Correspondent: Yovita
Kristiani Widiyatno
Email: [email protected]
INTRODUCTION
Breast cancer is a malignant
tumor that develops in breast tissue (Anggraini et al., 2018). This type of cancer is one of the most common
cancers. In 2020, breast cancer ranked number one in the world as the type of
cancer with the newest cases. More than two million people in the world had
breast cancer that year (Huang et al., 2022).
Based on data from the Global
Cancer Observatory (2020), breast cancer cases have a high prevalence in
Indonesia (Ng et al., 2023). The
incidence of new cases of breast cancer in Indonesia reached 68,858 cases, and
the death rate was more than 22 thousand people in 2020 (Hamami et al., 2022). This
makes breast cancer one of the first causes of death due to cancer in
Indonesia.
Breast cancer can be prevented in
several ways, including avoiding risk factors. Although the etiology of breast
cancer is still not entirely known, several risk factors influence the
development of breast cancer (Hutagalung & Utomo, 2017). According
to researchers, breast cancer has several risk factors, including consumption
of alcohol and cigarettes, BMI, and inappropriate amount of physical activity.
Etc (Singh & Sharma, 2020).
Physical activity is any body
movement that expends more energy than when resting (Lieberman, 2020). The
physical activity that is often recommended is moderate to vigorous physical
activity or MVPA (Lieberman, 2020). Physical
activity is often referred to as one thing that affects body functions, such as
strengthening muscles and bones and losing weight. Apart from that, regular
physical activity also plays a role in reducing risk factors for various
diseases, one of which is cancer (Adraskela et al., 2017).
The intensity of physical activity is
divided into two: absolute and relative. Absolute physical activity is measured
based on how complex the activity is. For example, in aerobic activity, the
intensity of physical activity is measured based on the energy expended. The
amount of energy expended during physical activity is usually classified in MET
units or Metabolic Equivalent of Task. MET is the energy amount expended based
on specific activities (Hills et al., 2014).
One MET is the energy expended while
resting or sitting still, equivalent to calorie consumption of 1 kcal/kg/hour.
Absolute intensity is divided into three categories: low, moderate, and high.
Compared to sitting still (low intensity), the calories consumed at moderate
intensity are four times more. Meanwhile, for high activities, it is eight
times more. So, it can be concluded that physical activity is classified as
moderate intensity if the energy expended is 4.0 MET and high intensity if the
energy expended is 8.0 MET (WHO, 2020).
If absolute intensity measures are
based on how hard the activity is performed, relative intensity measures are
based on the subject. Relative intensity measures the cardiorespiratory fitness
of subjects performing physical activity. For example, in aerobic activity, the
intensity of physical activity is measured by measuring the percentage of
maximum VO2, VO2 reserve, maximum H.R. (heart rate), or
H.R. reserve. In addition, relative physical activity intensity can be measured
by asking the subject how they feel when doing physical activity (such as using
a 0-10 scale) (Henry & Moore, 2016).
In previous research, breast
cancer was often associated with the intensity of physical activity as a risk
factor. According to researchers,
physically inactive people have a higher risk of cancer (Friedenreich et al.,
2021) (Ligibel et al., 2019).
However, according to
researchers, a history of physical activity is not related to
the incidence of breast cancer (Boeke et al., 2014).
Therefore, the relationship between breast cancer and physical activity
requires further research. According to WHO (2020), physical activity is all
movements that require energy and are carried out using skeletal muscles (Ramsey et al., 2021). WHO
(2021) recommends that adults do a minimum of 150 minutes of moderate-intensity
physical activity, 75 minutes of vigorous-intensity, or 600 MET (Metabolic
Equivalent of Task) minutes/per week (Wickramarachchi et al.,
2021).
Based
on the background above, the objective of this study is to determine and
analyze the relationship between the level of physical activity and the
incidence of breast cancer at Dr. Soetomo Hospital Surabaya. The benefits of
this research are to provide a better understanding of the role of physical
activity in preventing breast cancer, to provide a basis for the development of
effective preventive interventions, and to increase awareness of the importance
of a healthy lifestyle and physical activity in maintaining breast health.
METHOD
This type of
research is a correlation analysis study. The research was conducted using a
survey method by asking respondents the questions in the questionnaire. The
sample population was obtained from the Pusat Pengembangan Layanan Kanker
(PPLK) RSUD Dr. Soetomo Surabaya. This research uses a case-control design. The
inclusion criteria used in this study were female patients aged 40 � 60 years.
