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In Reply: We agree with Dr Burke that the optimal proof of the role of physical activity in the etiology of breast cancer would come from a randomized clinical trial. Short of that, randomized controlled trials of the effect of physical activity on biomarkers of breast cancer would be useful.¹ Unfortunately, few such studies are available.²

There is evidence from clinical trials that physical activity combined with dietary change can reduce the incidence of diabetes^3-4 and disease-related mortality in persons with known cardiovascular disease.⁵ The role of physical activity in preventing most diseases, however, has not been studied in clinical trials. This is principally because the costs of mounting such large-scale, long-term trials are prohibitive. For example, to our knowledge there has never been a trial of the effect of physical activity on incident cardiovascular disease. We fully support a research program consisting of small randomized trials testing physical activity . . . [Full Text of this Article]

Anne McTiernan, MD, PhD; Emily White, PhD; Charles Kooperberg, PhD
Division of Public Health Sciences
Fred Hutchinson Cancer Research Center
Seattle, Wash

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