in recreational PA and by 2% (95% CI 0.97-0.99) for every 10 metabolic equivalent of energy hours per week increment in total PA. CONCLUSIONS PA is significantly associated with a decrease in the risk of breast cancer.
Collapse
Affiliation(s)
- Xuyu Chen
- School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Qiru Wang
- School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Yanan Zhang
- School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Qian Xie
- School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Xiaodong Tan
- School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China.
| |
Collapse
|
9
|
Milk intake and mammographic density in premenopausal women. Breast Cancer Res Treat 2018; 174:249-255. [PMID: 30456438 DOI: 10.1007/s10549-018-5062-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Mammographic density is a strong risk factor for breast cancer. Although diet is associated with breast cancer risk, there are limited studies linking adult diet, including milk intake, with mammographic density. Here, we investigate the association of milk intake with mammographic density in premenopausal women. METHODS We analyzed data from 375 cancer-free premenopausal women who had routine screening mammography at Washington University School of Medicine, St. Louis, Missouri in 2016. We used Volpara to measure volumetric percent density, dense volume, and non-dense volume. We collected information on recent milk intake (past 12 months), and categorized skim milk and low/reduced-fat milk intake into 4 groups: < 1/week, 1/week, 2-6 times/week, ≥ 1/day, while whole and soy milk intake were categorized into 2 groups: < 1/week, ≥ 1/week. We used multivariable linear regression model to evaluate the associations of milk intake and log-transformed volumetric percent density, dense volume, and non-dense volume. RESULTS In multivariable analyses, volumetric percent density was 20% (p-value = 0.003) lower in the 1/week group, 14% (p-value = 0.047) lower in the 2-6/week group, and 12% (p-value = 0.144) lower in the ≥ 1/day group (p-trend = 0.011) compared with women who consumed low/reduced-fat milk < 1/week. Attenuated and non-significant associations were observed for low/reduced-fat milk intake and dense volume. There were no associations of whole, skim, and soy milk intake with volumetric percent density and dense volume. CONCLUSIONS Recent low/reduced-fat milk intake was inversely associated with volumetric percent density in premenopausal women. Studies on childhood and adolescent milk intake and adult mammographic density in premenopausal women are needed.
Collapse
|
10
|
|
11
|
Hardefeldt PJ, Penninkilampi R, Edirimanne S, Eslick GD. Physical Activity and Weight Loss Reduce the Risk of Breast Cancer: A Meta-analysis of 139 Prospective and Retrospective Studies. Clin Breast Cancer 2018; 18:e601-e612. [DOI: 10.1016/j.clbc.2017.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 09/21/2017] [Accepted: 10/11/2017] [Indexed: 12/17/2022]
|
12
|
Worse survival after breast cancer in women with anorexia nervosa. Breast Cancer Res Treat 2017; 168:495-500. [PMID: 29235044 DOI: 10.1007/s10549-017-4618-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE A history of anorexia nervosa has been associated with a reduced risk of developing breast cancer. We investigated survival after breast cancer among women with a prior anorexia nervosa diagnosis compared with women in a population comparison group. METHODS This register-based study included combined data from Sweden, Denmark and Finland. A total of 76 and 1462 breast cancer cases identified among 22,654 women with anorexia nervosa and 224,619 women in a population comparison group, respectively, were included in the study. Hazard ratios (HR) for overall and breast cancer-specific mortality after breast cancer diagnosis were estimated using Cox regression. Cause of death was available only for Swedish and Danish women; therefore, the analysis on breast cancer-specific mortality was restricted to these women. RESULTS We observed 23 deaths after breast cancer among anorexia nervosa patients and 247 among population comparisons. The overall mortality after the breast cancer diagnosis was increased in women with a history of anorexia nervosa compared with population comparisons (HR 2.5, 95% CI 1.6-3.9) after adjustment for age, period and extent of disease. Results were similar for overall (HR 2.3, 95% CI 1.4-3.6) and breast cancer-specific mortality (HR 2.1, 95% CI 1.3-3.6) among Swedish and Danish women. CONCLUSIONS We found that female breast cancer patients with a prior diagnosis of anorexia nervosa have a worse survival compared with other breast cancer patients.
Collapse
|
13
|
Tinker A, Haines E, Molloy L, Pennells L, Russell E, Monks I. What future for older women ex-athletes? Med Chir Trans 2017; 110:129-130. [DOI: 10.1177/0141076817692157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anthea Tinker
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Elodie Haines
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Laura Molloy
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Laura Pennells
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Evelina Russell
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| | - Imogen Monks
- Institute of Gerontology, King’s College London, London WC2R 2LS, UK
| |
Collapse
|
14
|
Moderate-vigorous recreational physical activity and breast cancer risk, stratified by menopause status: a systematic review and meta-analysis. Menopause 2017; 24:322-344. [DOI: 10.1097/gme.0000000000000745] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
15
|
Physical activity, hormone replacement therapy and breast cancer risk: A meta-analysis of prospective studies. Eur J Cancer 2015; 52:138-54. [PMID: 26687833 DOI: 10.1016/j.ejca.2015.10.063] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lower risk of breast cancer has been reported among physically active women, but the risk in women using hormone replacement therapy (HRT) appears to be higher. We quantified the association between physical activity and breast cancer, and we examined the influence that HRT use and other risk factors had on this association. METHODS After a systematic literature search, prospective studies were meta-analysed using random-effect models applied on highest versus lowest level of physical activity. Dose-response analyses were conducted with studies reporting physical activity either in hours per week or in hours of metabolic equivalent per week (MET-h/week). RESULTS The literature search identified 38 independent prospective studies published between 1987 and 2014 that included 116,304 breast cancer cases. Compared to the lowest level of physical activity, the highest level was associated with a summary relative risk (SRR) of 0.88 (95% confidence interval [CI] 0.85, 0.90) for all breast cancer, 0.89 (95% CI 0.83, 0.95) for ER+/PR+ breast cancer and 0.80 (95% CI 0.69, 0.92) for ER-/PR- breast cancer. Risk reductions were not influenced by the type of physical activity (occupational or non-occupational), adiposity, and menopausal status. Risk reductions increased with increasing amounts of physical activity without threshold effect. In six studies, the SRR was 0.78 (95% CI 0.70, 0.87) in women who never used HRT and 0.97 (95% CI 0.88, 1.07) in women who ever used HRT, without heterogeneity in results. Findings indicate that a physically inactive women engaging in at least 150 min per week of vigorous physical activity would reduce their lifetime risk of breast cancer by 9%, a reduction that might be two times greater in women who never used HRT. CONCLUSION Increasing physical activity is associated with meaningful reductions in the risk of breast cancer, but in women who ever used HRT, the preventative effect of physical activity seems to be cancelled out.
Collapse
|
16
|
Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Franklin NC, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D. Healthy Lifestyle Interventions to Combat Noncommunicable Disease—A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Mayo Clin Proc 2015; 90:1082-103. [PMID: 26143646 DOI: 10.1016/j.mayocp.2015.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/19/2015] [Accepted: 05/01/2015] [Indexed: 01/14/2023]
Abstract
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.
