Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Cancer Causes & Control
Published in: Cancer Causes & Control 3/2007

01-04-2007 | Review Article

Physical activity and endometrial cancer risk: a review of the current evidence, biologic mechanisms and the quality of physical activity assessment methods

Authors: Anne E. Cust, Bruce K. Armstrong, Christine M. Friedenreich, Nadia Slimani, Adrian Bauman

Published in: Cancer Causes & Control | Issue 3/2007

Login to get access

Abstract

Objectives

To (1) determine the nature of the association between physical activity and endometrial cancer risk; (2) assess the contribution of variation in the quality of physical activity measurement to inconsistencies in study results; and (3) review the biologic mechanisms that might mediate possible effects of physical activity on risk.

Methods

We reviewed and summarized all published epidemiologic studies examining physical activity and endometrial cancer risk, and evidence relating to possible biologic mechanisms. We assigned each study a quality score for physical activity measurement.

Results

Fourteen of the 18 studies showed a convincing or possible protective effect of physical activity on endometrial cancer risk, with an average relative risk reduction of around 30%. A dose–response relation was observed in 7 of 13 studies. The quality score was not related to the observed strength of association or the presence of a dose–response relation. There was epidemiologic and biologic evidence that vigorous activity, as well as light and moderate intensity activities, such as housework, gardening or walking for transportation, may reduce risk.

