A Botanical Approach to Symptom Management During and After Breast Cancer Treatment
by Lise Alschuler, ND
Breast cancer is the most common cancer in the United States, with 266,120 cases in women and 2,550 cases in men diagnosed in 2018.1 In women, breast cancer represents 30% of all cancers diagnosed and is responsible for 14% of all deaths from cancer.2 Of all breast cancers diagnosed in women, more than three-quarters are diagnosed in postmenopausal women.3 The five-year survival rate for localized breast cancer is 99%, whereas the five-year survival for metastatic breast cancer is 27%.4 According to the American Cancer Society, deaths from breast cancer in the United States have fallen by 30% over the past two decades.5 This improvement is likely due in part to better screening, which results in an increased proportion of early stage diagnoses that are more amenable to treatment. Improved treatments also have contributed to this favorable trend. The majority of women diagnosed with breast cancer will undergo conventional treatment in the form of surgery, radiation, chemotherapy, and/or endocrine therapy. Many of these women seek additional integrative therapies, including botanicals, to improve their tolerance to, and the efficacy of, these conventional treatments.
While the clinical data supporting the use of botanicals concurrent with conventional treatment is far from robust, there is a body of emerging data. One area of interest is the reduction of adverse side effects, which can make conventional treatment a more tolerable experience and improve treatment adherence, thereby supporting better outcomes. This article provides an overview of the current state of evidence for selected botanicals for improving outcomes with conventional therapies.
An Integrative Approach for Women with Breast Cancer
Breast cancer is a potentially life-threatening disease, and the conventional treatments in use are effective for most women. Adjunctive integrative therapies that support a woman’s well-being, while complementing and not interfering with conventional treatment efficacy or safety, may be valuable.6 Safe, concurrent integrative botanical therapy requires nuanced knowledge of the type of breast cancer diagnosis and the conventional treatment(s) being used. For each chemotherapeutic agent, molecular targeted therapy, immune therapy, and endocrine therapy, it is important to know the class of drug, mechanism(s) of action, metabolism and terminal half-life, schedule of treatments, intent of the treatment (curative or palliative), and how each botanical or other integrative therapy might interact or interfere. For radiation therapy, the type and duration of treatment as well as the type and location of tissues within the radiation field should be ascertained in order to accurately anticipate the nature and location of potential radiation toxicities, which, in turn, can inform botanical recommendations.
It is equally important to have strong knowledge of the botanicals intended for use in a patient with breast cancer undergoing conventional treatment. Phytochemical constituents have the potential to interfere with drug metabolism, drug mechanisms of action, and/or the effects of radiation and, therefore, may modulate efficacy or increase toxicities. Botanicals may be counterproductive when used in conjunction with certain conventional treatments. For instance, the use of herbs such as dong quai (Angelica sinensis, Apiaceae)7 and fenugreek (Trigonella foenum-graecum, Fabaceae) seed husks8 that may potentially raise estradiol levels or stimulate estrogen receptor-mediated cell growth would be contraindicated during hormonal treatment with aromatase inhibitors. In addition, herbs that may have antiplatelet or anticoagulant effects, such as dan shen (Salvia miltiorrhiza, Lamiaceae),9 should be used judiciously in patients with low platelet counts (less than 25,000), a relatively common effect of certain chemotherapeutics and found in some women with advanced disease. Finally, choosing high-quality botanicals is of utmost importance in order to avoid the introduction of potential adulterants, contaminants, excessive extraction residues, or other compounds with potentially toxic effects.
The primary focus of this discussion of herbal medicine in integrative oncology is to mitigate symptoms during conventional treatment. Given the lethality of cancer, it is essential to use an evidence-informed treatment approach. While the evidence base for botanicals in this regard is small, women are asking questions about the use of botanicals, and clinicians should be aware of the evidence for specific herbs that may aid in symptom management during active conventional treatment.
Botanicals during Chemotherapy
Turmeric (Curcuma longa, Zingiberaceae) is a well-known herb with anti-inflammatory actions. Systemic inflammation underlies many cancer- and treatment-related symptoms and is also a risk factor for disease progression and poor outcomes.10 A randomized, double-blind, placebo-controlled eight-week trial of 98 adults with solid tumors (primarily breast, colorectal, and gastric) assessed the impact of curcumin supplementation on systemic inflammation.11 The intervention was 300 mg phytosomal curcumin (Meriva; Indena SpA; Milan, Italy) three times daily, providing 180 mg curcuminoids daily. Chemotherapy regimens that were commonly used for these cancers were docetaxel-cisplatin-5-fluorouracil (5-FU) (gastric cancer and breast cancer), topotecan-cyclophosphamide-etoposide (breast cancer), cyclophosphamide-methotrexate-5-FU (breast cancer), and 5-FU-based regimens (colorectal cancer). Curcumin supplementation resulted in significantly greater improvements in quality of life (QoL) after eight weeks compared with placebo (P < 0.001). Additionally, various biomarkers of systemic inflammation reduced significantly in the curcumin group, including tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and calcitonin gene-related peptide (CGRP). The phytosomal, or liposomal, form of curcumin used in this trial may minimize the risk of herb-drug interactions, as compared to turmeric/curcumin products containing piperine (an alkaloid derived from black pepper [Piper nigrum, Piperaceae]).12
Capecitabine, another commonly used chemotherapeutic, is associated with a 40% to 50% incidence of hand-foot syndrome (HFS), a form of peripheral neuropathy. In a six-week pilot study of 40 patients (80% were female and 52% had breast cancer) receiving capecitabine, 4 g of turmeric (95% curcumin extract), taken as two capsules 12 hours apart, was associated with a reduced incidence of all grades of HFS, specifically 27.5% incidence after the first cycle of capecitabine treatment and 34% after the second cycle. The incidence of grade 2 or higher HFS (more severe) was only 10% after the first and second cycles of capecitabine, as compared to observed rates of 29% to 38% in placebo groups reported in other trials.13 While these data are encouraging, this study is limited by its small size and the lack of a control group.
Patients undergoing chemotherapy often experience fatigue. American ginseng (Panax quinquefolius, Araliaceae) is reputed to have anti-fatigue effects and has been a botanical of interest for this purpose. An eight-week, placebo-controlled clinical trial randomly assigned 364 adults actively receiving, or having recently completed, curative-intent treatment for cancer (all cancers were included except brain or central nervous system lymphoma) to 2 g American ginseng root extract (3% ginsenosides) or placebo daily to assess effects on fatigue.14 Compared to the placebo group, ginseng supplementation was associated with a significant improvement in fatigue after eight weeks of treatment (P = 0.003). A subgroup analysis comparing patients undergoing treatment versus those who had completed treatment found significant improvements in fatigue at both four weeks (P = 0.02) and eight weeks (P = 0.01) in the ginseng patients undergoing treatment, compared to those undergoing treatment in the placebo group.
American ginseng has been shown to downregulate inflammation and modulate cortisol levels in stressed individuals, which may explain its potential benefit in fatigued patients. American ginseng does not have significant effects on cytochrome P450 enzymes, according to an in vitro assay, though further study is required.15 Furthermore, water-extracted American ginseng and the crude root have not been shown to have estrogenic properties,16 and in vitro data suggest American ginseng may have an inhibitory effect on the growth of breast cancer cells.17 While these results need to be replicated in other studies, given the lack of any pharmacologic treatments for cancer-related fatigue, and the low risk presented by P. quinquefolius, this herb may be a reasonable option for patients.
Sleep disruption is common among patients undergoing conventional cancer treatment, particularly chemotherapy. Poor sleep contributes to fatigue and reduced QoL during treatment. Valerian (Valeriana officinalis, Caprifoliaceae) root was studied in a phase III randomized, placebo-controlled trial of 227 patients undergoing cancer treatment who had difficulty sleeping.18 More than 66% of participants had breast cancer and were receiving chemotherapy. The subjects were randomly assigned to receive 450 mg valerian root standardized to 0.8% valerenic acid or placebo one hour before bedtime each day for eight weeks. The Pittsburgh Sleep Quality Index (PSQI) and other sleep-quality questionnaires were used to evaluate response. While there was no significant improvement in overall sleep quality in the valerian group, the investigators reported improvements in several secondary outcomes including fatigue, sleep latency, amount of sleep per night, and drowsiness. However, these findings also lacked statistical validity. There were no serious toxicities reported. It should be noted that most studies of valerian root for insomnia use 450-900 mg of an ethanolic extract of valerian with an herb-extract ratio of 4-7:1. The use of 450 mg crude valerian root powder in this study is on the low end of typical doses.
Although there are several preclinical studies that demonstrate valerian’s effect on various cytochrome P450 enzymes, clinical studies have failed to find any relevant interactions with anticancer drugs.19 There seems to be no evidence that valerian raises serum estrogen levels or has significant stimulatory effects on the estrogen receptor.
Clinical studies have yielded varying results for the antiemetic effect of ginger (Zingiber officinale, Zingiberaceae) on chemotherapy-induced nausea.20 One positive trial was a double-blind, multisite prospective clinical study that included 744 participants with various types of cancer (74% breast cancer) receiving chemotherapy.21 The subjects were assigned to either placebo or to one of three different daily doses of ginger: 0.5 g, 1 g, or 1.5 g. All subjects took the treatment for six days beginning three days prior to the start of each chemotherapy treatment. All patients also received an antiemetic (5-HT3 receptor antagonist) and dexamethasone (a steroid) with each chemotherapy cycle. While all doses of ginger reduced nausea compared to placebo on the first day of chemotherapy (P = 0.003 overall), the two smallest doses (0.5 g and 1 g) reduced nausea the most (P = 0.017 and P = 0.036, respectively).