Collapse
|
17
|
Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Cherie Franklin N, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D, Arena R, Berra K, Dengel D, Franklin NC, Hivert MF, Kaminsky L, Lavie CJ, Lloyd-Jones DM, Myers J, Whitsel L, Williams M, Corra U, Cosentino F, Dendale P, Giannuzzi P, Gielen S, Guazzi M, Halle M, Niebauer J, Pelliccia A, Piepoli MF, Pinto FJ, Guthrie G, Lianov L, Shurney D. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J 2015; 36:2097-2109. [PMID: 26138925 DOI: 10.1093/eurheartj/ehv207] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carl J Lavie
- University of Queensland School of Medicine, New Orleans, LA
| | | | - Jonathan Myers
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University, Stanford, CA
| | | | | | | | - Ugo Corra
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - George Guthrie
- Center for Family Medicine at Florida Hospital, Winter Park, FL
| | - Liana Lianov
- American College of Lifestyle Medicine, Chesterfield, MO
| | | |
Collapse
|
18
|
Sorenson SC, Romano R, Azen SP, Schroeder ET, Salem GJ. Life span exercise among elite intercollegiate student athletes. Sports Health 2015; 7:80-6. [PMID: 25553217 PMCID: PMC4272691 DOI: 10.1177/1941738114534813] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Despite prominent public attention, data on life span health and exercise outcomes among elite, competitive athletes are sparse and do not reflect the diversity of modern athletes. Hypothesis: Life span exercise behavior differs between National Collegiate Athletic Association (NCAA) student athletes and a nonathlete control group. Sustained exercise is associated with improved cardiopulmonary health outcomes. Study Design: Cross-sectional, descriptive epidemiology study. Level of Evidence: Level 3. Methods: A total of 496 students and alumni (age range, 17-84 year) at a large, NCAA Division I university, including student athletes and an age- and sex-matched nonathlete control group, completed anonymous, self-report health and exercise questionnaires. Age-stratified, cross-sectional analysis evaluated previous week’s total exercise volume (ExVol), self-rated exercise importance (ExImp), and compliance with American College of Sports Medicine (ACSM) exercise guidelines for healthy adults. The association of ACSM guideline compliance with lifetime cardiopulmonary health outcomes was also assessed. Results: Current student athletes reported significantly greater ExVol (P < 0.001. Cohen d = 0.99, probability of clinically important difference [pCID] >99.5%), ExImp (P < 0.001, d = 1.96, pCID = 96%), and likelihood of compliance with ACSM guidelines (odds ratio [OR], 95% confidence interval [CI] = 30.6, 11.0-84.6) compared with nonathletes. No significant differences were found between alumni student athletes and nonathletes. Alumni student athletes demonstrated substantially lower ExVol (P < 0.001, d = –0.94, pCID >99.5%) and guideline compliance (OR = 0.09, 95% CI = 0.05-0.19) compared with current student athletes, whereas nonathletes had similar exercise behavior across the life span. Among alumni, ACSM guideline compliance was associated with significant attenuation of cardiopulmonary health concerns (P = 0.02, d = –0.50, pCID = 14%) independent of intercollegiate athletic participation. Conclusion: Although current NCAA Division I student athletes demonstrated significant, clinically important differences in exercise behavior compared with nonathletes, no group differences were evident later in life. Irrespective of collegiate athletic status, healthy exercise behavior among alumni was associated with cardiopulmonary health benefits. Clinical Relevance: To realize life span health benefits, it is imperative that student athletes maintain consistent patterns of healthy exercise beyond retirement from competitive sports.
Collapse
Affiliation(s)
- Shawn C Sorenson
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Russell Romano
- Department of Athletic Medicine, University of Southern California, Los Angeles, California
| | - Stanley P Azen
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - E Todd Schroeder
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - George J Salem
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| |
Collapse
|
19
|
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A. Health in older women athletes. Maturitas 2014; 79:357-61. [PMID: 25281439 DOI: 10.1016/j.maturitas.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 11/18/2022]
Abstract
Physical activity has been identified as a protective factor against a wide spectrum of diseases, but little is known about the link between older women's health and their professional involvement in sport in the past. The aim of this narrative review is to characterize and summarize the available data concerning the influence of physical activity on morbidity and mortality in former female athletes. Concerning bone health, it seems that physical activity in the past can be protective against osteoporosis in postmenopausal women, but these data come from observational studies only. Also the cardiovascular system appears to benefit in older women from regular sport in the past. This refers mainly to better heart efficiency, and improved endothelial function and metabolic profile. The incidence of different types of neoplasms, especially breast cancer, is also decreased in former athletes. Professional sport, on the other hand, acts negatively on the pelvic floor and is a risk factor for urinary incontinence. The overall effect on mortality is difficult to assess, because of many parameters, such as the sport's intensity, variety of the sport and exposure to extreme danger in some disciplines. Also, caution should be kept in interpretation of the data because of the shortage of well-designed studies.
Collapse
Affiliation(s)
- Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland.
| | - Krzysztof Katulski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - Adam Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| | - Agnieszka Podfigurna-Stopa
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, 60-535 Poznan, Poland
| |
Collapse
|
20
|
Sorenson SC, Romano R, Scholefield RM, Martin BE, Gordon JE, Azen SP, Schroeder ET, Salem GJ. Holistic life-span health outcomes among elite intercollegiate student-athletes. J Athl Train 2014; 49:684-95. [PMID: 25117874 DOI: 10.4085/1062-6050-49.3.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Competitive sports are recognized as having unique health benefits and risks, and the effect of sports on life-span health among elite athletes has received increasing attention. However, supporting scientific data are sparse and do not represent modern athletes. OBJECTIVE To assess holistic life-span health and health-related quality-of-life (HRQL) among current and former National Collegiate Athletic Association student-athletes (SAs). DESIGN Cross-sectional study. SETTING A large Division I university. PATIENTS OR OTHER PARTICIPANTS Population-based sample of 496 university students and alumni (age 17-84 years), including SAs and an age-matched and sex-matched nonathlete (NA) control group. MAIN OUTCOME MEASURE(S) Participants completed anonymous, self-report questionnaires. We measured the Short-Form 12 (SF-12) physical and mental component HRQL scores and cumulative lifetime experience and relative risk of treatment for joint, cardiopulmonary, and psychosocial health concerns. RESULTS Older alumni (age 43+ years) SAs reported greater joint health concerns than NAs (larger joint summary scores; P = .04; Cohen d = 0.69; probability of clinically important difference [pCID] = 77%; treatment odds ratio [OR] = 14.0, 95% confidence interval [CI] = 1.6, 126). Joint health for current and younger alumni SAs was similar to that for NAs. Older alumni reported greater cardiopulmonary health concerns than younger alumni (summary score P < .001; d = 1.05; pCID = 85%; OR = 5.8, 95% CI = 2.0, 16) and current students (P < .001; d = 2.25; pCID >99.5%; OR = 7.1, 95% CI = 3.3, 15), but the risk was similar for SAs and NAs. Current SAs demonstrated evidence of better psychosocial health (summary score P = .006; d = -0.52; pCID = 40%) and mental component HRQL (P = .008; d = 0.50; pCID = 48%) versus NAs but similar psychosocial treatment odds (OR = 0.87, 95% CI = 0.39, 1.9). Psychosocial health and mental component HRQL were similar between alumni SAs and NAs. No differences were observed between SAs and NAs in physical component HRQL. CONCLUSIONS The SAs demonstrated significant, clinically meaningful evidence of greater joint health concerns later in life, comparable cardiopulmonary health, and differences in life-span psychosocial health and HRQL profiles compared with NAs. These data provide timely evidence regarding a compelling public issue and highlight the need for further study of life-span health among modern athletes.