Conclusions

Physical activity probably has a protective role in endometrial cancer development. More epidemiologic and biologic evidence is needed to make conclusive recommendations on optimal types, characteristics or time periods of physical activity.
Literature
1.
Kaaks R, Lukanova A, Kurzer MS (2002) Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev 11:1531–1543PubMed
2.
Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:491–505PubMedCrossRef
3.
Calle EE, Kaaks R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4:579–591PubMedCrossRef
4.
Weight control and physical activity (2002) In: Vaino H, Bianchini F, (eds) IARC Handbook for Cancer Prevention, vol. 6. Lyon, France: IARC Press
5.
Friedenreich CM (2001) Physical activity and cancer prevention: from observational to intervention research. Cancer Epidemiol Biomarkers Prev 10:287–301PubMed
6.
Thune I, Furberg AS (2001) Physical activity and cancer risk: dose–response and cancer, all sites and site-specific. Med Sci Sports Exerc 33:S530–50 discussion S609–10PubMedCrossRef
7.
Kaaks R, Lukanova A (2001) Energy balance and cancer: the role of insulin and insulin-like growth factor-I. Proc Nutr Soc 60:91–106PubMedCrossRef
8.
Key TJ, Allen NE, Verkasalo PK, Banks E (2001) Energy balance and cancer: the role of sex hormones. Proc Nutr Soc 60:81–89PubMed
9.
Levine JA, Lanningham-Foster LM, McCrady SK et al (2005) Interindividual variation in posture allocation: possible role in human obesity. Science 307:584–586PubMedCrossRef
10.
Levine JA, Vander Weg MW, Hill JO, Klesges RC (2006) Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain. Arterioscler Thromb Vasc Biol 26:729–736PubMedCrossRef
11.
McTiernan A, Tworoger SS, Ulrich CM et al (2004) Effect of exercise on serum estrogens in postmenopausal women: a 12-month randomized clinical trial. Cancer Res 64:2923–2928PubMedCrossRef
12.
Modugno F, Ness RB, Chen C, Weiss NS (2005) Inflammation and endometrial cancer: a hypothesis. Cancer Epidemiol Biomarkers Prev 14:2840–2847PubMedCrossRef
13.
Atkinson C, Lampe JW, Tworoger SS et al (2004) Effects of a moderate intensity exercise intervention on estrogen metabolism in postmenopausal women. Cancer Epidemiol Biomarkers Prev 13:868–874PubMed
14.
Luo Z, Saha AK, Xiang X, Ruderman NB (2005) AMPK, the metabolic syndrome and cancer. Trends Pharmacol Sci 26:69–76PubMedCrossRef
15.
Physical Activity and Health: A Report of the Surgeon General (1996) Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
16.
Bauman A, Ford I, Armstrong T (2001) Trends in population levels of reported physical activity in Australia 1997, 1999 and 2000. Australian Sports Commission, Canberra
17.
Janz KF (2006) Physical activity in epidemiology: moving from questionnaire to objective measurement. Br J Sports Med 40:191–192PubMedCrossRef
18.
Willett W (1989) An overview of issues related to the correction of non-differential exposure measurement error in epidemiologic studies. Stat Med 8:1031–1040 discussion 1071–3PubMed
19.
Armstrong BK, White E, Saracci R (1992) Principles of exposure measurement in epidemiology. In: Kelsey JL, Marmot MG, Stolley PD, Vessey MP (eds) Monographs in epidemiology and biostatistics. Oxford University Press, Oxford
20.
Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS (1993) A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 25:81–91PubMedCrossRef
21.
R Development Core Team (2005) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3–900051-07-0, URL http://​www.​R-project.​org
22.
Powell KE, Thompson PD, Caspersen CJ, Kendrick JS (1987) Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 8:253–287PubMedCrossRef
23.
Levi F, La Vecchia C, Negri E, Franceschi S (1993) Selected physical activities and the risk of endometrial cancer. Br J Cancer 67:846–851PubMed
24.
Shu XO, Hatch MC, Zheng W, Gao YT, Brinton LA (1993) Physical activity and risk of endometrial cancer. Epidemiology 4:342–349PubMedCrossRef
25.
Pukkala E, Poskiparta M, Apter D, Vihko V (1993) Life-long physical activity and cancer risk among Finnish female teachers. Eur J Cancer Prev 2:369–376PubMedCrossRef
26.
Sturgeon SR, Brinton LA, Berman ML et al (1993) Past and present physical activity and endometrial cancer risk. Br J Cancer 68:584–589PubMed
27.
Dosemeci M, Hayes RB, Vetter R et al (1993) Occupational physical activity, socioeconomic status, and risks of 15 cancer sites in Turkey. Cancer Causes Control 4:313–321PubMedCrossRef
28.
