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| Natural Medicines in the Clinical Management of Breast Cancer |
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Breast Cancer Prevention |
Breast Cancer Treatment |
Miscellaneous
The Bottom Line |
References
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Breast cancer is by far the most common cancer in women. There will be about 182,000 new cases of breast cancer in women in the US in 2008...and about 40,000 breast cancer-related deaths. Breast cancer is second only to lung cancer in cancer-related deaths in women. The good news is that breast-cancer related deaths are declining.16632
No one knows exactly why some people get breast cancer and others don't. Genetics appear to play an important role. Patients with a certain mutation in the BRCA1 or BRCA2 gene have an 80% lifetime risk of developing breast cancer by age 70. Mutations of these genes are passed from the mother or father. People with a family history of breast cancer are more likely to carry the mutated genes. Blood tests can screen for BRCA1 or BRCA2 mutations.13784 But patients who complete the screening can face tough choices if the test is positive. Many do their best to minimize the modifiable risks. Others are more aggressive and opt for prophylactic mastectomy.
Genetic mutations account for about 5% to 10% of breast cancer cases. Non-genetic factors are also important. More than 80% of patients who get breast cancer do NOT have a family history of breast cancer. The biggest non-genetic risk factor is age. More than 75% of women diagnosed with breast cancer are over 50.13784
Some risk factors are modifiable. For example, obesity can increase chances of getting breast cancer and reducing weight might lower the risk. Cutting back on alcohol consumption might also lower risk. There is also evidence that people who consume more fruits and vegetables might have a lower risk of developing breast cancer.
| Factors Associated with INCREASED Risk of Breast Cancer13784 |
- Age - Risk increases with increasing age.
- Benign breast disease - Women with benign breast disease have a higher risk of developing breast cancer.
- Births - Having fewer than 2 children or having a first child after age 30 increases the risk of breast cancer.
- Estrogen - Taking estrogen for 1-2 years after menopause increases risk of breast cancer; but the increase risk is eliminated within 5 years of stopping.
- Family history - Having a first degree relative who has had breast cancer doubles the risk of developing breast cancer.
- Genetics - Women with BRCA1 or BRCA2 gene mutations have an 80% lifetime risk of developing breast cancer by age 70.
- Height - Taller women seem to have an increased risk of breast cancer.
- Jewish ethnicity - Jewish women are more likely to have gene mutations that increase the risk of breast cancer.
- Menstruation - women who started menstruating before age 12 or who go through menopause after age 55 have a higher risk of breast cancer.
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| Practice Pearl |
| There are a lot of myths about what increases breast cancer. Explain to women that there is no truth to rumors that antiperspirants/deodorants, abortion, or underwire bras increase breast cancer risk. |
| Commonly Used Conventional and Natural Medicines for Breast Cancer*
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Prevention
- Antiestrogens
- Antioxidants
- Fatty Acids
- Selective Estrogen Receptor Modulators (SERMs)
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Treatment
- Aromatase Inhibitors
- Conventional Medicines
- Anastrozole (Arimidex)
- Exemestane (Aromasin)
- Letrozole (Femara)
- Natural Medicines
- Biological Agents
- Chemotherapy
- Conventional Medicines
- Capecitabine (Xeloda)
- Cyclophosphamide (Cytoxan)
- Docetaxel (Taxotere)
- Doxorubicin (Adriamycin)
- Epirubicin (Ellence)
- Fluorouracil (5-FU, Adrucil)
- Paclitaxel (Taxol)
- Paclitaxel protein-bound particles (Abraxane)
- Vinorelbine (Navelbine)
- Natural Medicines
- Hormonal Agents
- Fulvestrant (Faslodex)
- Goserelin acetate (Zoladex)
- Megestrol (Megace)
- Immunostimulants
- Selective Estrogen Receptor Modulators (SERMs)
- Conventional Medicines
- Raloxifene (Evista)
- Tamoxifen (Nolvadex)
- Toremifene (Fareston)
- Natural Medicines
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| *Note: Many natural products are tried for breast cancer, but very few have reliable evidence that they work. Inclusion in this list does NOT imply that these products are effective for breast cancer.
