The effect of the number of biopsies on the delay in the time from the delivery of mammography results to breast cancer histopathological diagnosis.

PURPOSE: The delay in the time (in calendar days) from the delivery of mammography results to histopathological breast cancer (BC) diagnosis could be associated with more advanced clinical stages, a worse prognosis and higher mortality. Therefore, we assessed the association between the number of biopsies and the delay in the time (in calendar days) from the delivery of mammography results to histopathological BC. METHODS: A survey was performed on 563 women aged between 35 and 69 years with histopathologically confirmed BC who attended 11 Mexican hospitals. RESULTS: After adjusting for potential confounders, the odds of having a delay in the time (in calendar days) from the delivery of mammography results to histopathological BC diagnosis (≥ 60 days) among women with ≥ 3 biopsies were 2.99 times the odds of those who had only one biopsy (95% CI 1.35, 6.63). CONCLUSION: The number of biopsies should be considered as a predictor of the time delay between the delivery of the mammography result and the diagnostic result.

Patient and treatment delays among Mexican women with breast cancer before and after the Seguro Popular / Retrasos del paciente y del tratamiento en mujeres mexicanas con cáncer de mama antes y después del Seguro Popular

Abstract: Objective: To assess whether the Catastrophic Health Expenditures Fund (FPGC, Spanish acronym) was associated with delays in seeking medical care and in starting treatment. Materials and methods: We conducted a before and after cross-sectional study. We included 266 women with breast cancer (BC) diagnosis treated during the last three years before the hospitals received the FPGC and 309 women treated in the following three years after the fund was received by the accredited hospitals. Results: After adjusting for potential confounders, we found no association between the FPGC and delay in seeking medical care or between the FPGC and the treatment delay. Conclusions: The FPGC initiative reduced neither the delay in seeking breast cancer medical care for breast cancer nor the treatment delay.

Resumen: Objetivo: Evaluar si el Fondo de Protección contra Gastos Catastróficos en Salud (FPGC) se asoció con retrasos en la búsqueda de atención médica e inicio del tratamiento. Material y métodos: Estudio transversal antes y después, que incluyó 266 mujeres con diagnóstico de cáncer de mama (CM) tratadas durante los últimos tres años previos a que los hospitales recibieran el FPGC y 309 mujeres tratadas en los siguientes tres años posteriores a que los hospitales recibieran el fondo. Resultados: El FPGC no se asoció con el retraso en la búsqueda de atención médica ni con el retraso del inicio del tratamiento. Conclusiones: El FPGC no redujo el retraso en la búsqueda de atención médica por CM ni el retraso del inicio del tratamiento.

Patient and treatment delays among Mexican women with breast cancer before and after the Seguro Popular.

OBJECTIVE: To assess whether the Catastrophic Health Expenditures Fund (FPGC, Spanish acronym) was associated with delays in seeking medical care and in starting treatment. MATERIALS AND METHODS: We conducted a before and after cross-sectional study. We included 266 women with breast cancer (BC) diagnosis treated during the last three years before the hospitals received the FPGC and 309 wo-men treated in the following three years after the fund was received by the accredited hospitals. RESULTS: After adjusting for potential confounders, we found no association between the FPGC and delay in seeking medical care or between the FPGC and the treatment delay. CONCLUSIONS: The FPGC initiative reduced neither the delay in seeking breast cancer medical care for breast cancer nor the treatment delay.

[Factors associated with early childhooddevelopment in mexican children]. / Características infantiles y contextuales asociadas con el desarrollo infantil temprano en la niñez mexicana.

OBJECTIVE: To estimate levels of early childhood develop-ment (ECD) and associated factors in Mexican population aged 19-59 months. MATERIALS AND METHODS: The Ensanut 2018-19 evaluated ECD using the Early Childhood Development Index (ECDI) and level of language develop-ment. We used multivariate models, with logistic or linear regression, depending on the outcome variable. RESULTS: Children of wealthier households and with children's books at home are more likely of having an adequate ECDI; in contrast, children who experienced violent discipline methods are less likely. Children living in rural areas, with more highly educated mothers, who were not undernourished, and with support for learning have higher language scores. CONCLUSIONS: Public policies aimed to enhance early childhood development should take into account the associated modifiable factors.