Collapse
Affiliation(s)
- Shawn C Sorenson
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Cuzick J. IBIS II: a breast cancer prevention trial in postmenopausal women using the aromatase inhibitor anastrozole. Expert Rev Anticancer Ther 2014; 8:1377-85. [DOI: 10.1586/14737140.8.9.1377] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
22
|
Wyshak G. Health disparities paradoxes: Depression and chronic back pain in college alumnae and U.S. women, 39–49. Scand J Public Health 2013; 41:230-2. [PMID: 23287395 DOI: 10.1177/1403494812470508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: In the US, higher SES (socio-economic status) groups and white Americans tend to be “healthier” than less advantaged groups. Elimination of disparities is a major public health goal. This study examines disparities for two highly prevalent medical conditions – depression and chronic back pain – and selected medical conditions and behavioral practices. The aim is to provide evidence that may have public health implications for prevention as well as for treatment. Methods: Data from two groups of women: 1) 1704 college-educated women who responded to a self-report questionnaire; and 2) women whose data are reported in the U.S. Health Interview survey and in epidemiologic studies of depression and chronic back pain were compared for depression, chronic back pain and selected behavioral practices and medical conditions reported by the two groups of women. Results: The percentages reporting depression were 17.6 and 16.6; for chronic back pain 9.6 and 10.2 – non statistically-significant differences. For other conditions, the higher SES women had significantly more favorable outcomes. Conclusions: The paradox of no SES disparities for depression and low back pain raises a number of questions regarding the underlying mechanisms; and also has implications for prevention and treatment strategies of the two highly prevalent conditions.
Collapse
Affiliation(s)
- Grace Wyshak
- Harvard Medical School and Harvard School of Public Health, USA
| |
Collapse
|
23
|
Loprinzi PD, Cardinal BJ, Smit E, Winters-Stone KM. Physical activity and breast cancer risk. J Exerc Sci Fit 2012. [DOI: 10.1016/j.jesf.2012.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
24
|
Veljkovic M, Dopsaj V, Dopsaj M, Branch DR, Veljkovic N, Sakarellos-Daitsiotis MM, Veljkovic V, Glisic S, Colombatti A. Physical activity and natural anti-VIP antibodies: potential role in breast and prostate cancer therapy. PLoS One 2011; 6:e28304. [PMID: 22140573 PMCID: PMC3227651 DOI: 10.1371/journal.pone.0028304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 11/05/2011] [Indexed: 12/14/2022] Open
Abstract
Background There is convincing evidence from numerous clinical and epidemiological studies that physical activity can reduce the risk for breast and prostate cancer. The biological mechanisms underlying this phenomenon remain elusive. Herein we suggest a role for naturally produced antibodies reactive with the vasoactive intestinal peptide (VIP) in the suppression of breast and prostate cancer, which we believe could offer a possible molecular mechanism underlying control of these cancers by physical exercise. Methodology and Results We found that sera from individuals having breast and prostate cancers have decreased titers of VIP natural antibodies as demonstrated by a lower reactivity against peptide NTM1, having similar informational and structural properties as VIP. In contrast, sera collected from elite athletes, exhibited titers of natural NTM1-reactive antibodies that are significantly increased, suggesting that physical activity boosts production of these antibodies. Significance Presented results suggest that physical exercise stimulates production of natural anti-VIP antibodies and likely results in suppression of VIP. This, in turn, may play a protective role against breast and prostate cancers. Physical exercise should be further investigated as a potential tool in the treatment of these diseases.
Collapse
Affiliation(s)
| | - Violeta Dopsaj
- Institute of Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Milivoj Dopsaj
- Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
| | | | - Nevena Veljkovic
- Center for Multidisciplinary Research, Institute of Nuclear Sciences VINCA, Belgrade, Serbia
| | | | - Veljko Veljkovic
- Center for Multidisciplinary Research, Institute of Nuclear Sciences VINCA, Belgrade, Serbia
- * E-mail:
| | - Sanja Glisic
- Center for Multidisciplinary Research, Institute of Nuclear Sciences VINCA, Belgrade, Serbia
| | - Alfonso Colombatti
- Divisione di Oncologia Sperimentale, Centro di Riferimento Oncologico CRO-IRCCS, Aviano, Italy
| |
Collapse
|
25
|
Wyshak G. Weight change, obesity, mental health, and health perception: self-reports of college-educated women. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 9:48-54. [PMID: 17599168 PMCID: PMC1894847 DOI: 10.4088/pcc.v09n0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 07/05/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Overweight, weight cycling, and obesity are major health risks with psychological effects that should not be overlooked by mental health professionals. METHOD This article examines behavioral and other factors associated with weight, weight changes, and obesity in 3940 college-educated women, using data from responses to self-administered mailed questionnaires received from fall 1996 to winter 1997. RESULTS The mean age of the women was 53.6 years, SD = 12.2. Body mass indexes, prevalence of obesity, and behavioral practices were more favorable than those of women in the general U.S. population. The mean body mass index of the sample was 23.3; median, 22.5; 6.5% were obese, 5% currently smoked, and 68% exercised regularly. Over the past 10 years, 31% maintained the same weight, 11% lost weight, 48% gained weight, and 10% gained and lost weight. Women who both gained and lost weight were more likely to report physician-diagnosed depression, alcoholism, and/or drug dependencies compared to women in the other 3 categories; the multivariable odds ratios are 1.48 (95% CI = 1.07, 2.05) versus those who maintained their weight, 1.38 (95% CI = 1.06, 1.80) versus those who gained weight, and 1.53 (95% CI = 1.06, 2.21) versus those who lost weight. Those who both lost and gained weight were also more likely to report having to forgo mental health care for financial reasons; the respective multivariable odds ratios versus those who maintained their weight, gained weight, and lost weight are 2.01 (95% CI = 1.28, 3.16), 2.21 (95% CI = 1.52, 3.22), and 2.19 (95% CI = 1.23, 3.89). CONCLUSION These findings affirm the view that mental health care deserves attention in the treatment of patients with problems with weight changes and weight control.
Collapse
Affiliation(s)
- Grace Wyshak
- Department of Psychiatry, Harvard Medical School; and the Department of Population and Department of International Health and Biostatistics, Harvard School of Public Health, Boston, Mass, USA.
| |
Collapse
|
26
|
Pudrovska T, Anishkin A, Shen Y. Early-Life Socioeconomic Status and the Prevalence of Breast Cancer in Later Life. Res Aging 2011; 34:302-320. [PMID: 22936839 DOI: 10.1177/0164027511415632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Knowledge of mechanisms linking early-life social environment and breast cancer remains limited. We explore direct and indirect effects of early-life socioeconomic status (SES) on breast cancer prevalence in later life. Using 50-year data from the Wisconsin Longitudinal Study (N = 4,275) and structural equation modeling, we found a negative direct effect of early-life SES, indicating that women from higher-SES family background had lower breast cancer prevalence than women from lower-SES families. Additionally, early-life SES has a positive indirect effect on breast cancer via women's adult SES and age at first birth. Were it not for their higher SES in adulthood and delayed childbearing, women from higher-SES families of origin would have had lower breast cancer prevalence than women from lower-SES families. Yet, early-life SES is associated positively with adult SES and age at first birth, and women's higher adult SES and delayed childbearing are related to higher breast cancer prevalence.
