Liam Davenport | May 16, 2016 | Medscape
The findings nevertheless strengthen recommendations on minimum activity levels, because the message that exercise reduces cancer risk can be added to that for cardiovascular disease.
Dr Moore noted: “In terms of getting people to be active, it depends on the number of communities and the number of constituencies that are invested in pushing it as a public health message.”
For him, the study “at least in part aligns the evidence for cancer with the evidence for heart disease.”
Dr Moore said: “In other words, there’s enough evidence now to suggest that physical activity may be an important part of cancer prevention and control messages, so that it can be pushed within that research community, and not just within that research community but perhaps also that advocacy community.”
Study Details
For the analysis, the researchers pooled data from 12 prospective cohorts from Europe and the United States that included self-reported physical activity, yielding a total of 1.44 million individuals (median age, 59 years).
Because different measures of physical activity were used across the studies, the team converted activity to metabolic equivalents (METs), with exercise of moderate intensity defined as 3 or more METs. The median activity level was the equivalent of 150 minutes of moderate-intensity activity per week, or 75 minutes of vigorous intensity, or the equivalent combination.
Higher activity levels of leisure-time physical activity were associated with younger age, more education, lower body mass index (BMI), and lower likelihood of being a current smoker.
During a median follow-up of 11 years, there were 186,932 incident cases of cancer.
The researchers found that higher levels of physical activity were associated with an increased risk for prostate cancer (hazard ratio [HR], 1.05) and malignant melanoma (HR, 1.27). Further analysis showed that the latter was statistically significant only in US regions where there are higher levels of solar ultraviolet radiation (HR, 1.26).
There were suggestions of associations between increased physical activity and reduced risk for gallbladder cancer, small intestine cancer, and non-Hodgkin lymphoma.
It was estimated that physical activity was associated with an overall 7% reduction in the risk of developing cancer (HR, 0.93).
Although BMI reduced the association for several cancers, 10 of the inverse associations remained significant after adjustment. Smoking modified the association only for lung cancer.
Editorialist Dr Gammon told Medscape Medical News that the pooled analysis has strengthened the evidence for an association between physical activity and some of the rarer cancers. “It’s really nice to be able to put it all together, because each of the individual studies were underpowered,” she said.
She believes that the intensity and duration of physical activity needed to lower cancer risk is likely to be tumor specific. “For instance, it was so much easier for us to figure out that physical activity was related to colon cancer, but it was much, much harder to do it with breast, and I’m thinking it’s possible that it could be related to dose and intensity.”
She added: “I think we’re going to need to do more individual type studies to try to really nail that down better, but right now, I would say the best evidence is what the CDC is recommending.”
Dr Gammon concluded that it is “really hopeful” to have the possibility of “such a good strategy to be able to reduce the risk of developing cancers, because some of the cancers on that list are very rare and very deadly.”
The study was supported by the Intramural Research Program of the National Institutes of Health. The work reflected in the editorial was supported in part by grants from the National Institutes of Health. The authorsand editorialists have disclosed no relevant financial relationships.
JAMA Intern Med. Published online May 16, 2016. Abstract, Editorial