Ginger is purported to have antithrombotic actions at high doses, although in a systematic review, the majority of studies did not find an inhibitory effect on platelet aggregation at the 3.6-5 g dosage range.20 Caution may be warranted with the concurrent use of ginger and chemotherapeutics metabolized by cytochrome P2C9 or cytochrome P3A4, as ginger has been shown to inhibit these enzymes in vitro.22 The rapid half-life of key compounds in ginger may, however, mitigate the risk of herb-drug interactions.
Botanicals during Endocrine Therapy
Hot flashes are a common symptom in women taking endocrine therapies (tamoxifen citrate, anastrozole, exemestane, letrozole, and fulvestrant). Since the aim of endocrine therapy is to lower estrogen levels, the use of estrogenic substances is ill-advised. Numerous studies have evaluated the effects of black cohosh (Actaea racemosa, Ranunculaceae) for menopausal hot flashes, making it an herb of interest for patients and clinicians. Black cohosh does not contain phytoestrogens and does not stimulate the estrogen receptor.23 In fact, some research suggests that black cohosh may inhibit the proliferation of estrogen receptor-positive (and estrogen receptor-negative) breast cancer cells.24 Though clinical trials on black cohosh for hot flashes are mixed, the plant might be helpful for some women. The effect on hot flashes appears to be due to the impact of various plant components acting on the central endogenous opioid system25 and the hypothalamus with dopaminergic, noradrenergic, serotoninergic, and GABAergic effects.26
In a study of 136 women taking tamoxifen (20 mg daily), a majority of the 90 patients who also took a black cohosh extract (Klimadynon, now sold as Monopret; Bionorica AG; Neumarkt, Germany; a 10:1 58% ethanol extract yielding 2.8 mg proprietary extractant) had reduced hot flashes after the intervention.27 Specifically, after 12 months of 20 mg Klimadynon daily, 50% were free of hot flashes compared to only 26% in the tamoxifen-only group. In addition, only 25% of the women who took black cohosh extract experienced severe hot flashes. No serious adverse events were reported. The study was limited by the fact that it was open-label, there was no placebo arm, and there were twice as many women in the tamoxifen-plus-black cohosh extract group than in the tamoxifen-only group.
In addition to its potential benefit in reducing hot flashes, black cohosh may be associated with reduced risk of breast cancer recurrence. In an observational retrospective cohort study of 1,102 women previously diagnosed with breast cancer and taking tamoxifen, the use of black cohosh was associated with a 17% reduced risk of recurrence.28 Another retrospective study of 949 patients with breast cancer and 1,524 controls found that the use of black cohosh was associated with a 53% reduced risk of recurrent breast cancer.29
Black cohosh has no known clinically relevant effects on cytochrome P450 enzymes,30 or any known hepatotoxic effects. However, there have been some reported cases of hepatotoxicity associated with black cohosh dietary supplement products. A United States Pharmacopeia review in 2010 recommended a caution label on black cohosh products, but a subsequent examination of these cases suggested that the hepatotoxicity might be the result of quality problems, likely adulteration with other Cimicifuga species, and that black cohosh itself does not appear to pose a risk of hepatoxicity.31,32 A 2018 study found that, when tested, only seven of 36 (19%) commercial black cohosh products contained true Actaea racemosa; the other 29 products indicated adulteration.33 Clinicians should be aware of the quality issues surrounding black cohosh in the marketplace and counsel women appropriately.
Botanicals during Radiation Therapy
One of the most common adverse effects associated with radiation therapy for breast cancer is radiation dermatitis. Radiation dermatitis is painful and, when severe, can interrupt radiotherapy. In a phase III non-blinded, randomized study of 254 patients with breast cancer receiving postoperative radiation therapy, application of topical calendula (Calendula officinalis, Asteraceae) ointment (Pommade au Calendula par Digestion; Boiron Ltd.; Messimy, France) to radiation-exposed skin resulted in 22% lower incidence of grade 2 or higher dermatitis compared to treatment with trolamine cream.34 The subjects applied the ointments twice daily at least two hours before each radiation treatment.
However, in a larger randomized, double-blinded phase III study that compared the use of topical calendula (Calendula Weleda cream, 10% calendula; Weleda; Arlesheim, Switzerland) to an aqueous cream in 411 women with breast cancer undergoing radiation, no differences between the groups in patient-reported symptoms (pain, burning, itching, pulling, tenderness) were noted at any of the evaluation points. The incidence of severe acute radiation skin reactions of grade 2 or lower at the follow-up visit was 23% in the calendula group and 19% in the aqueous cream (placebo) group.35 The cream was applied twice daily, and subjects were advised not to apply the cream within two hours of each radiation treatment.
Green tea (Camellia sinensis, Theaceae) preparations sometimes are used topically to minimize radiation dermatitis. Epigallocatechin gallate (EGCG), a key catechin in green tea, scavenges superoxide anions, hydroxyl radicals, and hydrogen peroxide, and can bind free radicals, protecting DNA from radiation-induced damage. This benefit was demonstrated in a single arm, prospective phase II clinical trial of 49 patients with breast cancer who received radiation therapy over four weeks.36 All patients receiving radiation therapy began treatment when they developed grade 1 dermatitis. Treatment consisted of a solution of 660 mmol of 95% EGCG per liter saline sprayed onto the exposed skin three times daily. In this group of patients, the maximum grade of dermatitis over a mean duration of treatment of four weeks was mild (grade 1) in 71%, moderate (grade 2) in 29%, and no patients experienced more severe (grades 3-4) dermatitis. EGCG also improved dermatitis and improved pain in 85.7% of patients, burning in 89.8%, itching in 87.8%, and skin pulling in 71.4%. While this was an open study without a placebo arm, the results suggest that topical EGCG may limit the severity and symptoms of radiation dermatitis. The solution used in this study can be approximated by mixing sufficient green tea standardized extract powder to obtain 350 mg EGCG with 1 liter of saline solution. The solution can then be sprayed onto skin with a nasal or throat mister.
Turmeric and Curcuminoids
Curcuminoids, the pigmented compounds found in turmeric rhizome, also have been studied for radiation dermatitis. In a randomized, double-blind, placebo-controlled trial of 30 patients with breast cancer receiving radiation therapy over four to seven weeks, 2 g turmeric containing 95% curcuminoids (Curcumin C3 Complex; Sabinsa; East Windsor, NJ) taken orally three times daily reduced the severity of radiation dermatitis at the end of treatment compared to placebo (radiation dermatitis scores of 2.6 vs. 3.4; P = 0.008).37 Significantly, only 28.6% of the curcuminoid-treated patients developed moist desquamation (skin thinning and oozing as a result of radiation-induced damage to the epithelium) compared to 87.5% of the placebo-treated patients.
In addition to the potential protective effect of curcumin on the skin, there is in vitro evidence of a radiosensitizing effect from curcumin on breast cancer cells.38 In spite of these positive results, a multisite double-blind, placebo-controlled trial of 686 patients with breast cancer failed to find benefit in the prevention of radiation dermatitis with 2 g of the previously mentioned turmeric product when taken orally three times daily over placebo throughout the course of radiation treatment plus one week after treatment.39
Not a class of botanicals, mushrooms are in the kingdom Fungi. A proprietary processed liquid fermentation of the turkey tail mushroom (Coriolus versicolor or Trametes versicolor, Polyporaceae) known as Polysaccharide Krestin (PSK) has been shown in an adjuvant randomized trial of 914 women to increase disease-free survival in patients with node-negative, ER-negative, and stage IIA T2N1 breast cancer. The dose used in the study was 3 g per day.40 Similar effects were observed in a randomized trial of 227 patients with operable breast cancer with vascular invasion of the tumor and/or of metastatic lymph nodes. The survival curve was improved in the group who took a daily dose of 3 g PSK concurrent with chemotherapy (5-FU, cyclophosphamide, mitomycin C, and prednisolone [FEMP]) compared to chemotherapy alone (P = 0.0739).41
The survival impact from the addition of T. versicolor to conventional treatment was assessed in a 2012 meta-analysis of 13 clinical trials with 2,587 subjects being treated for various solid tumors. Subjects with breast, gastric, or colorectal cancer who took T. versicolor extracts (PSK, PSP [Chinese product equivalent of PSK], and mycelium extracts were all included) typically dosed at 3 g daily had a 9% absolute five-year overall survival benefit, resulting in one additional patient alive after five years for every 11 patients treated with the mushroom.42 There are no known herb-drug interactions with turkey tail mushroom.
Conventional breast cancer treatments offer women the most desirable disease outcomes, including, for many, remission. However, the treatments can be difficult to tolerate due to the many accompanying side effects. A broader integrative approach may optimize treatment tolerance and, therefore, success. Women are pursuing adjunctive therapies, including botanicals, while clinicians are faced with trying to provide evidence-informed counsel on their use. While the body of evidence supporting the inclusion of botanicals in integrative breast cancer care continues to expand, studies that evaluate the efficacy and impact of botanicals on the main outcome of conventional treatment are limited. Additionally, the content and quality of botanical supplements may vary, confounding conclusions from clinical trials. This state of evidence has led the Society for Integrative Oncology, in its 2018 guidelines on the use of integrative therapies during and after breast cancer treatment, to conclude that there is no strong evidence to support the use of ingested dietary supplements (including herbs) in the management of treatment-related toxicities.43 Therefore, patients with cancer should only use these botanicals with the guidance of health care professionals. Future clinical efficacy studies may generate greater clarity on the specific indications for botanicals in the integrative treatment of breast cancer.