Collapse
|
27
|
Tseng M, Olufade TO, Evers KA, Byrne C. Adolescent lifestyle factors and adult breast density in U.S. Chinese immigrant women. Nutr Cancer 2011; 63:342-9. [PMID: 21391125 DOI: 10.1080/01635581.2011.535955] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined recalled measures of adolescent diet, physical activity, and body size in relation to adult breast density in 201 U.S. Chinese immigrant women recruited in January 2002 to May 2003 from Philadelphia region screening programs. Mammographic images were classified into 1 of 4 categories ranging from "entirely fatty" to "extremely dense." Questionnaires assessed diet and physical activity between ages 12-17, relative weight and height at age 10, and weight at age 18. To estimate odds ratios (ORs), we conducted logistic regression analyses using proportional odds models for polychotomous outcomes. Higher adult breast density was significantly associated with adolescent red meat intake (adjusted 3rd vs. 1st tertile OR = 3.0, 95% confidence interval (CI) 1.5-6.4, trend P = 0.003) but not with other adolescent factors. For the association of adult acculturation with breast density, adjustment for adolescent red meat intake attenuated the OR for the highest vs. lowest level of acculturation from 2.5 (95% CI 1.2-5.3) to 1.9 (95% CI 0.9-4.0). Greater adolescent red meat intake may have increased adult breast density and partly accounted for the strong association between acculturation and breast density in this sample of immigrant Chinese women. If confirmed by further study, dietary prevention efforts for breast cancer should be considered earlier in life.
Collapse
Affiliation(s)
- Marilyn Tseng
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California 93407, USA.
| | | | | | | |
Collapse
|
28
|
Veljkovic M, Branch DR, Dopsaj V, Veljkovic V, Veljkovic N, Glisic S, Colombatti A. Can natural antibodies to VIP or VIP-like HIV-1 glycoprotein facilitate prevention and supportive treatment of breast cancer? Med Hypotheses 2011; 77:404-8. [PMID: 21684085 DOI: 10.1016/j.mehy.2011.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The incidence of non-AIDS-defining cancer is remarkably higher in HIV-infected than in the general population. In contrast, breast cancer risk is significantly reduced in the HIV-infected population. The molecular mechanisms underlying the phenomenon of suppression of breast cancer in the HIV-infected population may serve as a basis for development of a new platform for prevention and treatment of breast cancer. HYPOTHESIS Various evidences indicate that vasoactive intestinal peptide (VIP) plays an important role in growth, and differentiation of breast cancer. We previously showed (i) that natural antibodies recognizing VIP and the gp120-derived peptide NTM significantly contribute to the control of HIV disease progression by suppression of VIP-like activity of HIV-1 gp120 and (ii) that physical exercise stimulates production of these natural antibodies. These findings suggest that natural anti-VIP/NTM antibodies could contribute to a decrease of breast cancer in the HIV-infected population by suppression of VIP, which may play a pro/oncogenic function. Aerobic exercise which stimulates production of anti-VIP/NTM antibodies could be used as prevention and supportive treatment of breast cancer. IMPACT Immunotherapy based on natural anti-VIP/NTM antibodies could serve as an effective adjunct therapy for the treatment of breast cancer. Similarly, aerobic exercise, which stimulates production of these antibodies, should be considered as an inexpensive and safe preventive and supportive breast cancer therapy. Natural anti-VIP/NTM antibodies also represent promising prognostic marker for breast cancer.
Collapse
|
29
|
Lynch BM, Neilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Recent Results Cancer Res 2011; 186:13-42. [PMID: 21113759 DOI: 10.1007/978-3-642-04231-7_2] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Breast cancer is the most commonly diagnosed invasive malignancy and the second leading cause of cancer death in women. This chapter considers epidemiologic evidence regarding the association between physical activity and breast cancer risk from 73 studies conducted around the world. Across these studies there was a 25% average risk reduction amongst physically active women as compared to the least active women. The associations were strongest for recreational activity, for activity sustained over the lifetime or done after menopause, and for activity that is of moderate to vigorous intensity and performed regularly. There is also some evidence for a stronger effect of physical activity amongst postmenopausal women, women who are normal weight, have no family history of breast cancer, and are parous. It is likely that physical activity is associated with decreased breast cancer risk via multiple interrelated biologic pathways that may involve adiposity, sex hormones, insulin resistance, adipokines, and chronic inflammation. Future research should include prospective observational epidemiologic studies relating proposed biomarkers to breast cancer risk and also randomized controlled trials to examine how physical activity influences the proposed biomarkers. Exercise trials will provide more clarity regarding the appropriate type, dose, and timing of activity that relate to breast cancer risk reduction.
Collapse
Affiliation(s)
- Brigid M Lynch
- Department of Population Health Research, Alberta Health Services-Cancer Care, 1331 29 St NW, Calgary, Alberta, Canada, T2N 4N2
| | | | | |
Collapse
|
30
|
Abstract
I investigated the association between depression and percent body fat, two major global problems. Participants are 1,704 American women, ages 39-49, who responded to a detailed self-administered mailed questionnaire. My results showed a positive correlation; the adjusted OR = 1.70, 95% CI (1.20, 2.39), p = .002. Percent body fat was estimated from age, height, and weight, a cost-free method that may be useful in areas in which dual energy X-ray absorptiometry, or other procedures are too costly or unavailable. My findings may aid health and mental health care providers in the management and treatment of patients seen in settings with limited resources.
Collapse
Affiliation(s)
- Grace Wyshak
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115, USA.
| |
Collapse
|
31
|
Abstract
OBJECTIVES Globally, in an aging population, osteoporosis and fractures are emerging as major public health problems; accessible and affordable recognition, prevention and treatment strategies are needed. Percent body fat is known to be associated with bone mineral density and fractures. This paper uses an innovative, virtually cost-free method to estimate percent body fat from age, height and weight, and assesses its validity by examining the association between percent body fat and fractures among women 39 and older. DESIGN An epidemiologic study. PARTICIPANTS 3940 college alumnae, median age 53.6, participated by responding to a mailed questionnaire covering medical history, behavioral factors, birth date, weight and height. STATISTICAL METHODS T-tests, chi-square and multivariable logistic regression. MEASUREMENTS Percent body fat estimated from age, weight, height and gender. RESULTS Associations of fractures with percent body fat are expressed as odds ratios: for osteoporotic (wrist, hip and/or x-ray confirmed vertebral), the adjusted OR = 2.41, 95% CI (1.65, 3.54), P < 0.0001; for wrist fractures, the adjusted OR = 2.56, 95% CI (1.65, 3.96), P < 0.0001; for x-ray confirmed vertebral fractures the adjusted OR = 4.69, 95% CI (2.05, 10.77), P=0.0003).; and for non-osteoporotic, he adjusted OR= 1.00, 95% CI (0.76 1.32), P=0.999. CONCLUSION The findings are consistent with methods using DXA and/or other technologies that show percent body fat is associated with fractures of the wrist and vertebrae. Identification of risk factors is necessary for the prevention and treatment of osteoporosis and osteoporotic fractures. Estimation of percent body fat from age, height and weight may be a valid, cost-saving, and cost-effective alternative tool for screening and assessing risk of osteoporosis in settings where Dual x-ray absorptiometry (DXA) or other radiological techniques are too costly or unavailable.
