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日常生活中缺乏体力活动的人群十分常见，在美国大约有51%的人群缺乏体力活动，而全球大约有31%的人群都没有达到推荐的体力活动水平；与体力活动相关的任何癌症风险降低，都对公众健康和癌症预防至关重要。 2016年5月16日，《美国医学会杂志·内科学分册》在线发表了美国、瑞典、挪威、芬兰、法国、英国的研究报告，发现高水平休闲体育活动与乳腺癌等13种不同癌症发病风险降低直接相关。 该研究对1987～2004年12项美国和欧洲自我报告体力活动参与者数据进行汇总，随后分析了参与者体力活动和26种癌症发生率之间的相关性。该研究包括了144万位参与者（中位年龄59岁，范围：19～98岁，女性占57%），其中在11年随访过程中被诊断为癌症186932例。 相比低水平体力活动而言，高水平体力活动可以促进26种癌症中的13种风险降低，包括食管腺癌（风险降低42%）、肝癌（27%）、肺癌（26%）、肾癌（23%）、贲门癌（22%）、子宫内膜癌（21%）、髓样白血病（20%）、骨髓瘤（17%）、结肠癌（16%）、头颈癌（15%）、直肠癌（13%）、结肠癌（13%）、乳腺癌（10%）；体力活动水平增加与各种癌症风险降低之间的相关性，与个体身材和吸烟史并不相关；总而言之，高水平体力活动会降低个体平均7%的患癌风险。 但是，体力活动会增加个体5%的前列腺癌风险以及27%的恶性黑色素瘤风险，这种相关性在美国太阳紫外辐射较强地区尤为明显，而在太阳紫外辐射水平较低的地区并无上述相关性。 该研究的最大限制在于无法完全阐明饮食、吸烟以及其他因素如何影响研究结果，同时该研究还利用了参与者自我体力活动报告数据，这些自我报告数据或许会存在一定偏差。 美国埃默里大学、北卡罗来纳大学的流行病学专家对此在线发表评论，认为当前相关研究结果也认同体力活动可以作为全球性预防癌症以及降低癌症风险的黄金法则，业余时间体力活动或许可以作为一种可能降低癌症个体风险的策略，当然后期还需要进行大量深入研究揭示体力活动与癌症之间相关性背后可能的分子机制。 JAMA Intern Med. 2016 May 16. [Epub ahead of print] Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. Steven C. Moore; I-Min Lee; Elisabete Weiderpass; Peter T. Campbell; Joshua N. Sampson; Cari M. Kitahara; Sarah K. Keadle; Hannah Arem; Amy Berrington de Gonzalez; Patricia Hartge; Hans-Olov Adami; Cindy K. Blair; Kristin B. Borch; Eric Boyd; David P. Check; Agnès Fournier; Neal D. Freedman; Marc Gunter; Mattias Johannson; Kay-Tee Khaw; Martha S. Linet; Nicola Orsini; Yikyung Park; Elio Riboli; Kim Robien; Catherine Schairer; Howard Sesso; Michael Spriggs; Roy Van Dusen; Alicja Wolk; Charles E. Matthews; Alpa V. Patel.
Importance: Leisure-time physical activity has been associated with lower risk of heart-disease and all-cause mortality, but its association with risk of cancer is not well understood. Objective: To determine the association of leisure-time physical activity with incidence of common types of cancer and whether associations vary by body size and/or smoking. Design, Setting, and Participants: We pooled data from 12 prospective US and European cohorts with self-reported physical activity (baseline 1987-2004). We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals for associations of leisure-time physical activity with incidence of 26 types of cancer. Leisure-time physical activity levels were modeled as cohort-specific percentiles on a continuous basis and cohort-specific results were synthesized by random-effects meta-analysis. Hazard ratios for high vs low levels of activity are based on a comparison of risk at the 90th vs 10th percentiles of activity. The data analysis was performed from January 1, 2014, to June 1, 2015. Exposures: Leisure-time physical activity of a moderate to vigorous intensity. Main Outcomes and Measures: Incident cancer during follow-up. Results: A total of 1.44 million participants (median [range] age, 59 [19-98] years; 57% female) and 186,932 cancers were included. High vs low levels of leisure-time physical activity were associated with lower risks of 13 cancers: esophageal adenocarcinoma (HR 0.58, 95% CI 0.37-0.89), liver (HR 0.73, 95% CI 0.55-0.98), lung (HR 0.74, 95% CI 0.71-0.77), kidney (HR 0.77, 95% CI 0.70-0.85), gastric cardia (HR 0.78, 95% CI 0.64-0.95), endometrial (HR 0.79, 95% CI 0.68-0.92), myeloid leukemia (HR 0.80, 95% CI 0.70-0.92), myeloma (HR 0.83, 95% CI 0.72-0.95), colon (HR 0.84, 95% CI 0.77-0.91), head and neck (HR 0.85, 95% CI 0.78-0.93), rectal (HR 0.87, 95% CI 0.80-0.95), bladder (HR 0.87, 95% CI 0.82-0.92), and breast (HR 0.90, 95% CI 0.87-0.93). Body mass index adjustment modestly attenuated associations for several cancers, but 10 of 13 inverse associations remained statistically significant after this adjustment. Leisure-time physical activity was associated with higher risks of malignant melanoma (HR 1.27, 95% CI 1.16-1.40) and prostate cancer (HR 1.05, 95% CI 1.03-1.08). Associations were generally similar between overweight/obese and normal-weight individuals. Smoking status modified the association for lung cancer but not other smoking-related cancers. Conclusions and Relevance: Leisure-time physical activity was associated with lower risks of many cancer types. Health care professionals counseling inactive adults should emphasize that most of these associations were evident regardless of body size or smoking history, supporting broad generalizability of findings. DOI: 10.1001/jamainternmed.2016.1548 JAMA Intern Med. 2016 May 16. [Epub ahead of print] The Promise of Leisure-Time Physical Activity to Reduce Risk of Cancer Development. Lauren E. McCullough; Kathleen M. McClain; Marilie D. Gammon.
Cancer is among the leading causes of morbidity and mortality worldwide, with 14.1 million new cancer cases and 8.2 million cancer-related deaths in 2012. By 2030 the global cancer burden is expected to double, with 21.7 million new cases and 13.2 million cancer deaths projected due to demographic changes alone. These estimates will likely be compounded by the trend toward unhealthy lifestyle behaviors (eg, smoking and poor diet), particularly in emerging economies. Given that large increases in cancer incidence and mortality are expected to occur in developing countries where economic resources for secondary and tertiary care are low, primary preventive strategies for cancer risk reduction could help to decrease the worldwide cancer burden. DOI: 10.1001/jamainternmed.2016.1521
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