Source : American Botanical Council
Link to Source with References
Dietary walnut altered gene expressions related to tumor growth, survival, and metastasis in breast Cancer patients: A pilot clinical trial
W. Elaine Hardman a, Donald A.Primerano a, Mary T.Legenza b, James Morgan c 1, Jun Fan, a James Denvir
Consumption of walnuts has slowed breast cancer growth and/or reduced the risk of mammary cancer in mice. The benefit against cancer was associated with altered expression of genes for cancer growth and survival. We hypothesized that walnut consumption would alter gene expression in pathologically confirmed breast cancers of women in a direction that would be expected to decrease breast cancer growth and survival, as was seen in mice. The study was a non-placebo, two-arm, clinical trial. Women with breast lumps large enough for research and pathology biopsies were recruited and randomized to walnut consuming or control groups. Immediately after biopsy collection, women in the walnut group began to consume two ounces of walnuts per day until follow-up surgery. Pathological studies confirmed that lumps were breast cancer in all women who remained in the trial. At surgery, about two weeks after biopsy, additional specimens were taken from the breast cancers. Changes in gene expression in the surgical specimen compared to baseline were determined in each individual woman in walnut-consuming (n = 5) and control (n = 5) groups. RNA-Seq expression profiling revealed that expression of 456 identified genes was significantly changed in the tumor due to walnut consumption. Ingenuity Pathway Analysis showed activation of pathways that promote apoptosis and cell adhesion, and inhibition of pathways that promote cell proliferation and migration. These results support the hypothesis that, in humans, walnut consumption could suppress growth and survival of breast cancers.
Source : Journal Nutrition Research
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“Evaluation of anti-breast cancer, anti-angiogenic and antioxidant properties of selected medicinal plants
Sonali S.Kamblea, Rajesh N.Gaccheab
Historically, medicinal plants and natural products have been used to treat a variety of human health issues and there has been renewed interest in their use for integrated cancer management. The present investigation was aimed to evaluate the anti-breast cancer, anti-angiogenic and antioxidant potential of selected local botanicals.
The methanolic extracts of Cassia occidentalis, Callistemon viminalis, Cleome viscosa and Mimosa hamata were assessed for their cytotoxic properties against a human breast cancer cell line MCF-7 by using the Sulforhodamine B (SRB) assay. The anti-angiogenic potential of all plant extracts was assessed by using an in vivo chorioallantoic membrane (CAM) model. Furthermore, the antioxidant potential of plant samples was evaluated using 2, 2-diphenyl-1-picryl hydrazine(DPPH), hydroxyl (OH) and superoxide radical (SOR) scavenging assays.
The results of the present investigation revealed that all the selected plant extracts: C. occidentalis (IC50 = 70 ± 0.11 μg/ml), C. viminalis (IC50 = 44 ± 0.19 μg/ml), C. viscosa leaves (IC50 = 70 ± 0.22 μg/ml), C. viscosa root (IC50 = 73.2 ± 0.36 μg/ml) and M. hamata (IC50 = 65.8 ± 0.25 μg/ml) demonstrated an effective cytotoxic effect against MCF-7 cells. In the CAM model, the plant extracts exhibited significant anti-angiogenic activity by inhibiting the blood vessels density. Amongst the tested samples, the most efficient anti-angiogenic effect was demonstrated by extract of C. viminalis (67.76 ± 0.77%). Additionally, all the studied plant extracts were found to possess considerable antioxidant activity.
The selected botanicals with their anti-angiogenic and antioxidant potential could be considered as natural resources in the identification of possible therapeutic agents for breast cancer.
Source : The European Journal of Integrative Medicine
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An innovative anti-cancer Chinese herbal formula exhibited multi-targeted efficacies in metastatic breast cancer mouse model
Grace Gar-Lee Yue, Julia Kin-Ming Lee, Ben Chung-Lap Chan, Hin-Fai Kwok, Sandy Wan-Heng Hoi, Daniel Man-Yuen Sze, Kwok-Pui Fung, Ping-Chung Leung and Clara Bik-San Lau
The incidence and mortality of cancer metastasis is high worldwide. Despite of the chemotherapeutic agents, many cancer patients still take traditional Chinese herbal prescriptions as adjuvant treatments. However, most of these herbal formulae/products lack of evidence-based efficacy. Based on our previous investigations on anti-tumor, anti-angiogenic, anti-metastatic, bone protective and immunomodulating activities of various Chinese herbal medicines, four constituent herbs, namely Andrographis paniculata, Acanthopanax senticosus, Camellia sinensis, and Hedyotis diffusa were eventually selected to form an innovative herbal formula.
The anti-tumor efficacies of the formula were evaluated in metastatic breast cancer mice model. The bone protective and immunomodulatory effects were also assessed after formula treatment.
Our results showed that the breast tumor weight as well as lung and liver metastasis in mice could be reduced after herbal formula treatment for 4 weeks. The breast tumor-induced osteolysis in mice was restored by herbal formula treatment, in which the bone volume in treated mice tibia was comparable to that in the non-tumor bearing normal mice. The IL-12 level was augmented and the survival of mice with metastatic breast tumors was prolonged after treatment. Furthermore, combination of herbal formula with chemotherapeutic agent doxorubicin resulted in better anti-tumor efficacy and increased life span in tumor-bearing mice, when compared with doxorubicin alone treatment.
In summary, our innovative Chinese herbal formula was demonstrated to possess anti-tumor, anti-metastatic and bone-protective activities in metastatic breast tumor-bearing mice. The preclinical data generated in this study would lead to the development of evidence-based supplement as adjuvant therapy for metastatic breast cancer.
Source : Journal Chinese Medicine
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Impact of Self-Acupressure on Co-Occurring Symptoms in Cancer Survivors
Suzanna Maria Zick Ananda Sen Afton Luevano Hassett Andrew SchrepfGwen Karilyn Wyatt Susan Lynn Murphy John Todd Arnedt Richard Edmund Harris
Cancer survivors with fatigue often experience depressive symptoms, anxiety, and pain. Previously, we reported that self-acupressure improved fatigue; however, its impact on other co-occurring symptoms and their involvement in treatment action has not been explored.
Changes in depressive symptoms, anxiety, and pain were examined prior to and following two formulas of self-acupressure and usual care using linear mixed models in 288 women from a previously reported clinical trial. Participants were categorized by random assignment into one of three groups: 1) relaxing acupressure, 2) stimulating acupressure, or 3) usual care. Moderators investigated were body mass index, age, depressive symptoms, anxiety, sleep and pain, and mediators were change in these symptoms.
Following treatment, depressive symptoms improved statistically significantly for the relaxing acupressure group (41.5%) compared with stimulating acupressure (25%) and usual care (7.7%). Both acupressure groups were associated with greater improvements in anxiety than usual care, but only relaxing acupressure was associated with greater reductions in pain severity, and only stimulating acupressure was associated with greater reductions in pain interference. There were no statistically significant moderators of sleep quality, anxiety, or depressive symptoms. Fatigue statistically significantly moderated pain, and age statistically significantly modified fatigue. Changes in depressive symptoms and sleep quality statistically significantly mediated the relationship between relaxing acupressure and usual care on fatigue; however, the effect was small.
Acupressure was associated with greater improvements than usual care in anxiety, pain, and symptoms of depression in breast cancer survivors with troublesome fatigue. These findings warrant further evaluation in suitably controlled randomized trials.
Source : JNCI Cancer Spectrum,
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Fruit and vegetable consumption and breast cancer incidence: Repeated measures over 30 years of follow‐up
Maryam S. Farvid , Wendy Y. Chen, Bernard A. Rosner, Rulla M. Tamimi, Walter C. Willett, A. Heather Eliassen
We evaluated the relation of fruit and vegetable consumption, including specific fruits and vegetables, with incident breast cancer characterized by menopausal status, hormone receptor status, and molecular subtypes. Fruit and vegetable consumption, cumulatively averaged across repeated, validated questionnaires, was examined in relation to risk of invasive breast cancer among 182,145 women initially aged 27‐59y in the Nurses' Health Study (NHS, 1980‐2012) and NHSII (1991‐2013). Cox proportional hazards regression, adjusted for known risk factors, was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and assessed tumors by hormone receptor status and molecular subtypes. We prospectively documented 10,911 invasive breast cancer cases. Greater intake of total fruits and vegetables, especially cruciferous and yellow/orange vegetables, was associated with significantly lower breast cancer risk (>5.5 versus ≤2.5 servings/day HR=0.89, 95%CI=0.83‐0.96; Ptrend=0.005). Intake of total vegetables was especially associated with lower risk of estrogen receptor negative tumors (HR per 2 additional servings/day as a continuous variable=0.85, 95%CI=0.77‐0.93; Pheterogeneity=0.02). Among molecular subtypes, higher intake of total fruits and vegetables (HR per 2 additional servings/day as a continuous variable) was most strongly associated with lower risk of human epidermal growth factor receptor 2 (HER2)‐enriched (HR=0.78, 95%CI=0.66‐0.92), basal‐like (HR=0.85, 95%CI=0.73‐0.99), and luminal A (HR=0.94, 95%CI=0.89‐0.99), but not with luminal B tumors (Pheterogeneity=0.03). In conclusion, our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.
