Abstract
BackgroundPhysical activity has been inversely associated with risk of several cancers. We performed a systematic review and meta-analysis to evaluate the association between physical activity and risk of esophageal cancer (esophageal adenocarcinoma [EAC] and/or esophageal squamous cell carcinoma [ESCC]).MethodsWe conducted a comprehensive search of bibliographic databases and conference proceedings from inception through February 2013 for observational studies that examined associations between recreational and/or occupational physical activity and esophageal cancer risk. Summary adjusted odds ratio (OR) estimates with 95% confidence intervals (CI) were estimated using the random-effects model.ResultsThe analysis included 9 studies (4 cohort, 5 case–control) reporting 1,871 cases of esophageal cancer among 1,381,844 patients. Meta-analysis demonstrated that the risk of esophageal cancer was 29% lower among the most physically active compared to the least physically active subjects (OR, 0.71; 95% CI, 0.57-0.89), with moderate heterogeneity (I2 = 47%). On histology-specific analysis, physical activity was associated with a 32% decreased risk of EAC (4 studies, 503 cases of EAC; OR, 0.68; 95% CI, 0.55-0.85) with minimal heterogeneity (I2 = 0%). There were only 3 studies reporting the association between physical activity and risk of ESCC with conflicting results, and the meta-analysis demonstrated a null association (OR, 1.10; 95% CI, 0.21-5.64). The results were consistent across study design, geographic location and study quality, with a non-significant trend towards a dose–response relationship.ConclusionsMeta-analysis of published observational studies indicates that physical activity may be associated with reduced risk of esophageal adenocarcinoma. Lifestyle interventions focusing on increasing physical activity may decrease the global burden of EAC.
Highlights
Physical activity has been inversely associated with risk of several cancers
Study flow From 422 unique studies identified using the search strategy, 9 studies met the inclusion criteria [13,14,15,16,23,24,25,26,27]. These studies reported on the association between physical activity and 1,871 cases of esophageal cancer among 1,381,844 patients
Six studies on dietary or socioeconomic risk factors for cancer mentioned assessing physical activity as a covariate but did not measure or report association between physical activity and esophageal cancer per se [29,30,31,32,33,34]; four of these studies were published more than 15 years ago and data was not accessible; additional data could not be obtained from contacting authors of two recent studies and these were excluded
Summary
We performed a systematic review and meta-analysis to evaluate the association between physical activity and risk of esophageal cancer (esophageal adenocarcinoma [EAC] and/or esophageal squamous cell carcinoma [ESCC]). While the incidence of esophageal squamous cell cancer (ESCC) is declining in the United States, the incidence of esophageal adenocarcinoma (EAC) has increased more than 6-fold in the last three decades [2]; this has been partly attributed to the obesity epidemic. Routine endoscopic surveillance of patients with BE and endoscopic eradication therapy for a subset of patients with high-grade dysplasia are recommended [4]. This strategy is expensive and limited by suboptimal adherence and access. Chemopreventive strategies using aspirin, statins or proton-pump inhibitors require a large number of patients be treated to prevent a single cancer, making it difficult to ascertain risk-benefit ratio and cost-effectiveness [3,5,6]
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