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Question #1 | | Which of the following is a MODIFIABLE risk factor for breast cancer? | | | | | | | | |
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| | Breast Cancer Prevention |  | |
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Researchers are investigating other ways to help lower risks. They're targeting specific factors that seem to play a role in breast cancer.
| Breast Cancer Screening Guidelines16632 |
- Yearly mammograms for women starting at age 40
- Clinical breast exam about every 3 years for women in their 20s and 30s and annually for women 40 and older.
- Women should perform monthly self exams, to know how their breasts normally feel, and promptly report any change to their health care provider.
- Screening MRI for women with higher risk including women with a strong family history of breast cancer and those who have been treated for Hodgkin's disease.
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Estrogen
Patients with higher lifetime estrogen exposure seem to have a greater risk for developing breast cancer. Researchers use bone mineral density, body mass index, and serum estradiol levels to gauge lifetime estrogen exposure. Women with higher bone density, body mass, and serum estradiol levels seem to have more risk.
Preventive measures often target estrogen. The most promising research is being done with drugs called selective estrogen receptor modulators (SERMs). These agents act selectively on different areas of the body. For example, some SERMs can have estrogenic effects on bone...and help for osteoporosis. At the same time, they can have an antiestrogenic effect on breast tissue and potentially decrease the risk of breast cancer.
There are two SERMs being used...tamoxifen (Nolvadex) and raloxifene (Evista).
Tamoxifen is FDA approved for both treatment AND prevention of breast cancer. Raloxifene was approved for preventing breast cancer in high risk women in 2007. These drugs seem to decrease breast cancer risk by about 50% to 75%.13785 Clinicians rarely use tamoxifen for prevention because it can cause serious side effects such as uterine cancer. Raloxifene is less likely to cause uterine cancer and other adverse effects such as cataracts. The downside is that both drugs increase the risk of blood clots. They cause about 2 more cases per 1000 women per year.16633
For an overview of the role of raloxifene in breast cancer prevention, see the Pharmacist's Letter/Prescriber's Letter article, "Evista will be used more to reduce the risk of breast cancer."
A lot of patients are already trying "natural SERMs" called phytoestrogens. Soy is the most common phytoestrogen. Soy contains isoflavones that seem to have SERM-like effects. In women with high estrogen levels (e.g., premenopausal women), soy isoflavones have more of an antiestrogen effect, by blocking luteinizing hormone (LH), which decreases circulating estrogen levels and by competing with more potent circulating estrogens for binding sites.7805 In women with lower estrogen levels (e.g., postmenopausal women), soy isoflavones have a weak estrogenic effect.3373,3988,8529
Soy isoflavones also have different effects in different parts of the body. This is probably because there are at least two different kinds of estrogen receptors...alpha and beta. Soy isoflavones bind more strongly to the estrogen-beta receptor, which is more common in bone, brain, and vascular tissues. Soy isoflavones bind less strongly to estrogen-alpha receptors, which are more common in breast, uterine, ovary, and kidney tissues.3983,3992,6029,7344,7657
Despite soy's SERM-like effects, the effect of soy on breast cancer is controversial.
Population studies suggest that Asian women who eat a traditional diet high in soy have a lower risk of developing breast cancer.5939,7334,7335,7336,11038,11807,14363 There is some evidence that this benefit can persist even when Asian women immigrate to western cultures and decrease their level of soy intake.7335,7336,9674 Researchers theorize that early premenopausal exposure to soy might provide the most benefit against breast cancer.
In Western cultures, a link between soy and breast cancer risk has not been established. Total dietary intake of phytoestrogens among Western middle-aged women doesn't appear to affect the risk of breast cancer.11391 This could be because Western women simply don't consume enough soy in their diet compared to Asian women.
Studies in animal models show that soy might reduce breast cancer development.3976 Soy also seems to DECREASE breast cancer cell proliferation in vitro.3378,8965,9346,10461 But other evidence suggests that soy might actually INCREASE proliferation of normal breast cells in vivo.3980,3981
Patients will be asking about other sources of phytoestrogens...red clover...flaxseed. But little is known about the effects of these phytoestrogens on breast cancer.