Source : International Journal of Cancer via Sci-Hub.tw
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Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial
Robert Zachariae Ali Amidi Malene F Damholdt Cecilie D R ClausenJesper Dahlgaard Holly Lord Frances P Thorndike Lee M Ritterband
Insomnia is two to three times more prevalent in cancer survivors than in the general population, where it is estimated to be 10% to 20%. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia, but meeting survivor needs remains a challenge. Internet-delivered CBT-I (iCBT-I) has been shown efficacious in otherwise healthy adults. We tested the efficacy of iCBT-I in breast cancer survivors with clinically significant sleep disturbance.
Women from a national sample of Danish breast cancer survivors who experienced clinically significant sleep disturbance were randomly allocated to iCBT-I or waitlist control (55:45). The fully automated iCBT-I program consisted of six cores. Online measures of insomnia severity, sleep quality, and fatigue were collected at baseline, postintervention (nine weeks), and follow-up (15 weeks). Online sleep diaries were completed over two-week periods pre- and postintervention. Intention-to-treat analyses (time × group interactions) were conducted with mixed linear models and corrected for multiple outcomes. All statistical tests were two-sided.
A total of 255 women were randomly allocated to iCBT-I (n = 133) or waitlist control (n = 122). Statistically significant (P ≤ .02) time × group interactions were found for all sleep-related outcomes from pre- to postintervention. Effect sizes (Cohen’s d) ranged from 0.33 (95% confidence interval [CI] = 0.06 to 0.61) for wake after sleep onset to 1.17 (95% CI = 0.87 to 1.47) for insomnia severity. Improvements were maintained for outcomes measured at follow-up (d = 0.66–1.10).
iCBT-I appears to be effective in breast cancer survivors, with additional benefit in terms of reduced fatigue. This low-cost treatment could be incorporated in cancer rehabilitation programs.
Source : Journal of the National Cancer Institute
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Phytoestrogen (+)-pinoresinol exerts antitumor activity in breast cancer cells with different oestrogen receptor statuses
- Alicia López-Biedma,
- Cristina Sánchez-Quesada,
- Gabriel Beltrán,
- Miguel Delgado-Rodríguez and
- José J. Gaforio
Background Consumption of virgin olive oil (VOO) has been associated with a low breast cancer incidence. Pinoresinol is a phytoestrogen that is typically found in VOO. Considering the role of oestrogen in breast cancer development and progression, we investigated the potential antitumor activity of pinoresinol in breast cancer cells.
Methods To address this question, we treated MDA-MB-231 (oestrogen receptor [ER] negative) and MCF7 (ER+) human breast tumour cells and MCF10A human mammary epithelial cells (ER-) with different concentrations of pinoresinol. The cytotoxic activity, cell proliferation, cell cycle profile, apoptosis induction, reactive oxygen species production and DNA damage were assessed.
Results Pinoresinol showed cytotoxic, anti-proliferative and pro-oxidant activity in human breast tumour cells, independent of their oestrogen receptor status. In addition, pinoresinol exerted antioxidant activity and prevented DNA damage associated with oxidative stress in human mammary epithelial cells.
Conclusions Overall, the results suggest that pinoresinol may have antitumor activity in human breast cancer cells independently of oestrogen receptor status. Furthermore, the results show that the pinoresinol has the typical characteristics of a chemopreventive compound.
Source : BMC Complementary and Alternative Medicine
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Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors A Randomized Clinical Trial
Suzanna M. Zick, ND, MPH; Ananda Sen, PhD; Gwen K. Wyatt, PhD, RN; Susan L. Murphy, PhD; J. Todd Arnedt, PhD; Richard E. Harris, PhD
IMPORTANCE Fatigue is a common and debilitating late-term effect of breast cancer that is associated with poor sleep and decreased quality of life, yet therapies remain limited. Acupressure has reduced fatigue in previous small studies, but rigorous clinical trials are needed.
OBJECTIVES To investigate if 6 weeks of 2 types of self-administered acupressure improved fatigue, sleep, and quality of life vs usual care in breast cancer survivors and to determine if changes were sustained during a 4-week washout period. DESIGN,
SETTING, AND PARTICIPANTS Phase 3 randomized, single-blind, clinical trial conducted from March 1, 2011, through October 31, 2014. Women were recruited from the Michigan Tumor Registry.
INTERVENTIONS Randomization (1:1:1) to 6 weeks of daily self-administered relaxing acupressure, stimulating acupressure, or usual care.
MAIN OUTCOMES AND MEASURES The primary outcome was change in the Brief Fatigue Inventory score from baseline to weeks 6 and 10. Secondary analyses were sleep (Pittsburgh Sleep Quality Index) and quality of life (Long-Term Quality of Life Instrument).
RESULTS A total of 424 survivors of stages 0 to III breast cancer who had completed cancer treatments at least 12 months previously were screened, and 288 were randomized, with 270 receiving relaxing acupressure (n = 94), stimulating acupressure (n = 90), or usual care (n = 86). One woman withdrew owing to bruising at the acupoints. At week 6, the percentages of participants who achieved normal fatigue levels (Brief Fatigue Inventory score <4) were 66.2% (49 of 74) in relaxing acupressure, 60.9% (42 of 70) in stimulating acupressure, and 31.3% (26 of 84) in usual care. At week 10, a total of 56.3% (40 of 71) in relaxing acupressure, 60.9% (42 of 69) in stimulating acupressure, and 30.1% (25 of 83) in usual care continued to have normal fatigue. At neither time point were the 2 acupressure groups significantly different. Relaxing acupressure, but not stimulating acupressure, showed significant improvements in sleep quality compared with usual care at week 6, but not at week 10. Only relaxing acupressure significantly improved quality of life vs usual care at weeks 6 and 10.
CONCLUSIONS AND RELEVANCE Both acupressure arms significantly reduced persistent fatigue compared with usual care, but only relaxing acupressure had significant effects on sleep quality and quality of life. Relaxing acupressure offers a possible low-cost option for managing symptoms.
Source : JAMA Oncology
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Low Fat Diet Helps Postmenopausal Women Avoid Deadly Breast Cancer
A large randomized clinical trial found that postmenopausal women who stayed on a low fat diet for 8 years had a reduced risk of death from invasive breast cancers and improved survival rates compared with women who did not follow the dietary regimen.1 The study was presented at a clinical trial plenary session at the American Association for Cancer Research Annual Meeting, held April 16-20, 2016 in New Orleans, Louisiana.
This analysis used data from 48,835 postmenopausal women who participated in the randomized, controlled, dietary modification trial that was part of the Women's Health Initiative. Though an association between dietary fat intake and breast cancer has been observed for about half a century, this study sought to clarify the effects of a low-fat dietary pattern on breast cancer.
The participating women were age 50 to 79 years, had no prior breast cancer, normal mammograms, and normal dietary fat intake. Of those, 19,541 women were put on a low-fat diet with nutritionist-led group sessions that sought to reduce fat intake reduction to 20% of energy and increase the consumption of fruits, vegetables, and grain. The other 29,294 women in the trial followed their usual dietary patterns.
After about 8 years of remaining on the low fat diet, 1,767 of the women were diagnosed with breast cancer. Researchers found the breast cancer overall survival from diagnosis was higher in the dietary group: 82% versus 78%. The researchers said this reduction is due, in part, to better survival following breast cancer diagnosis.
"This was the first time we had examined the deaths after breast cancer among this group, and we found that a sustained low-fat diet increased the survival rates among postmenopausal women after a breast cancer diagnosis," said presenting author Rowan Chlebowski, MD, PhD, of the Los Angeles Biomedical Research Institute in California. "The study also suggests that women would need to remain on the low fat diets to maintain the benefits of the dietary intervention."
The 2 groups of women had similar breast cancer characteristics, including size, nodal status, and distribution of poor prognosis, triple-negative cancers and HER2-positive cancers. However, the dietary group had fewer progesterone-receptor-negative cancers (28.4% versus 33%). In addition, researchers noted lower cardiovascular disease mortality in the dietary group.
1. Chlebowski RT, Aragaki AK, Anderson GL, et al. Low-fat dietary pattern and breast cancer mortality in the Women's Health Initiative (WHI) randomized trial. Abstract CT043. Presented at American Association for Cancer Research Annual Meeting, held April 16-20, 2016 in New Orleans, Louisiana.
Source : Oncology Nurse Advisor
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Breastfeeding Associated With A Reduced Risk of Aggressive Breast Cancer
A large international study shows that breastfeeding is associated with a lower risk of developing hormone-receptor–negative (HRN) breast cancer, an aggressive form of the disease. This breastfeeding meta-analysis, published inAnnals of Oncology (2015; doi:10.1093/annonc/mdv379), shows the risk was reduced by up to 20% in women who breastfed.
HRN breast cancers are more likely to be aggressive and life threatening. This subtype is more commonly diagnosed in women younger than 50 years. Women of African American or Sub-Saharan African descent are more likely to develop HRN breast cancers, as are women with the BRCA1 gene mutation. Other factors may put these women at even higher risk for developing HRN breast cancer, including obesity and multiple early pregnancies. Furthermore, women with these multiple risk factors are least likely to breastfeed.
