{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:51:57Z","timestamp":1791276717459,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2027171"],"award-info":[{"award-number":["2027171"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Physical activity is associated with lower risk of liver cancer, but obtaining an unbiased estimate of the causal effect is challenging due to the competing risk of death due to any other cause. We performed a causal competing risk analysis to estimate the total effect of physical activity on risk of liver cancer in the presence of competing deaths. Data were included for 263,184 participants (870 liver cancers) in the NIH\u2010AARP Diet and Health Study. Total effects in the presence of competing deaths were estimated on the risk difference (RD) scale as the differences, by age, in standardised cause\u2010specific cumulative incidence functions of liver cancer had all participants engaged in \u2265\u20094\u2009h\/week of moderate\u2010 to vigorous\u2010intensity physical activity (MVPA) versus &lt;\u20094\u2009h\/week. There were an estimated 18 per 100,000 fewer liver cancer cases for \u2265\u20094\u2009h\/week of MVPA versus &lt;\u20094\u2009h\/week (95% confidence interval [CI]: 6.2, 29.9) by age 67\u2009years (average age of diagnosis in the United States), and an estimated 58 per 100,000 fewer cases (95% CI: 21.1, 95.8) by age 78\u2009years (average US life expectancy). Estimated RDs were larger in older than younger age groups (e.g., RD per 100,000 at age 85\u2009years\u2009=\u2009\u221279.0, 95% CI: \u2212133.4, \u221224.7; at age 55\u2009years\u2009=\u2009\u22122.0, 95% CI: \u22124.5, 0.6). Our findings strengthen the evidence for physical activity reducing risk of liver cancer. Increasing physical activity at the population level may reduce the growing, global burden of liver cancer.<\/jats:p>","DOI":"10.1002\/ijc.70741","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:09:29Z","timestamp":1791274169000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Physical Activity and Risk of Liver Cancer: A Competing Risk Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7319-5182","authenticated-orcid":false,"given":"Frances E. M.","family":"Albers","sequence":"first","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health University of Melbourne  Melbourne Australia"},{"name":"Cancer Epidemiology Division, Cancer Council Victoria  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1399-7220","authenticated-orcid":false,"given":"S. Ghazaleh","family":"Dashti","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute  Melbourne Australia"},{"name":"Department of Paediatrics, Melbourne Medical School University of Melbourne  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Matthews","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch National Cancer Institute  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta  Calgary Canada"},{"name":"Department of Oncology, Department of Community Health Sciences, Cumming School of Medicine University of Calgary  Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren R.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta  Calgary Canada"},{"name":"Department of Oncology, Department of Community Health Sciences, Cumming School of Medicine University of Calgary  Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M.","family":"Liao","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch National Cancer Institute  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger L.","family":"Milne","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health University of Melbourne  Melbourne Australia"},{"name":"Cancer Epidemiology Division, Cancer Council Victoria  Melbourne Australia"},{"name":"Precision Medicine, School of Clinical Sciences at Monash Health, Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7828-8188","authenticated-orcid":false,"given":"Dallas R.","family":"English","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health University of Melbourne  Melbourne Australia"},{"name":"Cancer Epidemiology Division, Cancer Council Victoria  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2329-9933","authenticated-orcid":false,"given":"Katherine A.","family":"McGlynn","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch National Cancer Institute  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8060-547X","authenticated-orcid":false,"given":"Brigid M.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health University of Melbourne  Melbourne Australia"},{"name":"Cancer Epidemiology Division, Cancer Council Victoria  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1158\/1055-9965.EPI-24-0686","article-title":"Liver Cancer: Progress and Priorities","volume":"33","author":"McGlynn K. A.","year":"2024","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"key":"e_1_2_13_3_1","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray F.","year":"2024","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1016\/j.jhep.2022.08.021","article-title":"Global Burden of Primary Liver Cancer in 2020 and Predictions to 2040","volume":"77","author":"Rumgay H.","year":"2022","journal-title":"Journal of Hepatology"},{"issue":"1","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/hep.31288","article-title":"Epidemiology of Hepatocellular Carcinoma","volume":"73","author":"McGlynn K. A.","year":"2021","journal-title":"Hepatology"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s40471-019-00188-3","article-title":"The Changing Epidemiology of Primary Liver Cancer","volume":"6","author":"Petrick J. L.","year":"2019","journal-title":"Current Epidemiology Reports"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1001\/jamainternmed.2016.1548","article-title":"Association of Leisure\u2010Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults","volume":"176","author":"Moore S. C.","year":"2016","journal-title":"JAMA Internal Medicine"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1200\/JCO.19.02407","article-title":"Amount and Intensity of Leisure\u2010Time Physical Activity and Lower Cancer Risk","volume":"38","author":"Matthews C. E.","year":"2020","journal-title":"Journal of Clinical Oncology"},{"key":"e_1_2_13_9_1","volume-title":"Physical Activity Guidelines Advisory Committee Scientific Report","author":"2018 Physical Activity Guidelines Advisory Committee","year":"2018"},{"key":"e_1_2_13_10_1","unstructured":"World Cancer Research Fund\/American Insistute for Cancer Research \u201cContinuous Update Project Expert Report 2018. Diet Nutrition Physical Activity and Liver Cancer \u201ddietandcancerreport.org."},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1002\/sim.8471","article-title":"A Causal Framework for Classical Statistical Estimands in Failure\u2010Time Settings With Competing Events","volume":"39","author":"Young J. 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J.","year":"2021","journal-title":"Journal of Clinical Epidemiology"},{"key":"e_1_2_13_17_1","doi-asserted-by":"crossref","DOI":"10.1002\/bimj.202200326","article-title":"Recoverability and Estimation of Causal Effects Under Typical Multivariable Missingness Mechanisms","volume":"66","author":"Zhang J.","year":"2024","journal-title":"Biometrical Journal. Biometrische Zeitschrift"},{"key":"e_1_2_13_18_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-89629-2","article-title":"Pan\u2010Serological Antibodies and Liver Cancer Risk: A Nested Case\u2010Control Analysis","volume":"15","author":"Watling C. Z.","year":"2025","journal-title":"Scientific Reports"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1093\/ije\/dyz209","article-title":"A Quantitative Bias Analysis to Estimate Measurement Error\u2010Related Attenuation of the Association Between Self\u2010Reported Physical Activity and Colorectal Cancer Risk","volume":"49","author":"Mahmood S.","year":"2020","journal-title":"International Journal of Epidemiology"},{"key":"e_1_2_13_20_1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s40471-017-0119-7","article-title":"An Evaluation of the Evidence Relating to Physical Iinactivity, Sedentary Behavior, and Cancer Incidence and Mortality","volume":"4","author":"Lynch B. 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J.","year":"2021","journal-title":"Lifetime Data Analysis"}],"container-title":["International Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.70741","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijc.70741","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.70741","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:09:34Z","timestamp":1791274174000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ijc.70741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":25,"alternative-id":["10.1002\/ijc.70741"],"URL":"https:\/\/doi.org\/10.1002\/ijc.70741","archive":["Portico"],"relation":{},"ISSN":["0020-7136","1097-0215"],"issn-type":[{"value":"0020-7136","type":"print"},{"value":"1097-0215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2026-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijc.70741"}}