Zheng W, Shu XO, McLaughlin JK, Chow WH, Gao YT, Blot WJ (1993) Occupational physical activity and the incidence of cancer of the breast, corpus uteri, and ovary in Shanghai. Cancer 71:3620–3624PubMedCrossRef
29.
Hirose K, Tajima K, Hamajima N et al (1996) Subsite (cervix/endometrium)-specific risk and protective factors in uterus cancer. Jpn J Cancer Res 87:1001–1009PubMed
30.
Olson SH, Vena JE, Dorn JP et al (1997) Exercise, occupational activity, and risk of endometrial cancer. Ann Epidemiol 7:46–53PubMedCrossRef
31.
Goodman MT, Hankin JH, Wilkens LR et al (1997) Diet, body size, physical activity, and the risk of endometrial cancer. Cancer Res 57:5077–5085PubMed
32.
Moradi T, Nyren O, Bergstrom R et al (1998) Risk for endometrial cancer in relation to occupational physical activity: a nationwide cohort study in Sweden. Int J Cancer 76:665–670PubMedCrossRef
33.
Terry P, Baron JA, Weiderpass E, Yuen J, Lichtenstein P, Nyren O (1999) Lifestyle and endometrial cancer risk: a cohort study from the Swedish Twin Registry. Int J Cancer 82:38–42PubMedCrossRef
34.
Salazar-Martinez E, Lazcano-Ponce EC, Lira-Lira GG et al (2000) Case–control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women. Cancer Causes Control 11:707–711PubMedCrossRef
35.
Moradi T, Weiderpass E, Signorello LB, Persson I, Nyren O, Adami HO (2000) Physical activity and postmenopausal endometrial cancer risk (Sweden). Cancer Causes Control 11:829–837PubMedCrossRef
36.
Littman AJ, Voigt LF, Beresford SA, Weiss NS (2001) Recreational physical activity and endometrial cancer risk. Am J Epidemiol 154:924–933PubMedCrossRef
37.
Colbert LH, Lacey JV Jr, Schairer C, Albert P, Schatzkin A, Albanes D (2003) Physical activity and risk of endometrial cancer in a prospective cohort study (United States). Cancer Causes Control 14:559–567PubMedCrossRef
38.
Furberg AS, Thune I (2003) Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 104:669–676PubMedCrossRef
39.
Schouten LJ, Goldbohm RA, van den Brandt PA (2004) Anthropometry, physical activity, and endometrial cancer risk: results from the Netherlands Cohort Study. J Natl Cancer Inst 96:1635–1638PubMedCrossRef
40.
Matthews CE, Xu WH, Zheng W et al (2005) Physical activity and risk of endometrial cancer: a report from the Shanghai endometrial cancer study. Cancer Epidemiol Biomarkers Prev 14:779–785PubMedCrossRef
41.
Ainsworth BE, Haskell WL, Whitt MC et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–504PubMedCrossRef
42.
United States Department of Labor (1993) Selected characteristics of occupations defined in the revised dictionary of occupational titles. US Government Printing Office, Washington, DC
43.
Rennie KL, Wareham NJ (1998) The validation of physical activity instruments for measuring energy expenditure: problems and pitfalls. Public Health Nutr 1:265–271PubMedCrossRef
44.
Ainsworth BE, Sternfeld B, Slattery ML, Daguise V, Zahm SH (1998) Physical activity and breast cancer: evaluation of physical activity assessment methods. Cancer 83:611–620PubMedCrossRef
45.
Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled agreement or partial credit. Psychol Bull 70:213–220CrossRefPubMed
46.
Shephard RJ (2003) Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med 37:197–206 discussion 206PubMedCrossRef
47.
Slattery ML, Jacobs DR Jr (1995) Assessment of ability to recall physical activity of several years ago. Ann Epidemiol 5:292–296PubMedCrossRef
48.
Richardson MT, Leon AS, Jacobs DR Jr, Ainsworth BE, Serfass R (1994) Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol 47:271–281PubMedCrossRef
49.
Blair SN, Dowda M, Pate RR et al (1991) Reliability of long-term recall of participation in physical activity by middle-aged men and women. Am J Epidemiol 133:266–275PubMed
50.
Matthews CE, Shu XO, Yang G et al (2003) Reproducibility and validity of the Shanghai Women’s Health Study physical activity questionnaire. Am J Epidemiol 158:1114–1122PubMedCrossRef
51.
Taylor HL, Jacobs DR Jr, Schucker B, Knudsen J, Leon AS, Debacker G (1978) A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 31:741–755PubMedCrossRef
52.
Purdie DM, Green AC (2001) Epidemiology of endometrial cancer. Best Pract Res Clin Obstet Gynaecol 15:341–354PubMedCrossRef
53.
Brinton LA, Berman ML, Mortel R et al (1992) Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case–control study. Am J Obstet Gynecol 167:1317–1325PubMed
54.
Mayer-Davis EJ, D’Agostino R Jr, Karter AJ et al (1998) Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA 279:669–674PubMedCrossRef
55.
