Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia.
Laboratory of Research in Leisure and Physical Activity, Santa Catarina State University, Florianópolis, Brazil.
Cancer Epidemiol Biomarkers Prev. 2022 Jan;31(1):16-27. doi: 10.1158/1055-9965.EPI-21-0437. Epub 2021 Oct 20.
The effect of physical activity on breast cancer risk may be partly mediated by sex steroid hormones. This review synthesized and appraised the evidence for an effect of physical activity on sex steroid hormones. Systematic searches were performed using MEDLINE (Ovid), EMBASE (Ovid), and SPORTDiscus to identify experimental studies and prospective cohort studies that examined physical activity and estrogens, progestins, and/or androgens, as well as sex hormone binding globulin (SHBG) and glucocorticoids in pre- and postmenopausal women. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to appraise quality of the evidence. Twenty-eight randomized controlled trials (RCT), 81 nonrandomized interventions, and six observational studies were included. Estrogens, progesterone, and androgens mostly decreased, and SHBG increased, in response to physical activity. Effect sizes were small, and evidence quality was graded moderate or high for each outcome. Reductions in select sex steroid hormones following exercise supports the biological plausibility of the first part of the physical activity-sex hormone-breast cancer pathway. The confirmed effect of physical activity on decreasing circulating sex steroid hormones supports its causal role in preventing breast cancer..
体力活动对乳腺癌风险的影响可能部分通过性激素介导。本综述综合评价了体力活动对性激素的影响。系统检索了 MEDLINE（Ovid）、EMBASE（Ovid）和 SPORTDiscus，以确定研究体力活动与雌激素、孕激素和/或雄激素以及绝经前和绝经后妇女的性激素结合球蛋白 (SHBG) 和糖皮质激素的实验研究和前瞻性队列研究。进行了荟萃分析以生成效应估计值。评估了偏倚风险，并使用 GRADE 系统评估证据质量。共纳入 28 项随机对照试验 (RCT)、81 项非随机干预措施和 6 项观察性研究。雌激素、孕激素和雄激素大多随着体力活动而减少，SHBG 则增加。每个结果的效应大小都较小，证据质量被评为中等或高。运动后某些性激素的减少支持体力活动-性激素-乳腺癌途径的第一部分的生物学合理性。体力活动对降低循环性激素的确认作用支持其在预防乳腺癌中的因果作用。