Collapse
Affiliation(s)
- G Wyshak
- Harvard Medical School and Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| |
Collapse
|
32
|
Ratnasinghe LD, Modali RV, Seddon MB, Lehman TA. Physical Activity and Reduced Breast Cancer Risk: A Multinational Study. Nutr Cancer 2010; 62:425-35. [DOI: 10.1080/01635580903441295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
33
|
Bercovich D, Goodman G. Pregnancy and lactation after breast cancer elevate plasma prolactin, do not shorten and may prolong survival. Med Hypotheses 2009; 73:942-7. [PMID: 19632054 DOI: 10.1016/j.mehy.2009.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/13/2009] [Indexed: 01/19/2023]
Abstract
The affliction of breast cancer is doubled for young patients wishing to have a child. Because estrogens can cause breast cancer and its elevation during pregnancy, clinical advice historically restricted pregnancy to at least 5 years post-diagnosis. Opposing evidence gradually relaxed this. Furthermore, in the last decade it was clarified that overall, post-treatment pregnancy and breast-feeding do not shorten survival. Despite this evidence and patients such as S.B. (deceased) and remarkable L.H. (five children, starting immediately after treatment for node-positive breast cancer), much opposition and restrictive advice remain: additional therapy preferred over pregnancy. In healthy women, pregnancy reduces (cause unknown) the risk of breast cancer and lactation may reduce it. These are accompanied by highly elevated plasma prolactin (PRL) over many months (pregnancy, 15-25 x daily mean 10 ng/ml; lactation, up to 30 x daily mean). PRL concentration too increases in other natural and non-biological conditions, also apparently without increasing breast cancer incidence. Nevertheless, firm and implied support for early pregnancy (and lactation) post-diagnosis and treatment may face a new issue. Over a decade, some studies have claimed epidemiological evidence that a relatively minute PRL elevation (from zero to 0.6-0.8 ng/ml) over mean level increases the risk of breast cancer (i.e. it is a carcinogen) and that this supports (and is supported by) a similar view from some laboratory research. This two-pronged mutuality could create further anxiety and unjustified advice dashing the wish for a child. Is this justified? Epidemiology on PRL and breast cancer risk in the eighties/nineties was contradictory and inconclusive; in the last decade, it was also biologically implausible. 'Positive' laboratory results targeting a 'tamoxifen for PRL' have over-shadowed confounding, negative (often called 'inconsistent') laboratory evidence. Increasingly evident complexity of conflicting biochemical, hormonal, cellular and tissue interactions, confused further by failure of molecular genetics to confirm PRL as a carcinogen, make this target more a mirage than an oasis. While recognizing the value of laboratory research primarily for facts, future progress will be most sound and rapid from observation starting with the human entity, not with its parts. Molecular genetics makes this possible and will be the epicentre of breast cancer research. Meanwhile, young breast cancer patients after initial treatment and eager for a child can today reasonably benefit from advice based on phenomena evolved over eons: pregnancy, lactation and accompanying highly-elevated PRL will not increase risk of recurrence and will in some cases prolong survival.
Collapse
Affiliation(s)
- Dani Bercovich
- Human Molecular Genetics and Pharmacogenetics, Migal Biotechnology Institute, Galilee, POB 831, Kiryat Shmona 11016, Israel
| | | |
Collapse
|
34
|
Abstract
Physical exercise has attracted increased interest in rehabilitation of oncological patients. The purpose of this paper is to review the literature and summarize the evidence of physical exercise in preventing cancer, its ability in attenuating the effect of cancer and its treatments and to provide guidelines for exercise prescription Review of recent literature by electronic search of MEDline (Pub Med), Cancer lit, Cochrane libraries, CINAHL were done using Keywords and the variables were identified and systematically evaluated. There is strong evidence for reduced risk of colorectal and breast cancer with possible association for prostate, endometrial and lung cancer with increasing physical activity. Exercise helps cancer survivors cope with and recover from treatment; exercise may improve the health of long term cancer survivors and extend survival. Physical exercise will benefit throughout the spectrum of cancer. However, an understanding of the amount, type and intensity of exercise needed has not been fully elucidated. There is sufficient evidence to promote exercise in cancer survivors following careful assessment and tailoring on exercise prescription.
Collapse
Affiliation(s)
- P. Rajarajeswaran
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry – 6, India
| | - R. Vishnupriya
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry – 6, India
| |
Collapse
|
35
|
Fuemmeler BF, Pendzich MK, Tercyak KP. Weight, dietary behavior, and physical activity in childhood and adolescence: implications for adult cancer risk. Obes Facts 2009; 2:179-86. [PMID: 20054223 PMCID: PMC2924235 DOI: 10.1159/000220605] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Lifestyle factors related to energy balance, including weight, dietary behavior and physical activity, are associated with cancer risk. The period of childhood and growth into adolescence and early adulthood may re-present a 'cumulative risk' for later adult-onset cancers. We review a number of epidemiologic studies that have examined associations among childhood and adolescent body size, diet, and physical activity with adult cancer risk. These studies suggest that unhealthy behaviors that develop early in life and persist over time may increase the risk of some cancer types, such as premenopausal breast, ovarian, endometrial, colon and renal cancer, adversely affect cancer-related morbidities, and increase mortality. Continued research is needed to further determine and refine how timing and degree of such exposures in early childhood and adolescence relate to adult cancer risk. Presently, sufficient evidence suggests a continued need for stronger primary prevention in cancer and obesity research via modified lifestyle behaviors earlier in the developmental spectrum, i.e. during childhood and adolescence.
Collapse
Affiliation(s)
- Bernard F. Fuemmeler
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC
| | - Margaret K. Pendzich
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC
| | - Kenneth P. Tercyak
- Departments of Oncology and Pediatrics, Georgetown University Medical Center, Washington DC, USA
- *Dr. Kenneth Tercyak, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007 USA, Tel. +1 202 687-0802, Fax -8444, E-mail
| |
Collapse
|
36
|
Suzuki S, Kojima M, Tokudome S, Mori M, Sakauchi F, Fujino Y, Wakai K, Lin Y, Kikuchi S, Tamakoshi K, Yatsuya H, Tamakoshi A. Effect of Physical Activity on Breast Cancer Risk: Findings of the Japan Collaborative Cohort Study. Cancer Epidemiol Biomarkers Prev 2008; 17:3396-401. [DOI: 10.1158/1055-9965.epi-08-0497] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
37
|
Maruti SS, Willett WC, Feskanich D, Levine B, Rosner B, Colditz GA. Physical activity and premenopausal breast cancer: an examination of recall and selection bias. Cancer Causes Control 2008; 20:549-58. [PMID: 19011977 DOI: 10.1007/s10552-008-9263-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 10/28/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Compared with cohort studies, case-control investigations have tended to report clearer protective associations for the relationship between physical activity and premenopausal breast cancer risk. METHODS We conducted a case-control study within the Nurses' Health Study II cohort to examine whether recall or selection bias could explain the stronger protective associations. Self-reported total recreational physical activity during adulthood and over a woman's lifetime (ages 12 years to current) were assessed in 1997 before diagnosis and, again, from one to seven years after breast cancer diagnosis among the same women. RESULTS Eighty-seven percent of cases (417 of 479) and 82% of controls (390 of 474) responded. Selection bias was observed for activity during adulthood but not for activity over a woman's lifetime. Recall bias was not observed in the direction we expected: the odds ratios (ORs) for breast cancer comparing the highest versus lowest quintile of prospectively reported total activity were not significantly different than the corresponding estimates from retrospective reports (e.g., lifetime activity: prospective OR = 0.58, 95% CI: 0.37, 0.93 versus retrospective OR = 0.80; 95% CI: 0.50, 1.29). CONCLUSION Recall or selection bias may not have been accounted for protective associations among case-control investigations examining lifetime recreational physical activity and breast cancer. Selection bias related to recreational physical activity during adulthood and random error in the measurement of physical activity remain concerns.
