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Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the breast cancer family registry.
Keegan, Theresa H. M. 1,2; Milne, Roger L. 3,4; Andrulis, Irene L. 5,6; Chang, Ellen T. 1,2; Sangaramoorthy, Meera 1; Phillips, Kelly-Anne 7,8; Giles, Graham G. 9; Goodwin, Pamela J. 5,10; Apicella, Carmel 4; Hopper, John L. 4; Whittemore, Alice S. 2; John, Esther M. 1,2
[Miscellaneous] Breast Cancer Research & Treatment. 123(2):531-542, September 2010.

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Few studies have considered the joint association of body mass index (BMI) and physical activity, two modifiable factors, with all-cause mortality after breast cancer diagnosis. Women diagnosed with invasive breast cancer (n = 4,153) between 1991 and 2000 were enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. During a median follow-up of 7.8 years, 725 deaths occurred. Baseline questionnaires assessed moderate and vigorous recreational physical activity and BMI prior to diagnosis. Associations with all-cause mortality were assessed using Cox proportional hazards regression, adjusting for established prognostic factors. Compared with no physical activity, any recreational activity during the 3 years prior to diagnosis was associated with a 34% lower risk of death [hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.51-0.85] for women with estrogen receptor (ER)-positive tumors, but not those with ER-negative tumors; this association did not appear to differ by race/ethnicity or BMI. Lifetime physical activity was not associated with all-cause mortality. BMI was positively associated with all-cause mortality for women diagnosed at age >=50 years with ER-positive tumors (compared with normal-weight women, HR for overweight = 1.39, 95% CI: 0.90-2.15; HR for obese = 1.77, 95% CI: 1.11-2.82). BMI associations did not appear to differ by race/ethnicity. Our findings suggest that physical activity and BMI exert independent effects on overall mortality after breast cancer.