Physical activity and risk of endometrial cancer in the Norwegian Women and Cancer (NOWAC) study

Abstract

Few studies have investigated the association between endometrial cancer and physical activity (PA) using repeated measures of PA and different subtypes of endometrial cancer. We aimed to investigate the association between endometrial cancer and PA level at two points in time in women with different body mass index (BMI) profiles, and to calculate the population attributable fraction (PAF) of endometrial cancer for low PA levels. We included 82,759 women with complete information on PA at baseline in the Norwegian Women and Cancer Study; 52,370 had follow-up information on PA. 687 endometrial cancer cases were identified. Multivariate cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). The PAF indicated the proportion of endometrial cancer that could be avoided in the population if these women had a higher PA level. There was a statistically significant association between low PA levels at baseline and follow-up and endometrial cancer risk, with a dose-response trend (lowest PA level: HR = 1.60, 95% CI 1.16-2.20; highest PA level: HR = 0.73, 95% CI 0.45-1.16 compared to the median). Analyses that included follow-up measurements yielded similar results. 21.9% (95% CI 7.1-34.3) of endometrial cancers could be avoided if women with low PA levels (≤ 4 in a 1-10 degree self reported PA scale) increased their PA levels to 5-10. We found an inverse dose-response association between PA and endometrial cancer, independent of BMI. In this nationally representative cohort, 21.9% of endometrial cancers could potentially be avoided if PA levels increased to higher PA levels.