Tell patients the jury is still out on the overall effect of phytoestrogens on breast cancer. Explain that adding a moderate amount of soy (e.g., 20-60 grams of soy protein/day) to the diet is not harmful and might have other benefits. It's a good source of fiber and protein, and can help lower cholesterol.
| Estimated Amount of Soy Protein Contained in Soy Foods |
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Typical Serving Size |
Soy Protein/Serving |
| Soy milk |
228 grams (1 cup) |
10 grams |
| Tofu (uncooked) |
114 grams (4 ounces) |
18 grams |
| Green soybeans (uncooked) |
128 grams (1/2 cup) |
21 grams |
| Soy powder |
30 grams (1/4 cup) |
5.4 grams |
| Tempeh (uncooked) |
114 grams (4 ounces) |
19 grams |
Don't recommend purified isoflavone supplements. It's not known if they have the same effects as whole soy. And there is not as much known about their long-term safety.
| Practice Pearl |
| Tell patients with a history of breast cancer not to overdo it with soy. Normal dietary consumption is probably safe, but patients with a history of breast cancer should avoid supplements that provide high doses of purified isoflavones. |
Calcium D-glucarate is getting a lot of attention. Glucaric acid occurs naturally in fruits and vegetables such as oranges, apples, Brussels sprouts, broccoli, and cabbage. It is combined with calcium to form calcium D-glucarate, which is used in supplements.
Calcium D-glucarate is thought to decrease estrogen levels by affecting estrogen elimination. Estrogen is normally metabolized hepatically by combining with glucuronic acid. It's then excreted in the bile. A bacterial enzyme in the intestine called beta-glucuronidase breaks the estrogen-glucuronide bond. Breaking the bond allows estrogen to be reabsorbed. Calcium D-glucarate works at this step by inhibiting beta-glucuronidase. Blocking this enzyme is thought to decrease the amount of estrogen that is reabsorbed and therefore lower circulating estrogen levels. There is also some evidence that beta-glucuronidase activity might be increased in patients with hormone-dependent cancers like breast cancer.773,774
Calcium D-glucarate seems to protect against experimentally induced tumors in animals.775 But little is known about the effect of calcium D-glucarate in humans, or if supplements are safe. Calcium D-glucarate is already showing up in supplements that target women. Don't recommend them.
If women want to boost their calcium D-glucarate levels, suggest they increase consumption of foods that provide the highest amounts...oranges, apples, and Brussels sprouts.
| Practice Pearl |
| Warn patients taking calcium D-glucarate about potential drug interactions. It might decrease the effectiveness of drugs metabolized through glucuronidation such as lorazepam (Ativan), lamotrigine (Lamictal), entacapone (Comtan), estrogens, and oral contraceptives.772,3952 |
Another interesting compound from vegetables is indole-3-carbinol, also known as I3C. It is released from cruciferous vegetables when they are chewed. It affects estrogen in an interesting way. It doesn't lower estrogen levels, but it changes HOW estrogen is metabolized. It changes metabolism from a more potent metabolite to a less potent metabolite.
Estrogen can be converted to either 16-alpha-hydroxyestrone or 2-alpha-hydroxyestrone. The 16-alpha-hydroxyestrone is thought to have a role in developing cancer. The 2-alpha-hydroxyestrone seems to protect against breast cancer. Indole-3-carbinol induces cytochromes P450 1A1 and 1A2, which shifts metabolism away from 16-alpha-hydroxyestrone in favor of 2-alpha-hydroxyestrone.7175,7177,7179,7180,7181,7182 This means that indole-3-carbinol might boost levels of a protective estrogen metabolite and decrease levels of a harmful one.