The independent variable in this study is the patient's physical activity
level, while the dependent variable is the incidence of breast cancer. This
research uses the GPAQ or Global Physical Activity Questionnaire published by
WHO. GPAQ measures physical activity levels based on MET (Metabolic Equivalent
of Task). This questionnaire has moderate validity if tested on samples aged
less than or equal to 60 years. A more careful and detailed interpretation is
needed if tested on people over 60. GPAQ has been translated into Indonesian by
the author, and the validity value of this questionnaire is 0.64. Meanwhile,
the reliability value is 0.625, meaning this questionnaire is valid and
reliable. Researchers will convert the questionnaire results into MET units
using the MET calculation formula in the GPAQ guidebook in data processing.
RESULTS AND DISCUSSION
The following data on the
distribution of physical activity intensity from childhood to adolescence (8 -
18 years) in breast cancer patients aged 40-60 years and control sample
(non-cancer patients) taken from June to August are as follows:
Table 1 Data Distribution
|
|
Breast Cancer Patient
|
Healthy Woman (Non-Breast Cancer)
|
Total
|
|
Low
|
22
|
11
|
33
|
|
Moderate
|
13
|
13
|
26
|
|
High
|
18
|
29
|
47
|
|
Total
|
53
|
53
|
106
|
The expected value from the data in Table 2 is shown in
table 2 below.
Table 2
shows the expected value.
|
|
Breast Cancer Patient
|
Healthy Woman (Non-Breast Cancer)
|
Total
|
|
Low
|
16,5
|
16,5
|
33
|
|
Moderate
|
13
|
13
|
26
|
|
High
|
23,5
|
23,5
|
47
|
|
Total
|
53
|
53
|
106
|
The results
of the Chi-square calculation in this study are shown in Table 3 below.
Table
3 Chi-square Calculation Results
|
Probability
|
0,0441321
|
|
x2
|
6,2411348
|
|
Chi-square table
|
5,9914645
|
The x2 value was
more significant than the Chi-square table value, so the H0 value was rejected.
Rejected H0 is interpreted that there is a correlation between the intensity of
physical activity at 8 � 18 years old and the incidence of breast cancer.
The
following is a multivariate calculation using SPSS 26.
Table 4 Multivariate P-value Calculation Results
|
|
B
|
S.E.
|
Wald
|
df
|
Sig.
|
Exp
(B)
|
95% C.I. for Exp(B)
|
|
Lower
|
Upper
|
|
Step 2a
|
Low Intensity
|
|
|
7.456
|
2
|
0.024
|
|
|
|
|
Moderate Intensity
|
-1.593
|
0.586
|
7.381
|
1
|
0.007
|
0.203
|
0.064
|
0.642
|
|
High Intensity
|
-0.367
|
0.569
|
0.415
|
1
|
0.520
|
0.693
|
0.227
|
2.116
|
Table 4 shows that the P-value value is 0.007. This value is smaller
than 0.05, which means there is a significant influence between the level of
physical activity and the incidence of breast cancer in RSUD Dr. Soetomo
Surabaya.
Characteristics of Samples
All patients
involved as subjects of this research were female breast cancer patients.
Patients who are included in the inclusion criteria are aged 40 to 60 years;
this aims to avoid other risk factors for breast cancer, namely BRCA gene
mutations (Arpino et al., 2016). This study also only included breast cancer patients
who were fully aware so they could answer the questionnaire questions
optimally. Apart from that, for the comparison variable, the authors also
distributed questionnaires to healthy women (not currently suffering from or
ever who have breast cancer) aged 40 to 60 years.
The Effect of Physical
Activity on Breast Cancer Incidence
This research
uses the Global Physical Activity Questionnaire (GPAQ) questionnaire instrument
published by WHO. This questionnaire has been translated into Indonesian and is
declared valid. This questionnaire assesses several types of physical activity:
physical activity during work, transportation, sports or recreation, and
sedentary behavior. Apart from that, there are also three types of physical
activity classification, namely low, moderate, and heavy, based on the total
MET (Metabolic Equivalent of Task) calculation. Research subjects were
interviewed regarding the physical activity they did at the age of 8 to 18,
namely during the thelarche or breast development period (Cugno & Azzi, 2022).
In data
processing, it was found that of the 53 breast cancer patients who were
research subjects, 41.5% or 22 patients had low-intensity physical activity
from childhood to adolescence. Meanwhile, 13 (24.5%) and 18 (34%) patients were
for moderate and high intensity, respectively. This shows that most of the
breast cancer patients who were the subjects of this study had low physical
activity when they were children and teenagers. After obtaining the data, data
analysis was carried out using Microsoft Excel version 2019 and SPSS. Data
analysis found that the calculated Chi-square value was more significant than
the table Chi-square value, so the H0 value was rejected. H0,
which was rejected, interpreted that there was a relationship between the
intensity of physical activity from childhood to adolescence and the incidence
of breast cancer.
