Abstract
Epidemiological evidence suggests that physical activity may affect breast cancer risk and other health outcomes. Little information is available regarding changes in activity after diagnosis and treatment of in-situ cancer. We enrolled 487 women with newly diagnosed ductal carcinoma-in-situ (DCIS) in a longitudinal cohort study. Exercise behaviors were assessed at enrollment and at 18 months. Changes in exercise frequency over time were compared, and the impact of demographic and treatment-related variables was evaluated. Enrollment and 18-month exercise data were available for 391 women (80%). At enrollment, most women performed strenuous physical activity infrequently, and only half engaged in any type of exercise more than twice a week. Overall activity patterns did not change greatly over the course of the study. However, logistic regression modeling of changes in exercise revealed that women who underwent unilateral or bilateral mastectomy (hazard ratio [HR], 2.4; 95% confidence interval [95% CI], 1.3–4.4) and those who were anxious at enrollment (HR, 2.1; 95% CI, 1.1–4.1) were statistically significantly more likely to decrease exercise levels, and women who worked were significantly more likely to increase exercise over the course of the study (HR, 1.9; 95% CI, 1.1–3.3). Nonsignificant variables included age, reconstructive surgery, depressive symptoms, financial status, education, and tamoxifen use. A large proportion of women with newly diagnosed DCIS were inactive and remained so over time. Women who underwent mastectomy, as well as women who were more anxious, were more likely to decrease their level of physical activity. Women with DCIS might benefit from targeted interventions to increase physical activity.
Similar content being viewed by others
References
Burstein H, Polyak K, Wong J, et al. Medical progress: ductal carcinoma in situ. N Engl J Med. 2004;350:1430–41.
Morrow M, Schnitt S, Harris J. Ductal carcinoma in situ and microinvasive carcinoma. In: Morrow M, Schnitt S, Harris J, editors. Diseases of the Breast. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 383–403.
Holmes M, Chen W, Feskanich D, et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005;293:2479–86.
Pierce J, Stefanick M, Flatt S, et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 2007;17:2345–51.
Abrahamson P, Gammon M, Lund M, et al. Recreational physical activity and survival among young women with breast cancer. Cancer. 2006;107:1777–85.
Irwin M, Crumley D, McTiernan A, et al. Physical activity levels before and after a diagnosis of breast carcinoma. Cancer. 2003;97:1746–57.
Andrykowski M, Beacham A, Jacobsen P. Prospective, longitudinal study of leisure-time exercise in women with early-stage breast cancer. Cancer Epidemiol Biomarkers Prev. 2007;16:430–8.
Kumar N, Allen K, Riccardi D, et al. Fatigue, weight gain, lethargy and amenorrhea in breast cancer patients on chemotherapy: is subclinical hypothyroidism the culprit? Breast Cancer Res Treat. 2004;83:149–59.
Demark-Wahnefried W, Hars V, Conaway M, et al. Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. Am J Clin Nutr. 1997;65:1495–501.
Demark-Wahnefried W, Peterson B, Winer E, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19:2381–9.
Partridge A, Adloff K, Blood E, et al. Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst. 2008;100:243–51.
Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure. 1977;1:385–401.
Ernster V, Ballard-Barbash R, Barlow W, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002;94:1546–54.
Rosen PP, Braun DW Jr, Kinne D. The clinical significance of pre-invasive breast carcinoma. Cancer. 1980;46:919–25.
Page D, Dupont W, Rogers L, et al. Intraductal carcinoma of the breast: follow-up after biopsy only. Cancer. 1982;49:751–8.
Page D, Dupont W, Rogers L, et al. Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer. 1995;76:1197–200.
Meijnen P, Peterse J, Oldenburg H, et al. Changing patterns in diagnosis and treatment of ductal carcinoma in situ. Eur J Surg Oncol. 2005;31:833–9.
Sumner W, Koniaris L, Snell S, et al. Results of 23,810 cases of ductal carcinoma in situ. Ann Surg Oncol. 2007;14:1638–43.
Bijker N, Meijnen P, Peterse J, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24:3381–7.
Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328:1581–6.
Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B–17. J Clin Oncol. 1998;16:441–52.
Katz S, Lant P, Janz N, et al. Patterns and correlates of local therapy for women with ductal carcinoma in-situ. J Clin Oncol. 2005;23:3001–7.
Schuh M, Nemoto T, Penetrante R, et al. Intraductal carcinoma analysis of presentation pathologic findings, and outcome of disease. Arch Surg. 1986;121:1303–7.
Sunshine J, Mosley M, Fletcher W, et al. Breast carcinoma in situ: a retrospective review of 112 cases with a minimum 10 year follow-up. Am J Surg. 1985;150:44.
Ward B, McKhann C, Ravikumar T. Ten year follow-up of breast carcinoma in situ in Connecticut. Arch Surg. 1992;127:1392–5.
Solin L, Fourquet A, Vincini F, et al. Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer. 2005;103:1137–46.
Saquib N, Flatt S, Natarajan L, et al. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the Women’s Healthy Eating and Living (WHEL) study. Breast Cancer Res Treat. 2007;105:177–86.
Makari-Judson G, Judson C, Mertens W. Longitudinal patterns of weight gain after breast cancer diagnosis: observations beyond the first year. Breast J. 2007;13:258–65.
Herman D, Ganz P, Petersen L, et al. Obesity and cardiovascular risk factors in younger breast cancer survivors: the Cancer and Menopause Study (CAMS). Breast Cancer Res Treat. 2005;93:13–23.
Irwin M, McTiernan A, Baumgartner R, et al. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol. 2005;23:774–82.
Trentham-Dietz A, Newcomb P, Nichols H, et al. Breast cancer risk factors and second primary malignancies among women with breast cancer. Breast Cancer Res Treat. 2007;105:195–207.
Gammon M, John E, Britton J. Recreational and occupational physical activities and risk of breast cancer. J Natl Cancer Inst. 1998;90:100–17.
McTiernan A, Kooperberg C, White E, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women. JAMA. 2003;290:1331–6.
Patel A, Press M, Meeske K, et al. Lifetime recreational exercise activity and risk of breast carcinoma in situ. Cancer. 2003;98:2161–9.
Holick C, Newcomb P, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2008;17:379–86.
Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B–24 randomized controlled trial. Lancet. 1999;353:1993–2000.
Ganz P, Kwan L, Stanton A, et al. Quality of life at the end of primary treatment of breast cancer: first results from the Moving Beyond Cancer randomized trial. J Natl Cancer Inst. 2004;96:376–87.
Rowland J, Desmond K, Meyerowitz B, et al. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92:1422–9.
Montebarocci O, Lo Dato F, Baldaro B, et al. Anxiety and body satisfaction before and six months after mastectomy and breast reconstruction surgery. Psychol Rep. 2007;101:100–6.
Monteiro-Grillo I, Marques-Vidal P, Jorge M. Psychosocial effect of mastectomy versus conservative surgery in patients with early breast cancer. Clin Transl Oncol. 2005;7:499–503.
Acknowledgment
This research was supported in part by the Dana-Farber/Harvard Cancer Center SPORE in Breast Cancer (5 P50 CA89393-03).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ligibel, J.A., Partridge, A., Giobbie-Hurder, A. et al. Physical Activity Behaviors in Women with Newly Diagnosed Ductal Carcinoma-In-Situ. Ann Surg Oncol 16, 106–112 (2009). https://doi.org/10.1245/s10434-008-0174-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-008-0174-x