体力活动与乳腺癌风险：45 项研究报告中的 38 项队列研究的荟萃分析。
Physical Activity and Risk of Breast Cancer: A Meta-Analysis of 38 Cohort Studies in 45 Study Reports.
机构信息
School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China.
School of Health Science, Wuhan University, Wuhan, Hubei, People's Republic of China.
出版信息
Value Health. 2019 Jan;22(1):104-128. doi: 10.1016/j.jval.2018.06.020. Epub 2018 Dec 14.
OBJECTIVES
To evaluate and quantify the association between physical activity (PA) and risk of breast cancer.
METHODS
A systematic review meta-analysis was conducted. The literature was independently and manually searched by 2 reviewers through 3 English databases (PubMed, Embase, and ISI Web of Science) for data till October 2017. The quality of included studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Fixed-effects models were used to estimate the pooled relative risk and 95% confidence intervals (95% CI). Dose-response analysis was chosen for quantifying the association between PA and risk of breast cancer. The Begg test and the Egger test were used to estimate potential publication bias. Heterogeneity between studies was evaluated with I statistics.
RESULTS
The meta-analysis included 38 cohort studies published between 1994 and 2017, which included 68 416 breast cancer cases. The overall relative risk (ORR) for breast cancer was 0.87 (95% CI 0.84-0.90). The inverse association was consistent among all subgroup analyses. In subgroup analysis by menopausal status, the ORR of breast cancer was 0.83 (95% CI 0.79-0.87) for premenopausal status and 0.91 (95% CI 0.85-0.97) for postmenopausal status. In subgroup analysis by PA type, the ORR for total activity was 0.87 (95% CI 0.81-0.93), for recreational activity 0.88 (95% CI 0.85-0.91), for occupational activity 0.91 (95% CI 0.84-0.99), and for nonoccupational activity 0.87 (95% CI 0.83-0.92). The risk of breast cancer was significantly lower in people with exposure periods longer than 1 year and less than 5 years (ORR 0.62; 95% CI 0.46-0.78), followed by those with lifetime activity (ORR 0.81; 95% CI 0.69-0.93). The ORR for subjects with body mass index of less than 25 kg/m (0.88; 95% CI 0.83-0.93) was close to that for subjects with body mass index of more than 25 kg/m (0.87; 95% CI 0.77-0.97). A linear relationship was found between breast cancer risk and PA (recreational activity and total activity), and the ORR was reduced by 3% (95% CI 0.95-0.99) for every 10 metabolic equivalent of energy hours per week increment in recreational PA and by 2% (95% CI 0.97-0.99) for every 10 metabolic equivalent of energy hours per week increment in total PA.
CONCLUSIONS
PA is significantly associated with a decrease in the risk of breast cancer.
目的
评估和量化体力活动（PA）与乳腺癌风险之间的关联。
方法
进行了系统评价荟萃分析。两位评审员通过 3 个英文数据库（PubMed、Embase 和 ISI Web of Science）独立手动搜索文献，检索截至 2017 年 10 月的数据。使用纽卡斯尔-渥太华质量评估量表评估纳入研究的质量。采用固定效应模型估计合并的相对风险和 95%置信区间（95%CI）。选择剂量-反应分析来量化 PA 与乳腺癌风险之间的关联。使用贝叶斯检验和埃格检验来估计潜在的发表偏倚。用 I ²统计量评估研究间的异质性。
结果
荟萃分析纳入了 1994 年至 2017 年间发表的 38 项队列研究，共包括 68416 例乳腺癌病例。乳腺癌的总体相对风险（ORR）为 0.87（95%CI 0.84-0.90）。所有亚组分析均显示出一致的反比关系。按绝经状态进行亚组分析，绝经前的 ORR 为 0.83（95%CI 0.79-0.87），绝经后的 ORR 为 0.91（95%CI 0.85-0.97）。按 PA 类型进行亚组分析，总活动的 ORR 为 0.87（95%CI 0.81-0.93），娱乐活动为 0.88（95%CI 0.85-0.91），职业活动为 0.91（95%CI 0.84-0.99），非职业活动为 0.87（95%CI 0.83-0.92）。暴露时间超过 1 年且小于 5 年（ORR 0.62；95%CI 0.46-0.78）和终生活动（ORR 0.81；95%CI 0.69-0.93）的人群患乳腺癌的风险显著降低。BMI 小于 25kg/m²（0.88；95%CI 0.83-0.93）的受试者的 ORR 接近 BMI 大于 25kg/m²（0.87；95%CI 0.77-0.97）的受试者。PA（娱乐活动和总活动）与乳腺癌风险之间存在线性关系，每周每增加 10 个代谢当量的能量，ORR 降低 3%（95%CI 0.95-0.99），每周每增加 10 个代谢当量的能量，ORR 降低 2%（95%CI 0.97-0.99）。
结论
PA 与乳腺癌风险降低显著相关。
Zotero 插件