OBJETIVO: Estimar el nivel de desarrollo infantil temprano (DIT) y sus factores asociados en población mexicana de 19 a 59 meses. MATERIAL Y MÉTODOS: La Encuesta Nacional de Salud Pública y Nutrición 2018-19 evaluó el DIT mediante el Índice de Desarrollo Infantil Temprano (ECDI) y el nivel de desarrollo de lenguaje. Se estimaron modelos multivariados de acuerdo con la variable de resultado, usando modelos de regresión logística o lineal. RESULTADOS: Los niños/as de hogares con mayor nivel socioeconómico y que cuentan con libros infantiles en el hogar tienen mayores posibilidades de DIT adecuado, mientras que los/as niños/as educados con métodos de disciplina violenta tienen menores posibilidades. Además,los niños/as residentes de áreas rurales, hijos/as de madres con mayor escolaridad, sin desnutrición y con oportunidades de aprendizaje tienen un mayor puntaje de lenguaje. CONCLUSIONES: Las políticas públicas encaminadas a mejorar el desarrollo en la primera infancia deben tomar en cuenta los factores modificables asociados.

Características infantiles y contextuales asociadas con el desarrollo infantil temprano en la niñez mexicana / Factors associated with early childhood development in mexican children

Resumen: Objetivo: Estimar el nivel de desarrollo infantil temprano (DIT) y sus factores asociados en población mexicana de 19 a 59 meses. Material y métodos: La Encuesta Nacional de Salud Pública y Nutrición 2018-19 evaluó el DIT mediante el Índice de Desarrollo Infantil Temprano (ECDI) y el nivel de desarrollo de lenguaje. Se estimaron modelos multivariados de acuerdo con la variable de resultado, usando modelos de regresión logística o lineal. Resultados: Los niños/as de hogares con mayor nivel socioeconómico y que cuentan con libros infantiles en el hogar tienen mayores posibilidades de DIT adecuado, mientras que los/as niños/as educados con métodos de disciplina violenta tienen menores posibilidades. Además, los niños/as residentes de áreas rurales, hijos/as de madres con mayor escolaridad, sin desnutrición y con oportunidades de aprendizaje tienen un mayor puntaje de lenguaje. Conclusión: Las políticas públicas encaminadas a mejorar el desarrollo en la primera infancia deben tomar en cuenta los factores modificables asociados.

Abstract: Objective: To estimate levels of early childhood development (ECD) and associated factors in Mexican population aged 19-59 months. Materials and methods: The Ensanut 2018-19 evaluated ECD using the Early Childhood Development Index (ECDI) and level of language development. We used multivariate models, with logistic or linear regression, depending on the outcome variable. Results: Children of wealthier households and with children's books at home are more likely of having an adequate ECDI; in contrast, children who experienced violent discipline methods are less likely. Children living in rural areas, with more highly educated mothers, who were not undernourished, and with support for learning have higher language scores. Conclusion: Public policies aimed to enhance early childhood development should take into account the associated modifiable factors.

Thyroid hormones and breast cancer association according to menopausal status and body mass index.

