title: Physical activity, weight control, and breast cancer risk and survival: clinical trial rationale and design considerations.
abstract: Substantial observational epidemiological evidence exists that physical activity and weight control are associated with decreased risk of postmenopausal breast cancer. Uncertainty remains regarding several aspects of these associations, including the effect of possible confounding factors on these associations. We present the rationale and design for two randomized controlled trials that can help resolve this uncertainty. In a 5-year prevention trial conducted among women at high risk of breast cancer, the primary endpoint would be breast cancer incidence. For a comparable survivorship trial, the primary endpoint would be the disease-free interval and secondary endpoints would be breast cancer recurrence-free interval, second primary breast cancer, and total invasive plus in situ breast cancer. A set of inclusion and exclusion criteria is proposed for both trials. Intervention goals are the same for both trials. Goals for the weight control intervention would be, for women whose body mass index (BMI) is greater than 25 kg/m(2), to lose 10% of body weight and, for women whose BMI is less than or equal to 25 kg/m(2), to avoid weight gain. The goal for the physical activity intervention would be to achieve and maintain regular participation in a moderate-intensity physical activity program for a total of 150-225 minutes over at least 5 days per week. Sample size calculations are based on alternative assumptions about hazard ratio, adherence, follow-up duration, and power and are presented for the primary prevention and survivorship trials. Although both studies could enhance our understanding of breast cancer etiology and benefit public health, practical considerations, including smaller sample size, ease of recruitment, and reduced likelihood of early termination, favor the survivorship trial at this time.
authors.affiliation: Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, EPN 4005, Executive Blvd, Bethesda, MD 20892-7344, USA. barbashr@mail.nih.gov
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
authors.forename: Sally
authors.initials: S
authors.lastname: Hunsberger
authors.forename: Marianne H
authors.initials: MH
authors.lastname: Alciati
authors.forename: Steven N
authors.initials: SN
authors.lastname: Blair
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Goodwin
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Rena
authors.initials: R
authors.lastname: Wing
authors.forename: Arthur
authors.initials: A
authors.lastname: Schatzkin
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D003071:Cognition; D023381:Endpoint Determination; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D009043:Motor Activity; D054547:National Cancer Institute (U.S.); D018579:Patient Selection; D011322:Primary Prevention / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012042:Registries; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D018401:Sample Size; D055502:Secondary Prevention / Q000379:methods; D014481:United States