Collapse
Affiliation(s)
- Sonia S Maruti
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Howard RA, Leitzmann MF, Linet MS, Freedman DM. Physical activity and breast cancer risk among pre- and postmenopausal women in the U.S. Radiologic Technologists cohort. Cancer Causes Control 2008; 20:323-33. [PMID: 18941914 DOI: 10.1007/s10552-008-9246-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 10/02/2008] [Indexed: 11/29/2022]
Abstract
To clarify aspects of the association between physical activity and breast cancer, such as activity intensity required, and possible effect modification by factors such as menopausal hormone therapy (MHT) use. We prospectively examined physical activity in relation to breast cancer risk among 45,631 women participating in the U.S. Radiologic Technologists cohort. Participants provided information at baseline regarding hours spent per week engaging in strenuous activity, walking/hiking for exercise, and walking at home or work. We estimated multivariable relative risks (RR) and 95% confidence intervals (CI) of breast cancer using Cox regression. We identified 864 incident-invasive breast cancers. Greatest risk reduction was observed among women who reported walking/hiking for exercise 10 or more hours per week (RR, 0.57; 95% CI, 0.34-0.95) compared with those reporting no walking/hiking. The association between walking/hiking for exercise and breast cancer was modified by MHT use (p for interaction = 0.039). Postmenopausal women who never used MHT had reduced risks of breast cancer associated with physical activity whereas no relation was observed among ever users of MHT. Our study suggests moderate intensity physical activity, such as walking, may protect against breast cancer. Further, the relation between physical activity and breast cancer may be modified by MHT use.
Collapse
Affiliation(s)
- Regan A Howard
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute/NIH, Executive Plaza South, Bethesda, MD, 20892, USA
| | | | | | | |
Collapse
|
39
|
Maruti SS, Willett WC, Feskanich D, Rosner B, Colditz GA. A prospective study of age-specific physical activity and premenopausal breast cancer. J Natl Cancer Inst 2008; 100:728-37. [PMID: 18477801 DOI: 10.1093/jnci/djn135] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical activity has been consistently associated with lower risk of postmenopausal breast cancer, but its relationship with premenopausal breast cancer is unclear. We investigated whether physical activity is associated with reduced incidence of premenopausal breast cancer, and, if so, what age period and intensity of activity are critical. METHODS A total of 64,777 premenopausal women in the Nurses' Health Study II reported, starting on the 1997 questionnaire, their leisure-time physical activity from age 12 to current age. Cox regression models were used to examine the relationship between physical activity, categorized by age period (adolescence, adulthood, and lifetime) and intensity (strenuous, moderate, walking, and total), and risk of invasive premenopausal breast cancer. RESULTS During 6 years of follow-up, 550 premenopausal women developed breast cancer. The strongest associations were for total leisure-time activity during participants' lifetimes rather than for any one intensity or age period. Active women engaging in 39 or more metabolic equivalent hours per week (MET-h/wk) of total activity on average during their lifetime had a 23% lower risk of premenopausal breast cancer (relative risk = 0.77; 95% confidence interval = 0.64 to 0.93) than women reporting less activity. This level of total activity is equivalent to 3.25 h/wk of running or 13 h/wk of walking. The age-adjusted incidence rates of breast cancer for the highest (> or = 54 MET-h/wk) and lowest (< 21 MET-h/wk) total lifetime physical activity categories were 136 and 194 per 100 000 person-years, respectively. High levels of physical activity during ages 12-22 years contributed most strongly to the association. CONCLUSIONS Leisure-time physical activity was associated with a reduced risk for premenopausal breast cancer in this cohort. Premenopausal women regularly engaging in high amounts of physical activity during both adolescence and adulthood may derive the most benefit.
Collapse
Affiliation(s)
- Sonia S Maruti
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., M4-B402, Seattle, WA 98109-1024, USA.
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Goodman G, Bercovich D. Prolactin does not cause breast cancer and may prevent it or be therapeutic in some conditions. Med Hypotheses 2008; 70:244-51. [PMID: 17658223 DOI: 10.1016/j.mehy.2007.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 05/22/2007] [Indexed: 01/20/2023]
Abstract
The polypeptide hormone prolactin (PRL), ubiquitous and multifunctional in vertebrates, always interested biologists, was of restricted concern to clinicians and researched little compared to insulin and growth hormone. PRL in lactation initially aroused relatively little interest, but it rose when with ovarian steroids and chemical carcinogens, it was implicated in rodent mammary carcinoma. It declined when PRL suppression did not counter breast cancer. Meanwhile, long-known, estrogen-related cancers in the ovary and breast did not deter wide estrogen use for contraception and supplementation despite risk, and estrogen blockers and inhibitors have improved treatment and are on trial for prophylaxis, despite serious short and long term side-effects. Despite the great differences between steroid and polypeptide, research on PRL and breast cancer mirroring that on estrogens is now growing. This is mainly negative, much due to recent prospective research reporting minor rises in plasma levels as a basis, together with some recent laboratory research, for a hypothesis that PRL induces post-menopausal breast cancer. That view contradicts a reproductive biology that evolved to benefit women and offspring. Elevated PRL in pregnancy and probably that in lactation, reduce risk. Many exogenous chemical and physical PRL-stimulants also do not increase risk. It has not been shown that PRL increases risk of breast cancer and some older and recent cell and tissue data suggest it may be the key, two-sided, in human breast tissue homeostasis. Excessive disturbance of this is unlikely to originate in PRL itself. The natural biology of PRL, the reproductive woman's hormone par excellence, and research in various fields, suggest a positive potential in the PRL family for direct prevention and treatment of breast cancer, possibly greater than that in the estrogens. It is time to debate and research this.
Collapse
|
42
|
Teas J, Hurley T, Msph SG, Mph KO. Walking outside Improves Mood for Healthy Postmenopausal Women. Clin Med Oncol 2007. [DOI: 10.4137/cmo.s343] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Exercise has been shown to decrease breast cancer risk and slow the progression of breast cancer. Physician recommendations and clinical research data most often are for gym-based exercise programs. However, the importance of exercise location on mood and stress hormones that may influence adherence to exercise has not been addressed. Methods Women first walked for an hour outdoors along a university path and then a week later, for an hour indoors on a treadmill in a typical gym environment. Pre and post outdoor and indoor exercise moods (happy, pleased, sad, frustrated, worried, angry, delighted, and joy) were assessed by a 6 point Likert questionnaire, and saliva samples were collected for analysis of cortisol, and alpha amylase (a surrogate for serum norepinephrine). Results Nineteen healthy, non-smoking, postmenopausal women (average age 58 ± 4) participated. Compared with scores after walking outdoors, walking indoors was associated with higher scores of worry (p = 0.02; mean difference 0.9; 95% CI (0.17, 1.6) and frustration (p = 0.03; mean difference 0.9; 95% CI (0.12, 1.6), and lower scores for feelings of being pleased (p = 0.03; mean difference -0.8; 95% CI: -1.7, 0.1) and delighted (p = 0.05; mean difference -0.9; 95% CI: -1.75, -0.02). Changes in salivary hormone levels did not vary significantly between the two environments. Conclusion Walking outdoors was associated with improved mood, but walking indoors was not. Improved mood may reduce breast cancer risk indirectly by promoting regular exercise. Physician recommendations for exercise should include gym and non-gym based exercise options.