BACKGROUND: Thyroxine (T4) has been positively associated with tumor cell proliferation, while the effect of triiodothyronine (T3) on cell proliferation has not been well-established because it differs according to the type of cell line used. In Mexico, it has been reported that 14.5% of adult women have some type of thyroid dysfunction and abnormalities in thyroid function tests have been observed in a variety of non-thyroidal illnesses, including breast cancer (BC). These abnormalities might change with body mass index (BMI) because thyroid hormones are involved in the regulation of various metabolic pathways and probably by menopausal status because obesity has been negatively associated with BC in premenopausal women and has been positively associated with BC in postmenopausal women. METHODS: To assess the association between serum thyroid hormone concentration (T4 and T3) and BC and the influence of obesity as an effect modifier of this relationship in premenopausal and postmenopausal women, we measured serum thyroid hormone and thyroid antibody levels in 682 patients with incident breast cancer (cases) and 731 controls, who participated in a population-based case-control study performed from 2004 to 2007 in three states of Mexico. We tested the association of total T4 (TT4) and total T3 (TT3) stratifying by menopausal status and body mass index (BMI), and adjusted for other health and demographic risk factors using logistic regressions models. RESULTS: Higher serum total T4 (TT4) concentrations were associated with BC in both premenopausal (odds ratio (OR) per standard deviation = 5.98, 95% CI 3.01-11.90) and postmenopausal women (OR per standard deviation = 2.81, 95% CI 2.17-3.65). In premenopausal women, the effect of TT4 decreased as BMI increased while the opposite was observed in postmenopausal women. The significance of the effect modification was marginal (p = 0.059) in postmenopausal women and was not significant in premenopausal women (p = 0.22). Lower TT3 concentrations were associated with BC in both premenopausal and postmenopausal women and no effect modification was observed. CONCLUSIONS: There is a strong association between BC and serum concentrations of TT3 and TT4; this needs to be further investigated to understand why it happens and how important it is to consider these alterations in treatment.

The Western dietary pattern is associated with increased serum concentrations of free estradiol in postmenopausal women: implications for breast cancer prevention.

Little is known about the possible influence of food consumption on the serum concentrations of endogenous sex hormones in postmenopausal women. We evaluated the relationships of the Western dietary pattern with serum concentrations of free estradiol and testosterone of postmenopausal women to test the hypothesis that a highly Western dietary pattern is associated with high serum concentrations of these hormones. We used data from a representative subsample of 305 women from the control group of a population-based case-control study conducted in Mexico from 2004 to 2007. A Western dietary pattern index value was compared with log natural serum concentrations of testosterone and estradiol using multiple linear regression models. The median values of serum concentrations of free estradiol and testosterone were 0.26 pg/mL (interquartile range, 0.14-0.43) and 0.40 pg/mL (interquartile range, 0.30-0.70), respectively. A multiple linear regression model showed that for each unit increase in the Western dietary pattern index, there was a 16.2% increase in the serum concentrations of free estradiol (ß=0.15; 95% confidence interval [CI], 0.01-0.29); for each additional serving per week of chicken eggs, the increase was 31.0% (ß=0.27; 95% CI, 0.106-0.441); for each additional serving per week of red meat, the increase was 64.9% (ß=0.50; 95% CI, 0.01-1.01). There was no relationship found between dietary patterns and serum concentrations of free testosterone. The present findings suggest that intake of a Western diet, particularly of chicken eggs and meat, increases serum concentrations of free estradiol; these results have implications for breast cancer prevention.

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BACKGROUND: An alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries. METHODS: We evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed. RESULTS: Radiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms. CONCLUSIONS: Given the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography.

Recurrent BRCA1 and BRCA2 mutations in Mexican women with breast cancer.

BACKGROUND: Germline mutations in the BRCA1 and BRCA2 genes confer an estimated 58% to 80% lifetime risk of breast cancer. In general, screening is done for cancer patients if a relative has been diagnosed with breast or ovarian cancer. There are few data on the prevalence of mutations in these genes in Mexican women with breast cancer and this hampers efforts to develop screening policies in Mexico. METHODS: We screened 810 unselected women with breast cancer from three cities in Mexico (Mexico City, Veracruz, and Monterrey) for mutations in BRCA1 and BRCA2, including a panel of 26 previously reported mutations. RESULTS: Thirty-five mutations were identified in 34 women (4.3% of total) including 20 BRCA1 mutations and 15 BRCA2 mutations. Twenty-two of the 35 mutations were recurrent mutations (62.8%). Only five of the 34 mutation carriers had a first-degree relative with breast cancer (three with BRCA1 and two with BRCA2 mutations). CONCLUSION: These results support the rationale for a strategy of screening for recurrent mutations in all women with breast cancer in Mexico, as opposed to restricting screening to those with a sister or mother with breast or ovarian cancer. IMPACT: These results will impact cancer genetic testing in Mexico and the identification of at-risk individuals who will benefit from increased surveillance. Cancer Epidemiol Biomarkers Prev; 24(3); 498-505. ©2014 AACR.