Tell patients it's too soon to tell if indole-3-carbinol can reduce breast cancer risk in humans. The National Institutes of Health (NIH) is now sponsoring clinical research, which should answer some important questions. For now, recommend that patients stick to dietary sources of indole-3-carbinol...broccoli, cauliflower, cabbage, and Brussels sprouts.
| Practice Pearl |
| Watch for potential drug interactions in patients trying indole-3-carbinol supplements. Since indole-3-carbinol induces cytochrome P450 1A2, it could theoretically also reduce the effectiveness of drugs metabolized by this enzyme such as cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), olanzapine (Zyprexa), propranolol (Inderal), tacrine (Cognex), theophylline, warfarin (Coumadin), and others. |
Oxidative Damage
Oxidation of tissues can transform normal cells into cancerous cells. There is a lot of hype about boosting antioxidant intake to counteract oxidative damage and help reduce the risk of cancer. Some practitioners are even recommending megadoses of vitamins like vitamin C, vitamin E, vitamin A, beta-carotene, and others.
The evidence for antioxidant supplements is weak. But boosting antioxidant intake from DIETARY sources might help.
Consuming more vitamin A and beta-carotene from fruits and vegetables seems to modestly reduce the risk of breast cancer in premenopausal women. Increasing total intake of beta-carotene from food and supplements also seems to have this effect. The benefits of these antioxidants increase in women at higher risk, including premenopausal women with a family history of breast cancer or those who consume alcohol.1444,10132 It's not known if this benefit extends to postmenopausal women. And it's not known if taking vitamin A or beta-carotene supplements has this potential benefit.
Vitamin E is commonly recommended. However, both population studies and large-scale clinical trials show that neither dietary nor supplemental vitamin E seems to have any effect on the risk of developing breast cancer.4658,4659,13036,13131
Vitamin C is also suggested for preventing breast cancer due to its antioxidant effects. Research related to breast cancer is mixed. Some population research suggests that higher dietary intake of vitamin C (e.g., fruits and vegetables) is associated with a reduced risk of breast cancer.1444,10823,10824 However, other population research has shown no effect.10825,10826 There is no reliable evidence that vitamin C supplements have any effect on breast cancer risk.
Green tea is a popular "healthy" drink. It's different than regular black tea because it's not fermented. Green tea usually contains a greater amount of the natural constituents of tea leaves. The most interesting constituent is called epigallocatechin gallate (EGCG). EGCG is a polyphenolic compound thought to have several anticancer properties. EGCG is an antioxidant and free radical scavenger. There is also some evidence that it might induce certain enzymes that detoxify carcinogens, and possibly decrease new blood vessel growth (angiogenesis) in tumors.1454,1455,1456,4212,8117,8118,11309,12523
Population studies suggest that green tea does not seem to reduce the risk of initially developing breast cancer in Asian populations;13189,14426 however, in Asian-American populations, drinking green tea is associated with a reduced risk of developing breast cancer.14427
Additional population research suggests that Asian women who have had stage I or II breast cancer, who drink 3-5 of more cups of green tea daily, seem to have reduced risk of breast cancer recurrence.3926,13189 But drinking green tea does not seem to significantly reduce the risk of recurrence of later-stage breast cancer.
It's too soon to recommend green tea for preventing breast cancer. But consider recommending it as a safe, healthy alternative to other drinks like soda. Tell patients to stick to BREWED green tea. There is no reliable evidence green tea extracts in tablets or capsules are beneficial.
| Practice Pearl |
| Green tea contains 10-80 mg caffeine per cup and can cause caffeine-related side effects in some patients such as headache, irritability, nervousness, palpitations, tachycardia, etc. Recommend decaffeinated preparations for these caffeine-sensitive patients. |
Dietary Fat
There is a lot of controversy about the role of dietary fat in breast cancer. Some research shows that high-fat diets increase the risk of breast cancer by boosting estrogen levels in women. But more recent research suggests that there is no link between fat and breast cancer.13784
There is also evidence that the TYPE of fat intake is more important than total fat intake. Saturated fats and trans-fatty acids - the "bad" fats - might INCREASE cancer risk. The "good" fats such as monounsaturated fats in olive oil or polyunsaturated fatty acids in fish oil might DECREASE the risk of breast cancer. There is some evidence that women with higher intake of olive oil or fish oil from dietary sources have a lower risk of breast cancer, compared to women with lower intakes.2221,2222,2223,12962 But not all research findings are consistent.