Collapse
Affiliation(s)
- Jane Teas
- South Carolina Cancer Center, 2221 Devine Street, 2nd Floor, University of South Carolina, Columbia, SC 29205, U.S.A
| | - Thomas Hurley
- Cancer Prevention and Control Program, 2221 Devine Street, 2nd Floor, University of South Carolina, Columbia, SC 29205, U.S.A
| | - Santosh Ghumare Msph
- South Carolina Cancer Center, 2221 Devine Street, 2nd Floor, University of South Carolina, Columbia, SC 29205, U.S.A
| | - Kisito Ogoussan Mph
- South Carolina Cancer Center, 2221 Devine Street, 2nd Floor, University of South Carolina, Columbia, SC 29205, U.S.A
| |
Collapse
|
43
|
Monninkhof EM, Peeters PHM, Schuit AJ. Design of the sex hormones and physical exercise (SHAPE) study. BMC Public Health 2007; 7:232. [PMID: 17767724 PMCID: PMC2031900 DOI: 10.1186/1471-2458-7-232] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 09/04/2007] [Indexed: 11/24/2022] Open
Abstract
Background Physical activity has been associated with a decreased risk for breast cancer. The biological mechanismn(s) underlying the association between physical activity and breast cancer is not clear. Most prominent hypothesis is that physical activity may protect against breast cancer through reduced lifetime exposure to endogenous hormones either direct, or indirect by preventing overweight and abdominal adiposity. In order to get more insight in the causal pathway between physical activity and breast cancer risk, we designed the Sex Hormones and Physical Exercise (SHAPE) study. Purpose of SHAPE study is to examine the effects of a 1-year moderate-to-vigorous intensity exercise programme on endogenous hormone levels associated with breast cancer among sedentary postmenopausal women and whether the amount of total body fat or abdominal fat mediates the effects. Methods/Design In the SHAPE study, 189 sedentary postmenopausal women, aged 50–69 years, are randomly allocated to an intervention or a control group. The intervention consists of an 1-year moderate-to-vigorous intensity aerobic and strenght training exercise programme. Partcipants allocated to the control group are requested to retain their habitual exercise pattern. Primary study parameters measured at baseline, at four months and at 12 months are: serum concentrations of endogenous estrogens, endogenous androgens, sex hormone binding globuline and insuline. Other study parameters include: amount of total and abdominal fat, weight, BMI, body fat distribution, physical fitness, blood pressure and lifestyle factors. Discussion This study will contribute to the body of evidence relating physical activity and breast cancer risk and will provide insight into possible mechanisms through which physical activity might be associated with reduced risk of breast cancer in postmenopausal women. Trial registration NCT00359060
Collapse
Affiliation(s)
- Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Public Health and Health Care, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Petra HM Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albertine J Schuit
- Division of Public Health and Health Care, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
44
|
Monninkhof EM, Elias SG, Vlems FA, van der Tweel I, Schuit AJ, Voskuil DW, van Leeuwen FE. Physical Activity and Breast Cancer. Epidemiology 2007; 18:137-57. [PMID: 17130685 DOI: 10.1097/01.ede.0000251167.75581.98] [Citation(s) in RCA: 315] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many epidemiologic studies have found an association between physical activity and breast cancer risk, although this has not been a consistent finding. METHODS Studies were identified through a systematic review of literature available on PubMed through February 2006. We included all cohort and case-control studies that assessed total or leisure time activities in relation to occurrence or mortality of breast cancer. The fully adjusted risk estimates and 95% confidence intervals for the highest versus lowest level of activity were documented for each study as well as evidence for a dose-response relationship. Methodologic quality was also assessed. Due to statistical and methodologic heterogeneity among studies, we did not carry out statistical pooling. To draw conclusions, we performed a best-evidence synthesis taking study quality into account. RESULTS Nineteen cohort studies and 29 case-control studies were evaluated. There was strong evidence for an inverse association between physical activity and postmenopausal breast cancer with risk reductions ranging from 20% to 80%. For premenopausal breast cancer, however, the evidence was much weaker. For pre- and postmenopausal breast cancer combined, physical activity was associated with a modest (15-20%) decreased risk. Evidence for a dose-response relationship was observed in approximately half of the higher-quality studies that reported a decreased risk. A trend analysis indicated a 6% (95% confidence interval = 3% to 8%) decrease in breast cancer risk for each additional hour of physical activity per week assuming that the level of activity would be sustained. CONCLUSIONS There is evidence for an inverse association between physical activity and breast cancer risk. The evidence is stronger for postmenopausal breast cancer than for premenopausal breast cancer.
Collapse
Affiliation(s)
- Evelyn M Monninkhof
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
45
|
Goedert JJ, Schairer C, McNeel TS, Hessol NA, Rabkin CS, Engels EA. Risk of breast, ovary, and uterine corpus cancers among 85,268 women with AIDS. Br J Cancer 2006; 95:642-8. [PMID: 16868538 PMCID: PMC2360686 DOI: 10.1038/sj.bjc.6603282] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
By linking HIV/AIDS and cancer surveillance data in 12 US regions, breast and reproductive cancer risks with AIDS were compared to those in the general population. Trends in standardized incidence ratios (SIRs) were assessed by CD4 count, AIDS-relative time, and calendar time. Standardized incidence ratios were indirectly adjusted for cancer risk factors using data from AIDS cohort participants and the general population. With AIDS, 313 women developed breast cancer (SIR 0.69, 95% confidence interval (CI) 0.62–0.77), 42 developed ovary cancer (SIR 1.05, 95% CI, 0.75–1.42), and 31 developed uterine corpus cancer (SIR 0.57, 95% CI, 0.39–0.81). Uterine cancer risk was reduced significantly after age 50 (SIR 0.33). Breast cancer risk was reduced significantly both before (SIR 0.71) and after (SIR 0.66) age 50, and was lower for local or regional (SIR 0.54) than distant (SIR 0.89) disease. Breast cancer risk varied little by CD4 count (Ptrend=0.47) or AIDS-relative time (Ptrend=0.14) or after adjustment for established cancer risk factors. However, it increased significantly between 1980 and 2002 (Ptrend=0.003), approaching the risk of the general population. We conclude that the cancer deficit reflected direct or indirect effects of HIV/AIDS and that anti-HIV therapy reduced these effects.
Collapse
Affiliation(s)
- J J Goedert
- Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20892, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Tehard B, Friedenreich CM, Oppert JM, Clavel-Chapelon F. Effect of Physical Activity on Women at Increased Risk of Breast Cancer: Results from the E3N Cohort Study. Cancer Epidemiol Biomarkers Prev 2006; 15:57-64. [PMID: 16434587 DOI: 10.1158/1055-9965.epi-05-0603] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There is a need to investigate the type, duration, frequency, and intensity of physical activity that are critical to reduce the risk of breast cancer, and if this relation differs among subgroups of women. METHODS We analyzed the relation between physical activity and breast cancer incidence between 1990 and 2002 (n=3,424 cases), among 90,509 women of the French E3N cohort, ages between 40 and 65 years in 1990. We gave special attention to effect modification by body mass index (BMI), family history of breast cancer, parity, and hormone replacement therapy (HRT). RESULTS A linear decrease in risk of breast cancer was observed with increasing amounts of moderate (P(trend)<0.01) and vigorous (P(trend)<0.0001) recreational activities. Compared with women who reported no recreational activities, those with more than five weekly hours of vigorous recreational activity had a relative risk of 0.62 (0.49-0.78). This decrease was still observed among women who were overweight, nulliparous, had a family history of breast cancer, or used HRT. Compared with the whole cohort, among nulliparous women, the reduction of risk observed was of a higher magnitude, although the test for heterogeneity did not reach statistical significance. CONCLUSION A risk reduction of breast cancer was particularly observed with vigorous recreational activity. Further investigations are needed to confirm that intensity is an important variable to consider in risk reduction and to identify the precise biological mechanisms involved in such a risk reduction.