Hormonal therapy and risk of breast cancer in mexican women.

The use of hormonal therapies, including hormonal contraceptives (HC) and postmenopausal hormone replacement therapy (HRT) have been shown to influence breast cancer (BC) risk. However, the variations of these effects among populations and ethnic groups are not completely documented, especially among Hispanic women. We evaluated the association between HC and premenopausal BC risk, and between HRT and postmenopausal BC risk in Mexican women. Data from a Mexican multi-center population-based case-control study ofwomen aged 35 to 69 years were analysed. A total of 1000 cases and 1074 matched controls were recruited between 2004 and 2007. Information on hormonal therapy was collected through a structured questionnaire. Results were analysed using conditional logistic regression models. Overall, HC were used by 422/891 (47.3%) premenopausal women and HRT was used by 220/1117 (19.7%) postmenopausal women. For HC, odds ratios (ORs) for BC were 1.11 (95% confidence interval (CI): 0.82, 1.49) for current users and 1.68 (95% CI: 0.67, 4.21) for ever-users. No clear effect of duration of use was observed. For HRT, the OR for BC was significantly increased in ever users (OR: 1.45; 95% CI: 1.01, 2.08). A non-significant increased risk was observed for combined estrogen/progestin, (OR =  1.85; 95% CI: 0.84, 4.07) whereas no effect was observed for the use of estrogen alone (OR = 1.14; 95% CI: 0.68, 1.91). Our results indicate that, HC had a non-significant effect on the risk of pre-menopausal BC, but suggested that injected contraceptives may slightly increase the risk, whereas HRT had a significant effect on post-menopausal BC in this population. This study provides new information about the effects of HC and HRT on BC risk in a Mexican population, which may be of relevance for the population of Latin America as a whole.

[Utilization patterns of prevention and early diagnosis for cancer in women]. / Patrones de utilización de programas de prevención y diagnóstico temprano de cáncer en la mujer.

OBJECTIVE: To estimate the utilization patterns of cancer prevention programs in women during the period 2000-2012 in Mexican women who participated in three national surveys. MATERIALS AND METHODS: We analyzed data from the ENSA 2000, ENSANUT 2006 and ENSANUT 2012 that are representative of the Mexican population. Prevalences were obtained, trend tests and Poisson regression were used to determine the possibility of having more coverage. RESULTS: The coverage of Papanicolaou use in the last 12 months in 2012 was 45.5%, HPV testing in the last four years was 11.9% and mammography use in the past two years was 29.4% and 17.2% in women aged 50-69 years and 40-49 years, respectively. CONCLUSIONS: Although there was an increase in the coverage of screening programs, there should be a boost in the service quality and universal coverage.

Patrones de utilización de programas de prevención y diagnóstico temprano de cáncer en la mujer / Utilization patterns of prevention and early diagnosis for cancer in women

Objetivo. Estimar los patrones de utilización de los programas preventivos de cáncer en la mujer durante el periodo 2000-2012 en mujeres mexicanas que participaron en tres encuestas nacionales. Material y métodos. Se analizó información de la ENSA 2000 y de las ENSANUT 2006 y 2012 que son representativas de la población del país. Se obtuvieron prevalencias y se aplicaron pruebas de tendencia y regresión de Poisson para determinar las posibilidades de tener una mayor cobertura. Resultados. La cobertura de uso de Papanicolaou en los últimos 12 meses en 2012 fue de 45.5%, de prueba de VPH en los últimos cuatro años fue de 11.9% y de mastografía en los últimos dos años fue de 29.4 y de 17.2% en mujeres de 50 a 69 años y de 40 a 49 años, respectivamente. Conclusiones. Aunque se observa un incremento en la cobertura de los programas de detección se debe impulsar la calidad de los servicios y la cobertura universal.