In the United States, HRN breast cancers represent about 20% of all breast cancers. This subtype ofbreast cancer has no receptors for the hormones estrogen or progesterone; approximately two-thirds of these HRN cancers also have no receptors for human epidermal growth factor receptor 2 (HER2). Breast cancers with no receptors for estrogen, progesterone, or HER2 are called triple-negative (TN).
HRN and TN breast cancers are more often deadly because they tend to be diagnosed at later stages, respond to fewer treatment options, and are less likely to be cured by current therapies. In the absence of estrogen, progesterone, and HER2 receptors, medicines that target these receptors, such as tamoxifen, aromatase inhibitors, trastuzumab, and pertuzumab, are ineffective.
"Further evidence to support the long-term protection of breastfeeding against the most aggressive subtypes of breast cancer is very encouraging and actionable," said Marisa Weiss, MD, president and founder, Breastcancer.org, and director of breast health outreach, Lankenau Medical Center in Wynnewood, Pennsylvania. "Breastfeeding is a relatively accessible, low-cost, short-term strategy that yields long-lasting natural protection."
This work highlights the need for more public health strategies that directly inform women and girls about the maternal (and fetal) benefits of breastfeeding before and during a woman's childbearing years. Also important, this message should be reinforced by these women's health care professionals.
Removing the barriers to breastfeeding at home, in the community, and in the workplace is critical.
"All approaches will be necessary in order to protect the most women against the devastation of breast cancer over their lifetimes," said Farhad Islami, MD, PhD, director of Interventions, Surveillance and Health Services Research, American Cancer Society.
"Pregnant women and young mothers are highly receptive and motivated to make healthy choices. We need to encourage women who are able to breastfeed to do so for their breast health, in addition to the health of their children," said Paolo Boffetta, MD, associate director for population sciences at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York, New York. "Further prospective research will be necessary to further understand the full impact of breastfeeding duration and its effect on other subtypes."
The research is a collaboration between Breastcancer.org; Icahn School of Medicine at Mount Sinai; Washington University in St. Louis, Missouri; and the American Cancer Society.
Source : Oncology Nurse Advisor
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Forest adjuvant anti-cancer therapy to enhance natural cytotoxicity in urban women with breast cancer: A preliminary prospective interventional study
Studies have shown both significantly diminished natural cytotoxicity and immunosuppression in breast cancer patients after standard anti-cancer treatments. Therefore, an integrative approach employing adjuvant therapy in addition to current treatments is required to enhance immunoactivation. This preliminary prospective interventional study aimed to assess the feasibility of forest therapy as an adjuvant to enhance natural cytotoxicity.
Methods This was a feasibility study of 11 volunteer women aged 25–60 years with stage III breast cancer. All subjects were exposed to daily forest therapy for 14 days whilst living in accommodation in a forest. Interventions included a relaxing daily 2-h morning walk (3 miles), free time tailored to subjects interest, group interaction and prepared meals based on nutritional standards. Outcome measures included natural killer (NK) cell populations and levels of perforin and granzyme B.
Results Data from all participants were analysed. The mean volume of NK cells increased from 319.4 μL in the city to 444.6 μL in the forest after forest therapy (p < 0.01). The mean level of perforin increased from 216.9 pg/mL in the city to 344.9 pg/mL in the forest and then further increased to 463.2 pg/mL after subjects returned to the city (p < 0.02). The mean level of granzyme B increased from 4.4 pg/mL in the city to 11.2 pg/mL in the forest and then further increased to 20.2 pg/mL after subjects returned to the city (p < 0.02).
Conclusions This study demonstrates the potential of forest therapy as an adjuvant anti-cancer therapy after standard treatments. A definitive trial with a control group should now be performed with larger sample sizes and long-term follow-up periods to confirm the feasibility and potential therapeutic effectiveness of this approach.
Source : European Journal of Integrative Medicine
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A Randomized Controlled Trial for the Effectiveness of Progressive Muscle Relaxation and Guided Imagery as Anxiety Reducing Interventions in Breast and Prostate Cancer Patients Undergoing Chemotherapy
Andreas Charalambous,1 Margarita Giannakopoulou,2 Evangelos Bozas,2 and Lefkios Paikousis3
Objective. To test the effectiveness of guided imagery (GI) and progressive muscle relaxation (PMR) as stress reducing interventions in patients with prostate and breast cancer who undergo chemotherapy.
Methods. Patients were randomly assigned to either the control group or the intervention group (PMR and GI). Patients were observed for a total duration of 3 weeks and assessed with the SAS and BECK-II questionnaires for anxiety and depression, respectively, in addiotion to two biological markers (saliva cortisol and saliva amylase) (trial registration number: NCT01275872).
Results. 256 patients were registered and 236 were randomly assigned. In total 104 were randomised to the control group and 104 to the intervention group. Intervention’s mean anxiety score and depression score changes were significantly different compared to the control’s (b=-29.4, p<0.001. b=-29.4,p<0.001 resp). Intervention group’s cortisol levels before the intervention (0.30+0.25) gradually decreased up to week 3 (0.16+0.18), whilst the control group’s cortisol levels before the intervention (0.21+0.22) gradually increased up to week 3 (0.44+0.35). The same interaction appears for the Amylase levels (p<0.001).
Conclusions. The findings showed that patients with prostate and breast cancer undergoing chemotherapy treatment can benefit from PMR and GI sessions to reduce their anxiety and depression.
Source : Evidence Based Complementary and Alternative Medicine
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Laughter and Stress Relief in Cancer Patients: A Pilot Study
S. H. Kim,1 Y. H. Kim,1 and H. J. Kim2
1Department of Nursing, ASAN Medical Center, Seoul 138-736, Republic of Korea
2Department of Preventive Medicine, University of Ulsan College of Medicine, 43-Gil Olympic-ro, Songpa-gu, Seoul 138-736, Republic of Korea
The purpose of this study was to examine the effect of a therapeutic laughter program and the number of program sessions on anxiety, depression, and stress in breast cancer patients. A randomized controlled trial was conducted involving 31 patients who received four sessions of therapeutic laughter program comprised and 29 who were assigned to the no-program control group. Scores for anxiety, depression, and stress were measured using an 11-point numerical rating scale. While no change was detected in the control group, the program group reported reductions of 1.94, 1.84, and 2.06 points for anxiety, depression, and stress, respectively (p<0.01, p<0.01, and p<0.01). Scores decreased significantly after the first therapeutic laughter session (p<0.05, p<0.01, and p<0.01). As the therapeutic laughter program was effective after only a single session in reducing anxiety, depression, and stress in breast cancer patients, it could be recommended as a first-line complementary/alternative therapy.
Source : Evidence Based Complementary and Alternative Medicine
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Dietary Folate Intake and Breast Cancer Risk: European Prospective Investigation Into Cancer and Nutrition
Background: There is limited evidence on the association between dietary folate intake and the risk of breast cancer (BC) by hormone receptor expression in the tumors. We investigated the relationship between dietary folate and BC risk using data from the European Prospective Investigation into Cancer and Nutrition (EPIC).
Methods: A total of 367993 women age 35 to 70 years were recruited in 10 European countries. During a median follow-up of 11.5 years, 11575 women with BC were identified. Dietary folate intake was estimated from country-specific dietary questionnaires. Cox proportional hazards regression models were used to quantify the association between dietary variables and BC risk. BC tumors were classified by receptor status. Subgroup analyses were performed by menopausal status and alcohol intake. Intake of other B vitamins was considered. All statistical tests were two-sided.
Results: A borderline inverse association was observed between dietary folate and BC risk (hazard ratio comparing top vs bottom quintile [HRQ5-Q1] = 0.92, 95% CI = 0.83 to 1.01, P trend = .037). In premenopausal women, we observed a statistically significant trend towards lower risk in estrogen receptor-negative BC (HRQ5-Q1 = 0.66, 95% CI = 0.45 to 0.96, Ptrend = .042) and progesterone receptor-negative BC (HRQ5-Q1 = 0.70, 95% CI = 0.51 to 0.97, P trend = .021). No associations were found in postmenopausal women. A 14% reduction in BC risk was observed when comparing the highest with the lowest dietary folate tertiles in women having a high (>12 alcoholic drinks/week) alcohol intake (HRT3-T1 = 0.86, 95% CI = 0.75 to 0.98, P interaction = .035).
Conclusions: Higher dietary folate intake may be associated with a lower risk of sex hormone receptor–negative BC in premenopausal women.
Source : Journal of National Cancer Institute
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Acupuncture provides significant quality of life improvements among breast cancer patients taking drugs to prevent recurrence, study shows
Use of electroacupuncture (EA) -- a form of acupuncture where a small electric current is passed between pairs of acupuncture needles -- produces significant improvements in fatigue, anxiety and depression in as little as eight weeks for early stage breast cancer patients experiencing joint pain related to the use of aromatase inhibitors (AIs) to treat breast cancer. The results of a randomized, placebo-controlled trial examining the intervention led by researchers at the Perelman School of Medicine at the University of Pennsylvania are published online this week in the journal Cancer. The study is the first demonstration of EA's efficacy for both joint pain relief, as well as these other common symptoms. The results build upon earlier findings reported in November 2013, showing that EA can decrease the joint pain reported by roughly 50 percent of breast cancer patients taking AIs -- the most-commonly prescribed medications to prevent disease recurrence among post-menopausal women with early-stage, hormone receptor positive breast cancer. Despite their efficacy, the joint pain associated with the use of AIs often leads to fatigue, anxiety, depression, and sleep disturbances for these patients, which researchers suggest may cause premature discontinuation of the drug. Previous studies have shown that nearly half of women taking AIs do not complete their recommended course of treatment, and that those who stop taking the drugs or don't take them as prescribed have a higher chance of dying of both breast cancer and other causes.