For now, tell patients to shoot for moderate total fat consumption. Consider replacing saturated fats with monounsaturated (olive oil) or polyunsaturated (alpha-linolenic acid, fish oil) oils.
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Question #2 | | Which of the following is TRUE about SERMs? | | | | | | | | |
| | | View brands containing: | | - | Soy |
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Question #3 | | Which of the following is TRUE about soy? | | | | | | | | |
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Question #4 | | Both calcium D-glucarate and indole-3-carbinol are thought to work by decreasing estrogen. Which of the following pairs are correctly matched regarding these products? | | | | | | | | |
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Question #5 | | Regarding antioxidants, which of the following is the best advice for women who want to decrease their risk of breast cancer? | | | | | | | | |
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| | Breast Cancer Treatment | | |
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The good news about breast cancer is that there are effective treatments. Early diagnosis and treatment is a must. About 97% of women who are diagnosed with early-stage breast cancer survive for more than 5 years. The stage of breast cancer is based on tumor size, presence and extent of lymph node involvement, and presence or absence of metastases to other parts of the body. Stages 0, I, and II are referred to as early breast cancer. Stages III and IV are advanced and involve extensive nodal disease and/or metastases.
Despite successes with conventional treatments, more than 50% of breast cancer patients use some kind of alternative medicine. Unfortunately, breast cancer patients often turn to the internet, friends, and health food store clerks for advice on herbals and vitamins rather than their health care provider. It is important for health care providers to initiate dialogue with breast cancer patients to help them make good choices regarding alternative therapies.
Immunostimulants
Natural products that are thought to stimulate immune function are often promoted for breast cancer. The thinking is, if the immune system is stimulated the body has a better chance of fending off cancer.
You'll hear patients talking about coenzyme Q-10. Coenzyme Q-10 is a vitamin-like compound normally produced in the body. It's also in some meats and seafood, but only in small amounts. It's best known as an adjunctive treatment for heart failure and other cardiovascular conditions. Coenzyme Q-10 is an important cofactor in cellular oxidative respiration and generation of adenosine triphosphate (ATP). Researchers are now interested in coenzyme Q-10 for cancer because it also has antioxidant properties and might stimulate the immune system.3993
Coenzyme Q-10 concentrations can be lower in cancerous breast tissue than in healthy tissue.4846,5158 Some researchers think that very low levels of coenzyme Q-10 might be an indicator of a poor prognosis.4846 One small study evaluated the effects of coenzyme Q-10 in combination with other antioxidants in patients with advanced breast cancer. In addition to conventional treatment, women took coenzyme Q-10 plus beta-carotene, vitamin C, vitamin E, selenium, and omega-3 and omega-6 fatty acids. During the 3-5 year follow-up, none of the patients had further metastases and a small percentage had tumor regression. Three patients with multiple metastases received a higher dose of coenzyme Q-10 (390 mg per day) and had complete remission.3993,3995
Some clinicians are also trying coenzyme Q-10 to reduce the cardiovascular toxicity of chemotherapy such as doxorubicin (Adriamycin). It is theorized that doxorubicin might cause cardiotoxicity in part by inhibiting coenzyme Q-10-dependent enzymes.3368 Theoretically, taking coenzyme Q-10 might decrease this toxicity. But so far, there is not much evidence to support this.
Tell patients not to try coenzyme Q-10 on their own. There is some concern that taking coenzyme Q-10 with certain conventional treatments might do more harm than good. Radiation and some chemotherapeutic agents like cyclophosphamide (Cytoxan) work by generating oxygen radicals that damage tumors. Since coenzyme Q-10 is a potent antioxidant, it might protect tumor cells against these treatments.5158,5159
Further research will help determine if coenzyme Q-10 might be a good choice for use AFTER chemotherapy or radiation for preventing tumor recurrence.
