February 28 — 29, 2008 Advisory Committee Meeting
Subcommittee Report: Cancer
Anne McTiernan, M.D., Ph.D., presented the cancer subcommittee
work. The subcommittee focused on 2 areas: Physical activity effect on cancer
risk and the role of physical activity in cancer survivorship. The goals of the
Determine evidence of dose-response of physical activity and
Identify subgroups of individuals that may differ on physical
activity effect on cancer risk.
Review independent and combined effects of overweight/obesity
and physical activity on cancer risk.
Identify mechanisms that may explain links between physical
activity and cancer risk, to help determine validity of associations, and to
help with guidance on exercise prescriptions.
The data that was reviewed focused on cancer risk by specific
cancer subtypes. Most of the data is on breast and colorectal cancer. From the
studies the following risk reductions to cancer associated with physical
activity were extrapolated:
Breast cancer — 20 – 80% risk reduction
Colon cancer — 30% risk reduction
Edometrium cancer — 30% risk reduction
Lung cancer — 20 – 24% risk reduction
Prostate cancer — no effect
Ovary cancer — 19% risk reduction
Other cancers — insufficient evidence
The data also suggests there are no clear subgroups that differ from overall
physical activity cancer associations. Physical activity also reduces cancer
risk independent of weight control, but optimal effect may be seen with optimal
weight maintenance. Additionally, there is no clear dose cut-off for physical
activity effect across different cancer types.
There is a dose-response effect between physical activity and colon and breast
cancer, showing 30 – 60 minutes of moderate-to-vigorous activity per day reduces
risk. In other cancers there is insufficient evidence to support any
conclusions. Regular aerobic exercise is associated with reduced risk for
several cancers. Benefits are seen with moderate intensity exercise; however,
greater benefit can be seen with greater volume and intensity. The benefit is
also seen across age and avoiding lifetime weight gain will likely optimize
Additional questions that current data cannot sufficiently answer include the
effects of specific activities, the optimal dose(s) of the activity and the
optimal time of life for benefits.
Addressing the issue of the effects of physical activity on cancer survivors,
Dr. McTiernan noted that there are over 10 million U.S. cancer survivors with
length of survival increasing. Cancer survivors face long-term effects of their
cancer, treatments, and risk for future cancer and other chronic disease. The
evidence of benefit varies from preliminary to moderate to strong in different
cancer types in different domains.
There are several plausible mechanisms in this area. Human trials support the
effect of exercise on improving risk factors/biomarkers for cancer among adipose
tissue and cytokines, sex hormones, insulin and insulin resistance, and
inflammation. The greatest effect in serum biomarkers is seen with reduction in
The American Cancer Society issues the following
Reducing cancer risk in adults
Moderate-vigorous activity for at least 30 minutes per day, per week; however,
45 – 60 minutes per day is preferable.
Reducing cancer risks in children
Moderate-vigorous activity for at least 60 minutes or more per day, per week.
Reducing cancer risks in patients and survivors
When on treatment, physical activity is likely helpful; however reduced
intensity may be needed.
When off treatment one can participate in activity as one would when in
Regarding future research needs more information is needed on the associations
of physical activity with less well-studied cancers as well as in minority
populations. Additional information is also needed on the effects of specific
types of activity as well as different intensity, duration and frequency of
activity. Future research should focus on long-term observational follow-up of
survivors. There is not enough data to comment on the dose-response effect of
physical activity on recurrence and mortality as well as effect on early late
stages of cancer. More studies are needed on the effects of physical activity on
specific cancer treatments.
The subcommittee can conclude that 30 – 60 minutes per day of moderate-to-vigorous
endurance exercise reduces the risk for colon and breast cancers. There is
insufficient data to give clear dose recommendations for other cancers. Exercise
programs improve quality of life and fitness in cancer survivors.