Body size, physical activity, and risk of triple-negative and estrogen receptor-positive breast cancer

Background: Triple-negative breast cancer, characterized by a lack of hormone receptor and HER2 expression, is associated with a particularly poor prognosis. Focusing on potentially modifiable breast cancer risk factors, we examined the relationship between body size, physical activity, and triple-negative disease risk. Methods: Using data from 155,723 women enrolled in the Women's Health Initiative (median follow-up, 7.9 years), we assessed associations between baseline body mass index (BMI), BMI in earlier adulthood, waist and hip circumference, waist-hip ratio, recreational physical activity, and risk of triple-negative (n = 307) and estrogen receptor-positive (ER ⁺, n = 2,610) breast cancers. Results: Women in the highest versus lowest BMI quartile had 1.35-fold (95% CI, 0.92-1.99) and 1.39-fold (95% CI, 1.22-1.58) increased risks of triple-negative and ER⁺ breast cancers, respectively. Waist and hip circumferences were positively associated with risk of ER⁺ breast cancer (P_trend = 0.01 for both measures) but were not associated with triple-negative breast cancer. Compared with women who reported no recreational physical activity, women in the highest activity tertile had similarly lower risks of triple-negative and ER⁺ breast cancers (HR = 0.77; 95% CI, 0.51-1.13; and HR = 0.85; 95% CI, 0.74-0.98, respectively). Conclusions: Despite biological and clinical differences, triple-negative and ER⁺ breast cancers are similarly associated with BMI and recreational physical activity in postmenopausal women. The biological mechanisms underlying these similarities are uncertain and these modest associations require further investigation. Impact: If confirmed, these results suggest potential ways postmenopausal women might modify their risk of both ER⁺ and triple-negative breast cancers.