We usually think of melatonin for insomnia or jet lag. But its potential role in breast cancer is now being recognized. Breast cancer rates are higher in industrialized nations. It's theorized that exposure to artificial light in industrialized nations might reduce melatonin levels and contribute to increased rates of breast cancer. Animal studies show that removal of the pineal gland, which secretes melatonin, can enhance tumor growth after exposure to carcinogens. This theory has also been tested in blind women whose melatonin levels are not reduced by light exposure. Totally blind women have a lower risk of developing breast cancer.
Melatonin is a potent antioxidant with immunostimulant effects and possibly antitumor effects. In vitro, melatonin seems to have a direct antiproliferative effect on estrogen-responsive breast cancer cells.9711,9751 In preliminary clinical research, high-dose melatonin (20-40 mg per day), in combination with conventional treatments, seems to boost response and possibly double one-year survival rates.5857,7043
Patients with advanced cancer can have lower than normal melatonin levels. So there is some debate about whether taking melatonin is just replacing a deficiency, or if it actually has antitumor effects. It's not clear if melatonin will help for less advanced breast cancer.
This is a promising area of research. But tell patients not to try melatonin for treating breast cancer without expert advice and monitoring. Melatonin is a potent hormone. Doses used in research have been very high and might lead to significant adverse effects.
For more information on the role of melatonin in breast cancer, see Pharmacist's Letter/Prescriber's Letter Detail-Document #170515, "Melatonin and Breast Cancer."
Some patients will be asking about medicinal mushrooms like maitake and shiitake. These mushrooms contain a fibrous substance called beta glucans that can stimulate the immune system and possibly cause tumor cell death. Preliminary research looks good...but so far there's no proof they can effectively treat patients with breast cancer.
| Practice Pearl |
| Tell patients not to over do it with shiitake mushrooms. Doses over 4 grams of shiitake powder have been linked to eosinophilia.1149 |
European mistletoe extracts got a lot of attention in the press a few years ago. Remember when Suzanne Somers appeared on Larry King Live and said she was trying mistletoe for breast cancer?
Mistletoe extracts have been used for breast cancer in Europe since the early 1900s. It is usually injected subcutaneously in the abdomen and used either alone or in combination with conventional treatments.
There is good evidence that mistletoe extracts can affect the immune system in humans. It seems to increase white blood cell counts and increase secretion of cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor-alpha.7039,8843,8844 There is also preliminary evidence that it might have direct cytotoxic effects.8841,8849 However, these effects do not necessarily translate into an effective cancer treatment.
Some clinical studies have been done, but they are generally of poor quality and have produced inconsistent findings.7039,7044,7045 There is no convincing evidence that mistletoe extracts offer any significant clinical benefit in patients with breast cancer.
You might hear patients talking about Iscador, Eurixor, Helixor, and Isorel. These are common European mistletoe extract brand names. Tell patients not to rely on these treatments.
Aromatase Inhibitors
Some natural products are getting attention as potential treatments for breast cancer because they work like some convention drugs called aromatase inhibitors. Drugs in this class include Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole). These drugs block the enzyme aromatase, which is needed for estrogen synthesis. Blocking this enzyme decreases estrogen levels.
For more information on the role aromatase inhibitors for breast cancer, see Pharmacist's Letter/Prescriber's Letter Detail-Document #210113, "Arimidex (anastrozole) for Early Breast Cancer."
Some up and coming natural products also have this effect in vitro. One you might hear about is chrysin. It's a naturally occurring flavonoid found in plants such as passionflower and silver linden.7507,7508 Another is genistein combined polysaccharide. This is the genistein isoflavone from soy combined with a mushroom polysaccharide. There is some evidence that it might decrease the expression of the aromatase enzyme.12110
These are interesting compounds with some potential, but so far, there's no reliable evidence that they are effective for breast cancer. Don't recommend them.
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Question #6 | | Which of the following would be appropriate to tell a breast cancer patient who is considering using coenzyme Q-10? | | | | | | | | |
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Question #7 | | Which of the following factors suggest that melatonin might be a beneficial treatment for breast cancer? | | | | | | | | |
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| | Miscellaneous | | |
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You might get questions about an herbal combination called Essiac. Essiac is a mixture of the herbs burdock root, Indian rhubarb, sheep sorrel, and slippery elm. A Canadian nurse named Rene Caisse popularized the combination in the 1920s. The name "Essiac" is her last name spelled backwards. She claimed that Essiac was formulated by an Ojibwa medicine man "to purify the body and put it back in balance with the great spirit." But the scientific rationale for this herbal combination is not clear.