"Since many patients experience pain, fatigue, anxiety and depression simultaneously, our results provide an opportunity to offer patients one treatment that may target multiple symptoms," said lead author Jun Mao, MD MSCE, associate professor of Family Medicine and Community Health in Penn's Perelman School of Medicine, who directs the Integrative Oncology program in the Abramson Cancer Center. "We see patients every day who are looking for ways to combat some of the side effects of their treatment. What is particularly significant about these new results is that we can now offer more evidence-based treatment and management solutions for these women."
In the eight-week trial, researchers evaluated the short-term effects and safety of EA for AI-related joint pain and other side effects, compared with sham acupuncture (SA -- a non-electric, placebo acupuncture where the needles are not actually inserted into the skin), and usual care. The study participants, who were all receiving AI therapy and experiencing joint pain, were randomly assigned to receive EA, SA or usual care. Patient-reported experiences of fatigue and psychological distress, were measured prior to the study, and periodically throughout the duration, with additional follow-up four weeks after treatment.
• Fatigue: Compared with usual care, patients receiving EA had a greater reduction in the fatigue score at week eight and the effect was maintained at week 12. On average, patients reported a 2.0 point reduction in fatigue on the Brief Fatigue Inventory, an instrument designed to assess fatigue severity on a numerical scale ranging from 0-10.
• Anxiety: By week 12, patients receiving EA reported a significant improvement in their anxiety score, whereas patients receiving SA did not. On average, patients in the EA group reported a 2.2 point reduction in anxiety on the Hospital Anxiety and Depression Scale (HADS) compared to the usual care group.
• Depression: Patients in both EA and SA groups reported a significant improvement in HADS-Depression scores (2.4 points and 2.0 points, respectively) compared with the usual care group by week eight. The effects of both EA and SA on depression were maintained at week 12.
"Our study provides a novel understanding of how fatigue, sleep and psychological distress relate to pain in patients with AI-related joint pain. More importantly, we found that acupuncture helped reduce these symptoms and the effects persisted for at least four weeks following treatment," said Mao. "There is a small but growing body of literature showing that acupuncture is effective for the management of pain, fatigue, anxiety and depression. However, studies with larger sample sizes and longer follow-up periods are needed to provide more in-depth knowledge about how these treatments, combined with usual care, are improving quality of life for our patients."
- Jun J. Mao, John T. Farrar, Deborah Bruner, Jarcy Zee, Marjorie Bowman, Christina Seluzicki, Angela DeMichele, Sharon X. Xie. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: A randomized trial. Cancer, 2014; DOI: 10.1002/cncr.28917
Source : Science Daily
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Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study
Objective To investigate the association between dietary protein sources in early adulthood and risk of breast cancer.
Design Prospective cohort study.
Setting Health professionals in the United States.
Participants 88 803 premenopausal women from the Nurses’ Health Study II who completed a questionnaire on diet in 1991.
Main outcome measure Incident cases of invasive breast carcinoma, identified through self report and confirmed by pathology report.
Results We documented 2830 cases of breast cancer during 20 years of follow-up. Higher intake of total red meat was associated with an increased risk of breast cancer overall (relative risk 1.22, 95% confidence interval 1.06 to 1.40; Ptrend=0.01, for highest fifth v lowest fifth of intake). However, higher intakes of poultry, fish, eggs, legumes, and nuts were not related to breast cancer overall. When the association was evaluated by menopausal status, higher intake of poultry was associated with a lower risk of breast cancer in postmenopausal women (0.73, 0.58 to 0.91; Ptrend=0.02, for highest fifth v lowest fifth of intake) but not in premenopausal women (0.93, 0.78 to 1.11; Ptrend=0.60, for highest fifth v lowest fifth of intake). In estimating the effects of exchanging different protein sources, substituting one serving/day of legumes for one serving/day of red meat was associated with a 15% lower risk of breast cancer among all women (0.85, 0.73 to 0.98) and a 19% lower risk among premenopausal women (0.81, 0.66 to 0.99). Also, substituting one serving/day of poultry for one serving/day of red meat was associated with a 17% lower risk of breast cancer overall (0.83, 0.72 to 0.96) and a 24% lower risk of postmenopausal breast cancer (0.76, 0.59 to 0.99). Furthermore, substituting one serving/day of combined legumes, nuts, poultry, and fish for one serving/day of red meat was associated with a 14% lower risk of breast cancer overall (0.86, 0.78 to 0.94) and premenopausal breast cancer (0.86, 0.76 to 0.98).
Conclusion Higher red meat intake in early adulthood may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer.
Source : BMJ
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Meta-analysis of Vitamin D Sufficiency for Improving Survival of Patients with Breast Cancer
Background/Aim: To determine whether higher serum 25-hydroxyvitamin D [25(OH)D] at diagnosis is associated with longer survival of patients with breast cancer.
Materials and Methods: A meta-analysis was performed of five studies of the relationship between 25(OH)D and mortality from breast cancer. A pooled hazard ratio was calculated using a random-effects model. The Der Simonian-Laird test was used to assess homogeneity.
Results: Higher serum concentrations of 25(OH)D were associated with lower case-fatality rates after diagnosis of breast cancer. Specifically, patients in the highest quintile of 25(OH)D had approximately half the death rate from breast cancer as those in the lowest.
Conclusion: High serum 25(OH)D was associated with lower mortality from breast cancer. Serum 25(OH)D in all patients with breast cancer should be restored to the normal range (30-80 ng/ml), with appropriate monitoring. Clinical or field studies should be initiated to confirm that this association was not due to reverse causation.
Source : Anticancer Research
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The Compound in the Mediterranean Diet that Makes Cancer Cells 'Mortal'
New research suggests that a compound abundant in the Mediterranean diet takes away cancer cells’ “superpower” to escape death. By altering a very specific step in gene regulation, this compound essentially re-educates cancer cells into normal cells that die as scheduled. One way that cancer cells thrive is by inhibiting a process that would cause them to die on a regular cycle that is subject to strict programming. This study in cells, led by Ohio State University researchers, found that a compound in certain plant-based foods, called apigenin, could stop breast cancer cells from inhibiting their own death. Much of what is known about the health benefits of nutrients is based on epidemiological studies that show strong positive relationships between eating specific foods and better health outcomes, especially reduced heart disease. But how the actual molecules within these healthful foods work in the body is still a mystery in many cases, and particularly with foods linked to lower risk for cancer. Parsley, celery and chamomile tea are the most common sources of apigenin, but it is found in many fruits and vegetables. The researchers also showed in this work that apigenin binds with an estimated 160 proteins in the human body, suggesting that other nutrients linked to health benefits – called “nutraceuticals” – might have similar far-reaching effects. In contrast, most pharmaceutical drugs target a single molecule. “We know we need to eat healthfully, but in most cases we don’t know the actual mechanistic reasons for why we need to do that,” said Andrea Doseff, associate professor of internal medicine and molecular genetics at Ohio State and a co-lead author of the study. “We see here that the beneficial effect on health is attributed to this dietary nutrient affecting many proteins. In its relationship with a set of specific proteins, apigenin re-establishes the normal profile in cancer cells. We think this can have great value clinically as a potential cancer-prevention strategy.” Doseff oversaw this work with co-lead author Erich Grotewold, professor of molecular genetics and director of Ohio State’s Center for Applied Plant Sciences (CAPS). The two collaborate on studying the genomics of apigenin and other flavonoids, a family of plant compounds that are believed to prevent disease. The research appears this week in the online early edition of the journal Proceedings of the National Academy of Sciences. Though finding that apigenin can influence cancer cell behavior was an important outcome of the work, Grotewold and Doseff point to their new biomedical research technique as a transformative contribution to nutraceutical research. They likened the technique to “fishing” for the human proteins in cells that interact with small molecules available in the diet. “You can imagine all the potentially affected proteins as tiny fishes in a big bowl. We introduce this molecule to the bowl and effectively lure only the truly affected proteins based on structural characteristics that form an attraction,” Doseff said. “We know this is a real partnership because we can see that the proteins and apigenin bind to each other.” Through additional experimentation, the team established that apigenin had relationships with proteins that have three specific functions. Among the most important was a protein called hnRNPA2. This protein influences the activity of messenger RNA, or mRNA, which contains the instructions needed to produce a specific protein. The production of mRNA results from the splicing, or modification, of RNA that occurs as part of gene activation. The nature of the splice ultimately influences which protein instructions the mRNA contains. Doseff noted that abnormal splicing is the culprit in an estimated 80 percent of all cancers. In cancer cells, two types of splicing occur when only one would take place in a normal cell – a trick on the cancer cells’ part to keep them alive and reproducing. In this study, the researchers observed that apigenin’s connection to the hnRNPA2 protein restored this single-splice characteristic to breast cancer cells, suggesting that when splicing is normal, cells die in a programmed way, or become more sensitive to chemotherapeutic drugs. “So by applying this nutrient, we can activate that killing machinery. The nutrient eliminated the splicing form that inhibited cell death,” said Doseff, also an investigator in Ohio State’s Davis Heart and Lung Research Institute. “Thus, this suggests that when we eat healthfully, we are actually promoting more normal splice forms inside the cells in our bodies.” The beneficial effects of nutraceuticals are not limited to cancer, as the investigators previously showed that apigenin has anti-inflammatory activities. The scientists noted that with its multiple cellular targets, apigenin potentially offers a variety of additional benefits that may even occur over time. “The nutrient is targeting many players, and by doing that, you get an overall synergy of the effect,” Grotewold explained. Doseff is leading a study in mice, testing whether food modified to contain proper doses of this nutrient can change splicing forms in the animals’ cells and produce an anti-cancer effect.