Borghouts LB, Keizer HA (2000) Exercise and insulin sensitivity: a review. Int J Sports Med 21:1–12PubMedCrossRef
56.
Irwin ML, Mayer-Davis EJ, Addy CL et al (2000) Moderate-intensity physical activity and fasting insulin levels in women: the Cross-Cultural Activity Participation Study. Diabetes Care 23:449–454PubMed
57.
Allen NE, Appleby PN, Kaaks R, Rinaldi S, Davey GK, Key TJ (2003) Lifestyle determinants of serum insulin-like growth-factor-I (IGF-I), C-peptide and hormone binding protein levels in British women. Cancer Causes Control 14:65–74PubMedCrossRef
58.
Pischon T, Hankinson SE, Hotamisligil GS, Rifai N, Rimm EB (2003) Leisure-time physical activity and reduced plasma levels of obesity-related inflammatory markers. Obes Res 11:1055–1064PubMed
59.
Rajaram S, Baylink DJ, Mohan S (1997) Insulin-like growth factor-binding proteins in serum and other biological fluids: regulation and functions. Endocr Rev 18:801–831PubMedCrossRef
60.
Irwin ML, Ainsworth BE, Mayer-Davis EJ, Addy CL, Pate RR, Durstine JL (2002) Physical activity and the metabolic syndrome in a tri-ethnic sample of women. Obes Res 10:1030–1037PubMedCrossRef
61.
Kaaks R, Lukanova A (2002) Effects of weight control and physical activity in cancer prevention: role of endogenous hormone metabolism. Ann N Y Acad Sci 963:268–281PubMedCrossRef
62.
Lukanova A, Zeleniuch-Jacquotte A, Lundin E et al (2004) Prediagnostic levels of C-peptide, IGF-I, IGFBP -1, -2 and -3 and risk of endometrial cancer. Int J Cancer 108:262–268PubMedCrossRef
63.
Key TJ, Pike MC (1988) The dose–effect relationship between ‘unopposed’ oestrogens and endometrial mitotic rate: its central role in explaining and predicting endometrial cancer risk. Br J Cancer 57:205–212PubMed
64.
Frisch RE, Wyshak G, Vincent L (1980) Delayed menarche and amenorrhea in ballet dancers. N Engl J Med 303:17–19PubMedCrossRef
65.
Warren MP (1980) The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 51:1150–1157PubMed
66.
Frisch RE, Gotz-Welbergen AV, McArthur JW et al (1981) Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. JAMA 246:1559–1563PubMedCrossRef
67.
Bullen BA, Skrinar GS, Beitins IZ, von Mering G, Turnbull BA, McArthur JW (1985) Induction of menstrual disorders by strenuous exercise in untrained women. N Engl J Med 312:1349–1353PubMedCrossRef
68.
Dale E, Gerlach DH, Wilhite AL (1979) Menstrual dysfunction in distance runners. Obstet Gynecol 54:47–53PubMedCrossRef
69.
Broocks A, Pirke KM, Schweiger U et al (1990) Cyclic ovarian function in recreational athletes. J Appl Physiol 68:2083–2086PubMed
70.
Bernstein L, Ross RK, Lobo RA, Hanisch R, Krailo MD, Henderson BE (1987) The effects of moderate physical activity on menstrual cycle patterns in adolescence: implications for breast cancer prevention. Br J Cancer 55:681–685PubMed
71.
Loucks AB (2003) Energy availability, not body fatness, regulates reproductive function in women. Exerc Sport Sci Rev 31:144–148PubMedCrossRef
72.
Henderson BE, Casagrande JT, Pike MC, Mack T, Rosario I, Duke A (1983) The epidemiology of endometrial cancer in young women. Br J Cancer 47:749–756PubMed
73.
Forney JP, Milewich L, Chen GT et al (1981) Aromatization of androstenedione to estrone by human adipose tissue in vitro. Correlation with adipose tissue mass, age, and endometrial neoplasia. J Clin Endocrinol Metab 53:192–199PubMed
74.
Sherman B, Wallace R, Bean J, Schlabaugh L (1981) Relationship of body weight to menarcheal and menopausal age: implications for breast cancer risk. J Clin Endocrinol Metab 52:488–493PubMed
75.
Frisch RE, Wyshak G, Albright NL et al (1987) Lower lifetime occurrence of breast cancer and cancers of the reproductive system among former college athletes. Am J Clin Nutr 45:328–335PubMed
76.
La Vecchia C, Franceschi S, Decarli A, Gallus G, Tognoni G (1984) Risk factors for endometrial cancer at different ages. J Natl Cancer Inst 73:667–671PubMed
77.
78.
79.
King AC, Tribble DL (1991) The role of exercise in weight regulation in nonathletes. Sports Med 11:331–349PubMed
80.
Nelson ME, Meredith CN, Dawson-Hughes B, Evans WJ (1988) Hormone and bone mineral status in endurance-trained and sedentary postmenopausal women. J Clin Endocrinol Metab 66:927–933PubMedCrossRef
81.
Verkasalo PK, Thomas HV, Appleby PN, Davey GK, Key TJ (2001) Circulating levels of sex hormones and their relation to risk factors for breast cancer: a cross-sectional study in 1092 pre- and postmenopausal women (United Kingdom). Cancer Causes Control 12:47–59PubMedCrossRef
82.
Cauley JA, Gutai JP, Kuller LH, LeDonne D, Powell JG (1989) The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 129:1120–1131PubMed