Collapse
Affiliation(s)
- Bertrand Tehard
- Equipe Institut National de la Sante et de la Recherche Medicale Nutrition, Hormones et Cancer, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France.
| | | | | | | |
Collapse
|
47
|
Abstract
Osteoporosis is a major public problem. More than 35 million Americans are at risk of developing osteoporosis. Nearly half of all women will have an osteoporotic fracture in their lifetime. Tubal ligation (tubal sterilization) is used more than any other single method of contraception in the USA and worldwide. In 1995, 34.6% (approximately 7 million) of ever-married US women between ages 35-44 years had undergone tubal ligation. Tubal sterilization may disturb ovarian function and be associated with more menstrual and menopausal symptoms and, thus, may be a risk factor for osteoporosis. The objective of this paper is to examine the possible association between tubal sterilization and osteoporotic fractures. Data are from a questionnaire mailed to a previously identified cohort of college/university alumnae who had graduated between 1926 and 1981. This study was performed during 1996 and 1997, 15 years after the initial study. The subjects were 3,940 women participants in the follow-up study. Their mean age was 53.7 years at time of reporting, ranging from 37 to over 80 years. Excluding deaths and non-deliverables the response rate was 85%. Of the 3,940 subjects, 491 (12.5%), and, of the ever-pregnant women, 15.5%, had undergone tubal sterilization (TS); 899 (22.8%) reported at least one fracture after age 20, and 70 (1.8%) at least one vertebral fracture after age 20, which had been confirmed by X-ray. TS was strongly associated with self-reports of vertebral fractures that had been confirmed by X-ray. The multivariable adjusted odds ratios and 95% confidence intervals for women 50 years and over and for women 55 years and over were, respectively, 2.7 (1.4, 5.0) and 3.3 (1.5, 7.0). Having had any fracture was not significantly associated with TS: odds ratio (OR) = 1.1 for women 50 years and older and OR = 1.3 for those 55 years and older. This epidemiological study in a cohort of highly educated, mostly Caucasian women shows an association between past tubal sterilization and self-reported X-ray-confirmed vertebral fractures. These results need to be confirmed in other cohorts--the pathophysiology of this association is worthy of further study.
Collapse
Affiliation(s)
- Grace Wyshak
- Department of Population and International Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, Massachusetts, MA 02115, USA.
| |
Collapse
|
48
|
Margolis KL, Mucci L, Braaten T, Kumle M, Trolle Lagerros Y, Adami HO, Lund E, Weiderpass E. Physical Activity in Different Periods of Life and the Risk of Breast Cancer: The Norwegian-Swedish Women's Lifestyle and Health Cohort Study. Cancer Epidemiol Biomarkers Prev 2005. [DOI: 10.1158/1055-9965.27.14.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Physical activity has been found to be associated with decreased risk of breast cancer in postmenopausal women in the majority of epidemiologic studies, but the association is inconsistent in premenopausal women.
Methods: We studied the effect of physical activity at various ages on the incidence of breast cancer in 99,504 women from 30 to 49 years of age at enrollment in the Women's Lifestyle and Health Study, a prospective population-based cohort study in Norway and Sweden. Physical activity level on an ordinal scale at age 14, age 30, and age at enrollment, participation in competitive sports, as well as information on other covariates was obtained using a self-administered questionnaire. Complete follow-up with data on incident invasive breast cancer and mortality was collected by linkage to national registries. The relation between physical activity and time to breast cancer development was assessed using Cox proportional hazard models, controlling for potential confounders.
Results: During an average 9.1 years of follow-up, there were 1,166 incident breast cancer cases. The mean age of the women was 41 years at enrollment, and the mean age at breast cancer diagnosis was 48 years. Compared to inactive women, women with higher levels of physical activity at enrollment had a similar risk of incident breast cancer (adjusted relative risk, 1.24 for vigorous activity compared with no activity; 95% CI, 0.85-1.82). Physical activity at age 30 or at age 14 also did not afford any significant protection from breast cancer, nor did a consistently high level of activity from younger ages to enrollment.
Conclusions: We did not find evidence of a protective effect of physical activity on breast cancer risk in this group of primarily premenopausal women.
Collapse
Affiliation(s)
- Karen L. Margolis
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 2Division of Clinical Epidemiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Lorelei Mucci
- 3Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts
| | - Tonje Braaten
- 4Institute of Community Medicine, University of Tromsø, Tromsö, Norway; and
| | - Merethe Kumle
- 4Institute of Community Medicine, University of Tromsø, Tromsö, Norway; and
| | - Ylva Trolle Lagerros
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 3Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts
| | - Eiliv Lund
- 4Institute of Community Medicine, University of Tromsø, Tromsö, Norway; and
| | - Elisabete Weiderpass
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- 5Finnish Cancer Registry, Helsinki, Finland; and
- 6Cancer Registry of Norway, Oslo, Norway
| |
Collapse
|
49
|
van Noord PAH. Breast cancer and the brain: a neurodevelopmental hypothesis to explain the opposing effects of caloric deprivation during the Dutch famine of 1944-1945 on breast cancer and its risk factors. J Nutr 2004; 134:3399S-3406S. [PMID: 15570045 DOI: 10.1093/jn/134.12.3399s] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Most studies on calorie deprivation and cancer risk in rodents show reductions in tumor occurrence. However, the few human studies on calorie restriction are conflicting. An overview is given of results in the DOM (diagnostic onderzoek mammacarcinoom) cohorts among women exposed to the Dutch Famine of 1944-1945. Opposing effects were found on risk factors (shortening of leg length, later menarche, and earlier menopause), whereas urinary estrogens and plasma insulin-like growth factor (IGF)-1 and IGF binding protein-3 were increased, as was breast cancer itself. Exposure between 2 and 10 y old was an unexpected window of susceptibility to the effects of calorie deprivation. The effects of famine exposure were most clearly seen in women who never gave birth. These opposing observations can be explained by a neurodevelopmental hypothesis on set-point shifts at the level of the diencephalons/hypothalamus, either directly or from rebound effects. Such a mechanism reflects old evolutionary adaptation systems in lower and higher organisms to cope with periods of stress and famine by adjusting, for example, reproductive functions. These effects in exposed women may later also affect their unexposed offspring. This hypothesis provides several testable, hormone-mediated corollaries on the relationships between the role of calories in a Westernized lifestyle and human cancer risk. The underlying developmental perspective, as opposed to a risk factor approach, can explain why certain ages, even before breast development, are especially sensitive to effects of large fluctuations in calories. The observations presented may have implications for preventive strategies such as promoting moderation of calorie intake to curb cancer risks.
Collapse
|
50
|
Wyshak G. Menopausal symptoms and psychological distress in women with and without tubal sterilization. PSYCHOSOMATICS 2004; 45:403-13. [PMID: 15345785 DOI: 10.1176/appi.psy.45.5.403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Data from self-administered mailed questionnaires were used to examine the relationship between menopausal and psychological/psychiatric factors in women age 45-50 years with and without tubal sterilization. In multivariate logistic regression analysis, tubal sterilization was associated with current flushing (odds ratio = 8.78, 95% confidence interval [CI] = 1.58-48.67) and current symptoms of psychological distress (odds ratio = 3.37, 95% CI = 1.27-8.95); psychological distress was associated with tubal sterilization (odds ratio = 3.28, 95% CI = 1.28-8.42) and with being perimenopausal (odds ratio = 3.93, 95% CI = 1.08-14.34). Sterilization was marginally associated with a history of physician-diagnosed depression (univariate age-adjusted odds ratio = 2.24, 95% CI = 0.90-5.60). The menopausal and psychological symptoms of women with tubal sterilization should be taken seriously and treated appropriately.
Collapse
Affiliation(s)
- Grace Wyshak
- Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA.
| |
Collapse
|