A variation of Essiac is Flor-Essence. Flor-Essence is the same as Essiac, but also contains watercress, blessed thistle, red clover, and kelp.
Wonderful patient testimonials for these products are all over the internet. Marketers claim miraculous benefits for both prevention and treatment of breast cancer. But the supporting science is completely absent. There is no valid evidence that these products offer any benefit to breast cancer patients. Discourage patients from taking these products.
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Question #8 | | Which of the following natural products has a mechanism most similar to Arimidex (anastrozole)? | | | | | | | | |
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| | The Bottom Line | | |
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There is good evidence supporting the use of medications like raloxifene for breast cancer prevention. Researchers are working on other promising leads...soy, calcium D-glucarate, and indole-3-carbinol.
For now, encourage patients to adopt a healthy lifestyle approach to reduce risk factors for breast cancer...increase exercise, decrease weight if needed, decrease alcohol consumption, and eat a well-balanced diet containing plenty of fruits and vegetables.
Early identification of developing tumors is critical for minimizing breast cancer mortality. Suggest that patients perform regular breast self-exams and get a mammogram annually after age 40.
Conventional approaches to treatment of breast cancer are very effective...surgery, radiation, chemotherapy. But many patients will seek out alternative and complementary treatments. Encourage discussion on these topics. Help patients make good decisions about alternative therapies.
So far there is no substitute for conventional treatment. Discourage patients from using alternative therapies INSTEAD of conventional treatment. Advise patients interested in trying alternative therapies in conjunction with conventional treatments to discuss them with their oncologist. Some adjunctive therapies might be worth a try in some patients... coenzyme Q-10, melatonin. But appropriate medical supervision and monitoring is needed.
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Question #9 | | Which of the following natural medicines is correctly matched with its mechanism of action? | | | | | | | | |
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Question #10 | | Which of the following should be recommended for preventing breast cancer? | | | | | | | | |
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Recommendation Chart for Natural Medicines Used for Breast Cancer *
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| | KEY: | | Consider recommending this product.
| | | | | | Don't recommend using this product.
| | | | | | Recommend against using this product.
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* These proposed recommendations are based solely on the Safety and Effectiveness
Ratings contained in Natural Medicines Comprehensive Database. This assumes use
of high-quality, uncontaminated products and the use of typical doses. Keep in
mind that some products are never appropriate for some patients due to
concomitant disease states, potential drug interactions, or other clinical
factors. Use your clinical judgment before recommending any product.
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| References
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| | 772 | Dwivedi C, Heck WJ, Downie AA, et al. Effect of calcium glucarate on B-glucuronidase activity and glucarate content on certain vegetables and fruits. Biochem Med Metab Bio 1990;43:83-92. | | 773 | Heerdt AS, Young CW, Borgen PI. Calcium glucarate as a chemopreventive agent in breast cancer. Isr J Med Sci 1995;31:101-5. | | 774 | Walaszek Z, Szemraj J, Narog M, et al. Metabolism, uptake and excretion of D-glucaric acid salt and its potential use in cancer prevention. Cancer Detect Prev 1997;21:178-90. | | 775 | Walaszek Z, Hanausek-Walaszek M, Minton JP, Webb TE. Dietary glucarate as anti-promter of 7,12-dimethylbenz(a)anthracene-induced mammary tumorigenesis. Carcinogenesis 1986;7:1463-6. | | 1149 | Levy AM, Kita H, Phillips SF, et al. Eosinophilia and gastrointestinal symptoms after ingestion of shiitake mushrooms. J Allergy Clin Immunol 1998;101:613-20. | | 1444 | Zhang S, Hunter DJ, Forman MR, et al. Dietary carotenoids and vitamins A, C, and E and risk of breast cancer. 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