Source : Ohio State University - The James
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Diet Rich in Tomatoes May Lower Breast Cancer Risk
A tomato-rich diet may help protect at-risk postmenopausal women from breast cancer, according to new research accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.Breast cancer risk rises in postmenopausal women as their body mass index climbs. The study found eating a diet high in tomatoes had a positive effect on the level of hormones that play a role in regulating fat and sugar metabolism.
“The advantages of eating plenty of tomatoes and tomato-based products, even for a short period, were clearly evident in our findings,” said the study’s first author, Adana Llanos, PhD, MPH, who is an Assistant Professor of Epidemiology at Rutgers University. Llanos completed the research while she was a postdoctoral fellow with Electra Paskett, PhD, at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. “Eating fruits and vegetables, which are rich in essential nutrients, vitamins, minerals and phytochemicals such as lycopene, conveys significant benefits. Based on this data, we believe regular consumption of at least the daily recommended servings of fruits and vegetables would promote breast cancer prevention in an at-risk population.”
The longitudinal cross-over study examined the effects of both tomato-rich and soy-rich diets in a group of 70 postmenopausal women. For 10 weeks, the women ate tomato products containing at least 25 milligrams of lycopene daily. For a separate 10-week period, the participants consumed at least 40 grams of soy protein daily. Before each test period began, the women were instructed to abstain from eating both tomato and soy products for two weeks.
When they followed the tomato-rich diet, participants’ levels of adiponectin – a hormone involved in regulating blood sugar and fat levels – climbed 9 percent. The effect was slightly stronger in women who had a lower body mass index.
“The findings demonstrate the importance of obesity prevention,” Llanos said. “Consuming a diet rich in tomatoes had a larger impact on hormone levels in women who maintained a healthy weight.”
The soy diet was linked to a reduction in participants’ adiponectin levels. Researchers originally theorized that a diet containing large amounts of soy could be part of the reason that Asian women have lower rates of breast cancer than women in the United States, but any beneficial effect may be limited to certain ethnic groups, Llanos said
Source : Newswisw
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Phytochemical composition, antifungal, antiaflatoxigenic, antioxidant, and anticancer activities of Glycyrrhiza glabra L. and Matricaria chamomilla L. essential oils
Enas M. Ali
Department of Botany, Faculty of Science, Cairo University, Giza, 12613, Egypt.
The present study was undertaken to investigate the antifungal, antiaflatoxigenic, antioxidant, and anticancer activities of Glycyrrhiza glabra L. and Matricaria chamomilla L. essential oils and their phytochemical composition. The essential oils were obtained by hydrodistillation and their phytochemical composition was determined throughout gas chromatography-mas spectrometry (GC-MS) analysis. Both essential oils and their mixture showed broad antifungal spectrum against Aspergillus flavus, an important food contaminating fungus. The essential oils of G. glabra and M. chamomilla completely inhibited aflatoxin B1 (AFB1) production at 800 ppm. Both oils exhibited antioxidant activity as DPPH free radical scavenger in dose dependent manner. Percentage of radical scavenging activity of G. glabra and M. chamomilla oils at 400 μg/ml were calculated to be 85.2 and 91.7%, respectively as compared to standard (BHT) with 75.6% activity at the same concentration. The anticancer properties of essential oils against cells (MCF-7) were evaluated. In anticancer activity exposure of essential oils caused a significant decrease in cell viability in MCF-7 cell line (breast carcinoma). Exposure of MCF-7 cells with G. glabra essential oils resulted in dose dependent increase in cell growth inhibition (CGI) varying from 3 to 77% at concentration ranging from 10 to 640 μg/ml. Similarly, 7 to 89% CGI was obtained when M. chamomilla essential oils was used. The present study demonstrated that essential oils of G. glabra and M. chamomilla have potent antifungal, antioxidant, and anticancer with the presence of effective phytochemicals.
Source : Journal of Medicinal Plant Research
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Environmental Factors and Breast cancer
In addition to the traditionally acknowledged risk factors for breast cancer (age, reproductive history, genetic profile, alcohol intake, etc.), scientists are increasingly coming to understand that many chemicals commonly found in products we use daily may also be contributing to the very high incidence of breast cancer. We need to better understand the health effects of these environmental chemicals, especially so-called endocrine disrupting compounds (EDCs) in pesticides, plastics, many personal care products, etc. This knowledge may lead us to undertake actions that aim to prevent the disease.
Source : University of Texas, MD Anderson Cancer Centre
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Effects of Spiritual Healing for Women Undergoing Long-Term Hormone Therapy for Breast Cancer:A Qualitative Investigation
Fiona Barlow, PhD, MBACP(Accred),1Jan Walker, PhD,2and George Lewith, MD, FRCP3
Background:Spiritual Healing is widely available and used, but is a neglected area for research and its biologicand psychologic mechanisms are not understood. The side-effects of long-term hormonal therapy for breastcancer are onerous and have been reported to lead to ‘‘drug holidays’’ that could diminish the long-term treatment benefits. It was investigated whether Spiritual Healing could support patients with breast cancer undergoing this treatment.Methods:The qualitative observation study took place in a specialist research facility in a general hospital.Spiritual Healing was provided by 4 healers registered with the National Federation of Spiritual Healers. Twelve(12) patients with breast cancer undergoing long-term hormone treatment and who found the effects onerous,self-referred themselves and were given ten weekly sessions of approximately 40 minutes each. Data collected included participant’s daily records, direct observations noted by healers, the researcher’s field diary and a one-to-one semi-structured interview.
Findings:The positive effects of Spiritual Healing included alleviation of the physical side-effects of their treatment, increased energy levels, enhanced well-being, emotional relaxation, and re-engagement with pre-cancer activities. Although 1 participant admitted considering a drug holiday prior to joining the study, none of the participants felt tempted to stop their hormonal treatments while receiving Spiritual Healing.
Conclusions:These qualitative findings indicate that Spiritual Healing has the potential to support patients with breast cancer in the maintenance of their long-term orthodox treatments. Further research is needed to test Spiritual Healing as a cost-effective complementary therapy, for those undergoing long-term cancer treatments
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Qigong Improves Quality of Life for Breast Cancer Patients Undergoing Radiation Therapy
Researchers from The University of Texas MD Anderson Cancer Center have found qigong, an ancient mind-body practice, reduces depressive symptoms and improves quality of life in women undergoing radiotherapy for breast cancer.The study, published in the journal Cancer, is the first to examine qigong in patients actively receiving radiation therapy and include a follow-up period to assess benefits over time. Even though individual mind-body practices such as meditation and guided imagery appear to reduce aspects of distress and improve quality of life, questions remain about their effectiveness when conducted in conjunction with radiation therapy.
"We were also particularly interested to see if qigong would benefit patients experiencing depressive symptoms at the start of treatment," said Lorenzo Cohen, Ph.D., professor in MD Anderson's Departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program. "It is important for cancer patients to manage stress because it can have a profoundly negative effect on biological systems and inflammatory profiles."
For the trial, Cohen, the corresponding author, and his colleagues enrolled 96 women with stage 1-3 breast cancer from Fudan University Shanghai Cancer Center in Shanghai, China. Forty-nine patients were randomized to a qigong group consisting of five 40-minute classes each week during their five-to-six week course of radiation therapy, while 47 women comprised a waitlist control group receiving the standard of care.
The program incorporated a modified version of Chinese medical qigong consisting of synchronizing one's breath with various exercises. As a practice, qigong dates back more than 4,000 years when it was used across Asia to support spiritual health and prevent disease.
Participants in both groups completed assessments at the beginning, middle and end of radiation therapy and then one and three months later. Different aspects of quality of life were measured including depressive symptoms, fatigue, sleep disturbances and overall quality of life.
Results show benefits emerged over time
Patients in the qigong group reported a steady decline in depressive symptom scores beginning at the end of radiation therapy with a mean score of 12.3, through the three month post-radiation follow-up with a score of 9.5. No changes were noted in the control group over time.
The study also found qigong was especially helpful for women reporting high baseline depressive symptoms, Cohen said.
"We examined women's depressive symptoms at the start of the study to see if women with higher levels would benefit more," Cohen said. "In fact, women with low levels of depressive symptoms at the start of radiotherapy had good quality of life throughout treatment and three months later regardless of whether they were in the qigong or control group. However, women with high depressive symptoms in the control group reported the worst levels of depressive symptoms, fatigue, and overall quality of life that were significantly improved for the women in the qigong group."