Objective. To estimate the utilization patterns of cancer prevention programs in women during the period 2000-2012 in Mexican women who participated in three national surveys. Materials and methods. We analyzed data from the ENSA 2000, ENSANUT 2006 and ENSANUT 2012 that are representative of the Mexican population. Prevalences were obtained, trend tests and Poisson regression were used to determine the possibility of having more coverage. Results. The coverage of Papanicolaou use in the last 12 months in 2012 was 45.5%, HPV testing in the last four years was 11.9% and mammography use in the past two years was 29.4% and 17.2% in women aged 50-69 years and 40-49 years, respectively. Conclusions. Although there was an increase in the coverage of screening programs, there should be a boost in the service quality and universal coverage.

Moderate-intensity physical activity ameliorates the breast cancer risk in diabetic women.

OBJECTIVE: To evaluate the association between self-reported diabetes and the risk of breast cancer (BC) and its interaction with moderate-intensity physical activity in pre- and postmenopausal Mexican women. RESEARCH DESIGN AND METHODS: A population-based case-control study was conducted using 1,000 incident case subjects and 1,074 control subjects. Blood samples and information on health, diet, physical activity, and anthropometric measurements were obtained. RESULTS: The association between diabetes and BC risk decreased with increasing tertiles of moderate-intensity physical activity (odds ratio [OR] = 4.9 [95% CI 2.3-10.8]; 3.0 [1.3-6.9]; and 1.0 [0.1-9.2], respectively, for each tertile) (test for interaction = 0.04). Compared with the women in the lowest tertiles, increased risk was observed in those premenopausal women with the highest serum C-peptide, IGF-1, and IGF-1 binding protein 3 levels. CONCLUSIONS: Moderate-intensity physical activity can substantially ameliorate the increased BC risk in diabetic women.

Serum 25-hydroxyvitamin D and risk of breast cancer: results of a large population-based case-control study in Mexican women.

PURPOSE: Epidemiologic studies have suggested that higher levels of circulating vitamin D may reduce breast cancer risk, but no studies have investigated this association among women in developing countries, and very few studies have further investigated this association according to menopausal status. METHODS: A population-based case-control study in Mexico with 1,000 incident breast cancer cases aged 35-69 years, enrolled shortly after diagnosis (0-6 days) and frequency-matched to 1,074 controls on age, region, and health care system, was used to assess the association between serum 25-hydroxyvitamin D [25(OH)D] levels with overall, pre- and postmenopausal breast cancer risk. 25(OH)D concentration was measured on a random sub-sample of women (573 cases and 639 matched controls) using a liquid chromatography/tandem mass spectrometry method. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated from multivariable conditional logistic regression models. RESULTS: Serum 25(OH)D concentration (per 10 ng/mL increase) showed a strong inverse association with risk of breast cancer among all (p(trend) = 0.001), pre- (p(trend) = 0.006) and postmenopausal women (p(trend) = 0.0001). Compared with a predefined lower concentration of 25(OH)D (<20 ng/mL), higher levels (>30 ng/mL) were associated with lower overall (OR = 0.53, 95 % CI: 0.28-1.00; p(trend) = 0.002), pre- (OR = 0.60, 95 % CI: 0.16-2.17; p(trend) = 0.07) and postmenopausal (OR = 0.37, 95 % CI: 0.16-0.82; p(trend) = 0.004) breast cancer risk. CONCLUSIONS: The results of this large population-based case-control study indicate an inverse association between circulating vitamin D levels and breast cancer risk among pre- and postmenopausal Mexican women.

ω-3 and ω-6 Polyunsaturated fatty acid intakes and the risk of breast cancer in Mexican women: impact of obesity status.