The results
of this study are research by researchers, which state that increasing physical
activity is a supporting factor in lowering the risk of breast cancer (Consortium, 2022). The results of this study are also similar to the
results of several previous studies, which stated that the level of physical
activity is related to the incidence of breast cancer (Ligibel et al., 2019). This is also supported by a previously existing
theory, which states that low levels of physical activity can be a risk factor
for various diseases, one of which is breast cancer (Lontoh et al., 2020).
Physical
activity and obesity are two interrelated things. By doing the appropriate
amount of physical activity, obesity can be prevented and can reduce the risk
of various diseases, including breast cancer (Ligibel et al., 2019). Obesity can increase breast cancer risk factors in
women before and after menopause. A diet can be categorized as bad if the food
consumed is high in starch, sugar, saturated, and trans-saturated fats but low
in fiber, omega-3 fatty acids, and natural antioxidants (Seiler et al., 2018). Besides poor diet, daily sedentary behavior (such as
sitting or lying) can also increase the risk of cancer and other
non-communicable diseases (Syamsudin et al., 2021).
According to
researchers, physical activity also has a positive relationship with sex
hormones, namely SHBG (sex hormone-binding-globulin) (Friedenreich et al., 2021). Ideal physical activity can increase SHBG so that
the risk of breast cancer decreases. Vice versa, a decrease in SHBG can
increase the risk of breast cancer (Hawkins et al., 2019).
CONCLUSION
The level of physical activity is
closely related to the occurrence of breast cancer. In the group of breast
cancer patients, more individuals reported engaging in low-intensity physical
activity since childhood to adolescence. Conversely, in the non-breast cancer
group, more individuals were reported to engage in high-intensity physical
activity between the ages of 8-18 years. Therefore, the higher the intensity of
physical activity during childhood to adolescence, the lower the incidence of
breast cancer. The implication of this research underscores the importance of
paying attention to and promoting sufficient physical activity from an early
age as part of breast cancer prevention strategies. This reaffirms that
patterns of physical activity during development can affect the risk of breast
cancer later in life, and supports the adoption of an active lifestyle as a
proactive step in maintaining breast health.
REFERENCES
Adraskela,
K., Veisaki, E., Koutsilieris, M., & Philippou, A. (2017). Physical
exercise positively influences breast cancer evolution. Clinical Breast
Cancer, 17(6), 408�417. https://doi.org/10.1016/j.clbc.2017.05.003
Anggraini, D., Semiarty, R., Rasyid, R., &
Khambri, D. (2018). Faktor-faktor yang mempengaruhi kualitas hidup penderita
kanker payudara di kota Padang. Jurnal Endurance, 3(3), 562�567. https://doi.org/10.22216/jen.v3i3.1259
Arpino, G., Pensabene, M., Condello, C., Ruocco, R.,
Cerillo, I., Lauria, R., Forestieri, V., Giuliano, M., De Angelis, C., &
Montella, M. (2016). Tumor characteristics and prognosis in familial breast
cancer. BMC Cancer, 16(1), 1�8. https://doi.org/10.1186/s12885-016-2962-1
Boeke, C. E., Eliassen, A. H., Oh, H., Spiegelman, D.,
Willett, W. C., & Tamimi, R. M. (2014). Adolescent physical activity in
relation to breast cancer risk. Breast Cancer Research and Treatment, 145,
715�724. https://doi.org/10.1007/s10549-014-2919-5
Consortium, B. C. A. (2022). Physical activity,
sedentary time and breast cancer risk: a Mendelian randomisation study. British
Journal of Sports Medicine, 56(20), 1157�1170.
Cugno, S., & Azzi, A. J. (2022). Congenital Breast
Anomalies. In Plastic Surgery-Principles and Practice (pp. 565�573).
Elsevier. https://doi.org/10.1016/B978-0-323-65381-7.00037-X
Friedenreich, C. M., Ryder‐Burbidge, C., &
McNeil, J. (2021). Physical activity, obesity and sedentary behavior in cancer
etiology: epidemiologic evidence and biologic mechanisms. Molecular Oncology,
15(3), 790�800. https://doi.org/10.1002/1878-0261.12772
Hamami, S. M. A., Fai, M., Aththar, A. F., Zakaria, M.
