Recreational Physical Activity and Ovarian Cancer Risk and Survival
Introduction
Physical activity has been examined as a risk factor for many types of cancer, with consistent findings of protective associations for certain types of cancer, including colon and postmenopausal breast cancer 1, 2, 3. The literature on physical activity and ovarian cancer risk is more limited, and the evidence for a protective association is less clear than for other types of cancer. Although the majority of the studies in the literature have not reported statistically significant inverse associations between physical activity and epithelial ovarian cancer risk 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, a meta-analysis of 12 cohort and case-control studies reported a pooled estimate of an approximate 20% reduction in ovarian cancer risk when comparing the highest to the lowest categories of recreational physical activity (19). Proposed mechanisms for the protective effects of physical activity on ovarian cancer include its effects on ovulation, sex hormone levels, metabolic pathways, inflammatory markers, and the immune system 19, 20, 21, 22.
Physical activity has been associated with improved survival in breast and colorectal cancer 23, 24, 25, 26, 27, but there are few reports on the effect of physical activity and ovarian cancer outcomes. To our knowledge, only one published study has described associations between physical activity and ovarian cancer survival. The investigators reported no significant associations with either recent or early life physical activity (28). Other cross-sectional analyses on the effects of physical activity in women with an ovarian cancer diagnosis suggest that cases who engage in physical activity have a better quality of life, less fatigue, less peripheral neuropathy, and improved psychosocial functioning 29, 30. Whether these benefits of physical activity translate into improved survival has not yet been studied in ovarian cancer patients.
In this study, we use data from a population-based case-control study to evaluate the relationship between self-reported physical activity at different periods of life on both ovarian cancer risk and survival. Because physical activity is a modifiable risk factor, if it is shown to be associated with reduced risk for or improved survival from ovarian cancer, it could represent an intervention to reduce morbidity and mortality from this highly lethal disease.
Section snippets
Methods
The study population was subjects from the North Carolina Ovarian Cancer Study, a population-based, case-control study conducted between 1999 and 2008. Cases were identified through the North Carolina Central Cancer Registry using rapid case ascertainment. Eligible cases had epithelial ovarian cancer, were aged 20–74 years at diagnosis, had no prior history of ovarian cancer and resided in the 48-county study area. They had to be mentally competent to give informed consent and complete an
Results
The analyses were restricted to cases with invasive epithelial ovarian cancer and those cases and controls who provided information on physical activity (638 cases and 683 controls). The distribution of levels of physical activity among cases and controls by selected characteristics is presented in Table 1. We observed statistically significant differences in reported levels of physical activity by BMI in both cases and controls (p = 0.009 and 0.003, respectively), by age in cases (p = 0.006)
Discussion
Our results provide weak evidence in support of a reduced risk of ovarian cancer among women who engaged in aerobic physical activity as compared to those who reported less than 1 hour of activity per week. Although most of the OR associated with higher levels of physical activity were less than one, statistically significant associations were identified only for women reporting 1–2 hours of weekly activity in either the year before or the 10 years before diagnosis. There was no clear dose
Acknowledgement
This work was supported by National Cancer Institute Grant R01-CA76016.
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