BACKGROUND: ω-3 polyunsaturated fatty acids (PUFA) could play a protective role on the risk of breast cancer; however, little is known about this relation among Mexican women. We evaluated the association between ω-3 and ω-6 PUFA intake and breast cancer risk by obesity status in Mexican women. METHODS: A population-based case-control study was conducted in Mexico, including 1,000 incident breast cancer cases and 1,074 controls matched to cases by age, health care system, and region. Women provided information on health and diet by in-person interview. Body mass index (BMI) measures were used to define overall obesity. Obesity status was categorized as normal weight (18.5 < BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). A conditional logistic regression model was used to assess the association between PUFA and breast cancer risk. RESULTS: Overall, there was no significant association between ω-3 PUFA intake and breast cancer risk (P = 0.31). An increased risk of breast cancer was associated with increasing ω-6 PUFA intake in premenopausal women [OR = 1.92, 95% confidence interval (CI) = 1.13-3.26; P = 0.04]. A decreased risk of breast cancer was significantly associated with increasing ω-3 PUFA intake in obese women (OR = 0.58, 95% CI = 0.39-0.87; P = 0.008) but not in normal weight nor in overweight women (P(heterogeneity) = 0.017). CONCLUSIONS: Obesity status may affect the association between ω-3 PUFA intake and breast cancer risk. The underlying mechanisms may be related to decreased inflammation and improved adipokin and estrogen levels induced by ω-3 PUFA in adipose tissue in obese women. IMPACT: Increased intake of ω-3 PUFA should be recommended among Mexican women in particular in obese women.

Alcohol and risk of breast cancer in Mexican women.

BACKGROUND: Little is known about the relationship between alcohol intake and breast cancer risk among Mexican women. This association may be modified by folate and Vitamin B12. METHODS: A population-based case-control study conducted in Mexico recruited 1,000 incident breast cancer cases aged 35-69 and 1,074 controls matched on age, region, and health care system. In-person interviews were conducted to assess breast cancer risk factors and recent diet using a food frequency questionnaire. Conditional logistic regression models estimated adjusted odds ratios and 95% confidence intervals. RESULTS: Over one-half (57%) of cases and less than one-half of controls (45%) reported any lifetime alcohol consumption. Compared with never drinkers, women reporting ever drinking (Adjusted OR = 1.25, 95% CI = 0.99-1.58) had a greater odds of breast cancer. There was evidence for interaction in the association between ever consuming any alcohol and breast cancer by folate (p for interaction = 0.04) suggesting women with lower folate intake had a higher odds of breast cancer (Adjusted OR = 1.99, 95% CI = 1.26-3.16) compared to women with higher folate intake (OR = 1.12, 95% CI = 0.69-1.83). CONCLUSIONS: Our findings support evidence that any alcohol intake increases risk of breast cancer. Insufficient intake of folate may further elevate risk for developing breast cancer among women who consume alcohol.

Moderate physical activity and breast cancer risk: the effect of menopausal status.

INTRODUCTION: It has been suggested that both moderate-and vigorous-intensity physical activity reduces the risk of breast cancer. However, the effect of moderate-intensity physical activity on breast cancer risk has not been consistently evaluated by menopausal status and has not been evaluated in Mexican women. OBJECTIVE: To evaluate the effect of moderate-intensity physical activity (h/week and MET-h/week) on the risk of breast cancer by menopausal status in Mexican women. METHODS: A population-based case-control study was conducted in Mexico. One thousand incident cases and 1,074 matched controls to cases by 5 years of age, site and health institution participated in the study. Women provided information on health, diet and physical activity by means of an in-person interview. Anthropometric measurements and blood samples were obtained from all women. A conditional logistic regression model was used to assess this association. RESULTS: Participating in moderate-intensity physical activity decreased the risk of BC in both pre- and postmenopausal women (OR = 0.96; 95% CI 0.92.-0.99; OR = 0.90; 95% CI 0.86-0.93, respectively) for every 3 h per week of moderate-intensity physical activity. There was a statistically significant modification effect by menopausal status (p = 0.009). CONCLUSIONS: Strategies need to be identified that will engage women in physical activity programs.