N. Z., Kharisma, V. D., Murtadlo, A. A. A., Tamam, M. B., Jakhmola, V.,
Widyananda, M. H., & Turista, D. D. R. (2022). Nano Transdermal Delivery
Potential of Fucoidan from Sargassum sp.(Brown Algae) as Chemoprevention Agent
for Breast Cancer Treatment. Pharmacognosy Journal, 14(6). DOI:10.5530/pj.2022.14.169
Hawkins, M., Tobias, D. K., Alessa, H. B., Chomistek,
A. K., Barnett, J. B., Willett, W. C., & Hankinson, S. E. (2019). Objective
and self-reported measures of physical activity and sex hormones: Women�s
lifestyle validation study. Journal of Physical Activity and Health, 16(5),
355�361. https://doi.org/10.1123/jpah.2018-0241
Henry, B. L., & Moore, D. J. (2016). Preliminary
findings describing participant experience with iSTEP, an mHealth intervention
to increase physical activity and improve neurocognitive function in people
living with HIV. Journal of the Association of Nurses in AIDS Care, 27(4),
495�511. https://doi.org/10.1016/j.jana.2016.01.001
Hills, A. P., Mokhtar, N., & Byrne, N. M. (2014).
Assessment of physical activity and energy expenditure: an overview of
objective measures. Frontiers in Nutrition, 1, 5. https://doi.org/10.3389/fnut
Huang, J., Chan, W. C., Ngai, C. H., Lok, V., Zhang,
L., Lucero-Prisno III, D. E., Xu, W., Zheng, Z.-J., Elcarte, E., & Withers,
M. (2022). Worldwide burden, risk factors, and temporal trends of ovarian
cancer: A global study. Cancers, 14(9), 2230. https://doi.org/10.3390/cancers14092230
Hutagalung, T. B., & Utomo, D. C. (2017).
Meta-analisis variasi penelitian dari peneliti akuntansi di indonesia. Diponegoro
Journal of Accounting, 6(4), 352�362.
Lieberman, D. (2020). Exercised: The science of
physical activity, rest and health. Penguin UK.
Ligibel, J. A., Basen-Engquist, K., & Bea, J. W.
(2019). Weight management and physical activity for breast cancer prevention
and control. American Society of Clinical Oncology Educational Book, 39,
e22�e33.
Lontoh, S. O., Kumala, M., & Novendy, N. (2020).
Gambaran Tingkat Aktifitas Fisik Pada Masyarakat Kelurahan Tomang Jakarta
Barat. Jurnal Muara Sains, Teknologi, Kedokteran Dan Ilmu Kesehatan, 4(2),
453�462.
Ng, B., Puspitaningtyas, H., Wiranata, J. A.,
Hutajulu, S. H., Widodo, I., Anggorowati, N., Sanjaya, G. Y., Lazuardi, L.,
& Sripan, P. (2023). Breast cancer incidence in Yogyakarta, Indonesia from
2008�2019: A cross-sectional study using trend analysis and geographical
information system. Plos One, 18(7), e0288073. https://doi.org/10.1371/journal.pone.0288073
Ramsey, K. A., Rojer, A. G. M., D�Andrea, L., Otten,
R. H. J., Heymans, M. W., Trappenburg, M. C., Verlaan, S., Whittaker, A. C.,
Meskers, C. G. M., & Maier, A. B. (2021). The association of objectively
measured physical activity and sedentary behavior with skeletal muscle strength
and muscle power in older adults: A systematic review and meta-analysis. Ageing
Research Reviews, 67, 101266. https://doi.org/10.1016/j.arr.2021.101266
Seiler, A., Chen, M. A., Brown, R. L., & Fagundes,
C. P. (2018). Obesity, dietary factors, nutrition, and breast cancer risk. Current
Breast Cancer Reports, 10, 14�27. https://doi.org/10.1007/s12609-018-0264-0
Singh, V. K., & Sharma, P. K. (2020). Oxidative
stress and lifestyle-based changes in breast cancer progression. Current
Advances in Breast Cancer Research: A Molecular Approach, 208�235.
Syamsudin, F., Wungu, C. D. K., Qurnianingsih, E.,
& Herawati, L. (2021). High-intensity interval training for improving
maximum aerobic capacity in women with sedentary lifestyle: a systematic review
and meta-analysis. Journal of Physical Education and Sport�(JPES), 21(4),
1788�1797.
WHO. (2020). Physical Activity�.
Wickramarachchi, B., Siop, S., & Perera, B.
(2021). Sinhalese version of the global physical activity questionnaire for
community-dwelling older adults: Reliability and validity. Aging and Health
Research, 1(2), 100016. https://doi.org/10.1016/j.ahr.2021.100016
Received: 02-01-2024 ���������������������������������� Accepted: 21-02-2024 �������������������� ��������������Published: 11-03-2024����� 