83.
Purohit A, Newman SP, Reed MJ (2002) The role of cytokines in regulating estrogen synthesis: implications for the etiology of breast cancer. Breast Cancer Res 4:65–69PubMedCrossRef
84.
Moldoveanu AI, Shephard RJ, Shek PN (2001) The cytokine response to physical activity and training. Sports Med 31:115–144PubMedCrossRef
85.
Pedersen BK, Ostrowski K, Rohde T, Bruunsgaard H (1998) The cytokine response to strenuous exercise. Can J Physiol Pharmacol 76:505–511PubMedCrossRef
86.
Shephard RJ, Shek PN (1998) Associations between physical activity and susceptibility to cancer: possible mechanisms. Sports Med 26:293–315PubMedCrossRef
87.
Nehlsen-Cannarella SL (1998) Cellular responses to moderate and heavy exercise. Can J Physiol Pharmacol 76:485–489PubMedCrossRef
88.
Matthews CE, Fowke JH, Dai Q et al (2004) Physical activity, body size, and estrogen metabolism in women. Cancer Causes Control 15:473–481PubMedCrossRef
89.
Bentz AT, Schneider CM, Westerlind KC (2005) The relationship between physical activity and 2-hydroxyestrone, 16alpha-hydroxyestrone, and the 2/16 ratio in premenopausal women (United States). Cancer Causes Control 16:455–461PubMedCrossRef
90.
Campbell KL, Westerlind KC, Harber VJ, Friedenreich CM, Courneya KS (2005) Associations between aerobic fitness and estrogen metabolites in premenopausal women. Med Sci Sports Exerc 37:585–592PubMedCrossRef
91.
Kelesidis I, Kelesidis T, Mantzoros CS (2006) Adiponectin and cancer: a systematic review. Br J Cancer 94:1221–1225PubMedCrossRef
92.
Ainsworth BE (2000) Issues in the assessment of physical activity in women. Res Q Exerc Sport 71:S37–42PubMed
93.
Pate RR, Pratt M, Blair SN et al (1995) Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 273:402–407PubMedCrossRef
94.
National Physical Activity Guidelines for Adults (2005) Canberra: Australian Government Department of Health and Ageing
95.
McTiernan A, Schwartz RS, Potter J, Bowen D (1999) Exercise clinical trials in cancer prevention research: a call to action. Cancer Epidemiol Biomarkers Prev 8:201–207PubMed
96.
Bassett DR Jr (2000) Validity and reliability issues in objective monitoring of physical activity. Res Q Exerc Sport 71:S30–36PubMed
97.
Freedson PS, Miller K (2000) Objective monitoring of physical activity using motion sensors and heart rate. Res Q Exerc Sport 71:S21–29PubMed
98.
Westerterp KR (1999) Physical activity assessment with accelerometers. Int J Obes Relat Metab Disord 23 Suppl 3:S45–49PubMedCrossRef
99.
Rodriguez DA, Brown AL, Troped PJ (2005) Portable global positioning units to complement accelerometry-based physical activity monitors. Med Sci Sports Exerc 37:S572–581PubMedCrossRef
100.
Pober DM, Staudenmayer J, Raphael C, Freedson PS (2006) Development of novel techniques to classify physical activity mode using accelerometers. Med Sci Sports Exerc 38:1626–1634PubMedCrossRef
101.
Crouter SE, Clowers KG, Bassett DR Jr (2006) A novel method for using accelerometer data to predict energy expenditure. J Appl Physiol 100:1324–1331PubMedCrossRef
102.
Levin S, Jacobs DR Jr, Ainsworth BE, Richardson MT, Leon AS (1999) Intra-individual variation and estimates of usual physical activity. Ann Epidemiol 9:481–488PubMedCrossRef
Metadata
Title
Physical activity and endometrial cancer risk: a review of the current evidence, biologic mechanisms and the quality of physical activity assessment methods
Authors
Anne E. Cust
Bruce K. Armstrong
Christine M. Friedenreich
Nadia Slimani
Adrian Bauman
Publication date
01-04-2007
Publisher
Kluwer Academic Publishers
Published in
Cancer Causes & Control / Issue 3/2007
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-006-0094-7

Other articles of this Issue 3/2007

Cancer Causes & Control 3/2007 Go to the issue

Original Paper

Second primary cancers in patients with nasopharyngeal carcinoma: a pooled analysis of 13 cancer registries

Original Paper

Screening for prostate cancer: A Cochrane systematic review

Original Paper

Ambient UV, personal sun exposure and risk of multiple primary melanomas

Original Paper

Occupational exposure to low frequency magnetic fields and the risk of low grade and high grade glioma

Original Paper

Glycemic load, glycemic index, and carbohydrate intake in relation to pancreatic cancer risk in a large US cohort

Editorial

Cohort studies of etiology and survival after cancer: the unique needs for uninterrupted funding
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits