Physical activity and premenopausal breast cancer: an examination of recall and selection bias

Abstract

Background: Compared with cohort studies, case-control investigations have tended to report clearer protective associations for the relationship between physical activity and premenopausal breast cancer risk.

Methods: We conducted a case-control study within the Nurses' Health Study II cohort to examine whether recall or selection bias could explain the stronger protective associations. Self-reported total recreational physical activity during adulthood and over a woman's lifetime (ages 12 years to current) were assessed in 1997 before diagnosis and, again, from one to seven years after breast cancer diagnosis among the same women.

Results: Eighty-seven percent of cases (417 of 479) and 82% of controls (390 of 474) responded. Selection bias was observed for activity during adulthood but not for activity over a woman's lifetime. Recall bias was not observed in the direction we expected: the odds ratios (ORs) for breast cancer comparing the highest versus lowest quintile of prospectively reported total activity were not significantly different than the corresponding estimates from retrospective reports (e.g., lifetime activity: prospective OR = 0.58, 95% CI: 0.37, 0.93 versus retrospective OR = 0.80; 95% CI: 0.50, 1.29).

Conclusion: Recall or selection bias may not have been accounted for protective associations among case-control investigations examining lifetime recreational physical activity and breast cancer. Selection bias related to recreational physical activity during adulthood and random error in the measurement of physical activity remain concerns.

Fig. 1

Flow chart of nested case-control study. Original incident cases (*) were defined as women who were diagnosed with invasive breast cancer from June 1997 to June 2003, were premenopausal at date of diagnosis, and had no previous report of cancer except non-melanoma skin cancer. Cases and controls were excluded (†) if they did not have prospective physical activity data or if reported their physical activity values. were