As the benefits of qigong were largely observed after treatment concluded, researchers suggest qigong may prevent a delayed symptom burden, or expedite the recovery process especially for women with elevated depressive symptoms at the start of radiotherapy.
Cohen notes the delayed effect could be explained by the cumulative nature of these modalities, as the benefits often take time to be realized.
Future research needed
The authors note several limitations to the study, including the absence of an active control group making it difficult to rule out whether or not the effects of qigong were influenced by a patient's expectations or simply being a light exercise. Additionally, the homogeneity of the group, Chinese women at a single site, limits the ability of applying the results to other populations.
According to the authors, the findings support other previously reported trials examining qigong benefits, but are too preliminary to offer clinical recommendations. Additional work is needed to understand the possible biological mechanisms involved and further explore the use of qigong in ethnically diverse populations with different forms of disease.
Source : Newswise
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A New Study on Breast Cancer Highlights the Need for Chemical Reform
How many of us have been rocked to the core by that malicious word, “cancer”? If you haven’t been slapped in the face with this fearsome news, then consider yourself a member of the fortunate few. One of every four deaths in the United States is due to cancer. Down with cancer. Seriously.
Its mysteries are maddening. Why do the people we love get cancer? Why do people who lead intentionally careful and healthful lives get cancer? Can we prevent our likelihood of being diagnosed? Is it genetic and inevitable, or environmentally triggered? Can we stop it?! How many family members and friends have asked themselves these questions? Consequently, cancer researchers are asking themselves the same things. A new study of breast cancer done in Ontario, Canada was released this week. It explores increased breast cancer risks in relation to occupational exposures to known carcinogenic chemicals.
Next to skin cancer, breast cancer is the most commonly diagnosed cancer in women in the United States. Fewer than half of the cases can be explained by recognized risk factors like family or reproductive history. Breast cancer is likely caused by a combination of environmental, genetic, hormonal, and lifestyle influences. No one fully understands how these factors interplay to increase your risk of a diagnosis.
Yet, scientists do have a hunch or two regarding the identification of specific risk factors. In industrialized countries, breast cancer incidence increased dramatically in the second half of the twentieth century as thousands of new chemicals with unknown health effects were introduced. This lead scientists to wonder, is this toxic soup of chemicals that we’re exposed to everyday increasing our risk of getting cancer? What about women exposed to exceptionally high levels of suspected carcinogens by virtue of their occupation? Are these women diagnosed with breast cancer at a higher rate than the general population? This is the set of questions that the scientists in Ontario set out to explore.
This study involved the participation of 1005 women with breast cancer and 1147 women without the disease to act as the control group. All women were asked to provide occupational histories in order to determine potential exposures to carcinogens and endocrine disruptors.
An endocrine disruptor is a chemical that creates hormone imbalance that results in some cancers, reproductive disorders, immune system dysfunction, birth defects, and neurological effects. Certain occupations require exposures to endocrine-disrupting chemicals on a daily basis.
So, what are these high-risk jobs?
Women in farming showed a 36% increased breast cancer risk.
- Several pesticides commonly used in agriculture act as mammary carcinogens and endocrine disrupting chemicals. Women often begin working on the farm at early ages, when they are even more vulnerable to the effects of these toxic pesticides.
- They work with a variety of potentially hazardous metals and chemicals that metal working processes entail.
- Women in food canning are exposed to residual toxic pesticides, as well as emissions for the polymer linings of cans.
- Women working in the automotive plastics industry are exposed to many plastics that have been found to release carcinogenic chemicals. Cumulative exposures to mixtures of these chemicals are a significant concern.
- For women who are pre-menopausal in either industry, their breast cancer risk becomes 5-fold.
- This may largely be attributable to the greater exposure to second-hand smoke as well as the night work, which has been found to disrupt the endocrine system.
To date, no women in Canada from any these high-risk industries have received worker compensation. It’s not like these industries don’t know that the chemicals they’re using have been identified as probable carcinogens. How is this acceptable? These workers are shouldering all of the risks and all of the costs (in the form of medical bills) so that these industries can save a dime by using carcinogenic chemicals as opposed to safer chemical alternatives. It’s not fair; it’s not right.
These findings have important implications not only for women workers, but for the general population as well. There are over 80,000 chemicals registered for production today, but fewer than 200 of these chemicals have been tested for human health and safety. These chemicals aren’t being tested because federal regulations, dictated by the Toxic Substances Control Act of 1976, puts the burden of safety determination on the Environmental Protection Agency rather than the chemical manufacturers. The EPA must prove that a chemical presents an “unreasonable risk” for consumers before it can be banned or restricted for use. This has made it really difficult for the EPA to protect us from harmful exposures. In fact, they can’t do much to protect us until after people begin to sicken or die, and undeniable evidence begins piling up linking these illnesses to a specific chemical exposure. That is too little protection too late for some.
As a result, we are exposed every day to the same chemicals that are making women workers in this study sick, albeit at much lower levels. However, some studies are finding that lower exposure to certain endocrine disruptors can actually be more harmful to our bodies than higher exposures. And it’s not like we’re being exposed to one or two carcinogenic chemicals every day, we’re being exposed to hundreds, maybe even thousands every day in the products all around us! That is not what I want for my loved ones or for myself. If safer chemical alternatives exist, we need to begin using them NOW.
Source : Michigan Network for Children's Environmental
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Link to Study : Breast cancer risk in relation to occupations with exposure to carcinogens and endocrine disruptors: a Canadian case--control study
Breast-feeding Reduced Risk for ER/PR-negative Breast Cancer
Breast-feeding reduced the risk for estrogen receptor-negative and progesterone receptor-negative breast cancer, according to results presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held here Oct. 16-19, 2012.“We found an increased risk for estrogen receptor- and progesterone receptor- (ER/PR) negative breast cancer in women who do not breast-feed, but in women who have children and breast-feed, there is no increased risk,” said Meghan Work, M.P.H., doctoral student in the department of epidemiology at Columbia University’s Mailman School of Public Health in New York, N.Y.
Work and colleagues examined the relationship between reproductive risk factors — such as the number of children a woman delivers, breast-feeding and oral contraceptive use — and ER/PR-negative breast cancer. ER/PR-negative breast cancer often affects younger women and has a poor prognosis, according to Work.
The researchers used data from three sites of the Breast Cancer Family Registry, which includes women with and without breast cancer from the United States, Canada and Australia. This study included 4,011 women with breast cancer and 2,997 population-based controls.
The results indicated that having three or more children without breast-feeding was associated with an increased risk for ER/PR-negative breast cancer.
“Women who had children but did not breast-feed had about 1.5 times the risk for ER/PR-negative breast cancer when compared with a control population,” Work said. “If women breast-fed their children, there was no increased risk for ER/PR-negative cancer.”
Further, the researchers found that oral contraceptive use was not associated with ER/PR-negative cancer risk, with the exception of those formulations available before 1975. “These earlier formulations contained higher doses of estrogen and progestin than more recent versions,” Work said.
These findings are in line with previous findings that have demonstrated breast-feeding benefit in triple-negative breast cancer. “This is particularly important as breast-feeding is a modifiable factor that can be promoted and supported through health policy,” Work said.
Source : Newswise
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Mechanisms of Action for Green Tea Extract in Breast Cancer Prevention Identified
An oral green tea extract, Polyphenon E, appears to inhibit vascular endothelial growth factor and hepatocyte growth factor, both of which promote tumor cell growth, migration and invasion.
Researchers made this discovery during a secondary analysis of a phase Ib randomized, placebo-controlled study of Polyphenon E in a group of 40 women with hormone receptor-negative breast cancer. Katherine D. Crew, M.D., assistant professor of medicine and epidemiology at Columbia University Medical Center in New York, N.Y., presented the data at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held in Anaheim, Calif., Oct. 16-19, 2012.
"Many preclinical studies have looked at epigallocatechin-3-gallate, or EGCG, which is one of the main components of green tea, and the various possible mechanisms of its action against cancer, but it is very difficult to do those same kinds of studies in humans," Crew said. "This study was too small to say for sure if green tea will prevent breast cancer, but it may move us forward in terms of understanding antitumor mechanisms."
In the primary analysis, presented at last year's Frontiers in Cancer Prevention Research meeting, 40 women were randomly assigned to 400 mg, 600 mg or 800 mg of Polyphenon E or to placebo twice daily for six months. During that time, researchers collected blood and urine samples from participants at baseline and at two, four and six months.
In this secondary analysis, Crew and colleagues used the blood and urine samples to examine biologic endpoints, such as inflammatory proteins, growth factors and lipid biomarkers, which might point to the mechanism of action behind green tea extract. Biomarker data were available for 34 of the 40 patients.
Women assigned to the extract had an average 10-fold increase in green tea metabolites compared with placebo. In addition, they had a significant reduction in hepatocyte growth factor levels at two months compared with women assigned to placebo. However, at the four-month and six-month follow-ups, the difference was no longer statistically significant.
The researchers also identified a trend toward decreased total serum cholesterol and decreased vascular endothelial growth factor in women assigned to the extract.
According to Crew, it is still too early to recommend green tea extract to prevent breast cancer. Currently, researchers are conducting several ongoing studies to explore the use of oral green tea extract in high-risk women for the primary prevention of breast cancer.
Source : Science Daily
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Exercise, even mild physical activity, may reduce breast cancer risk
A new analysis has found that physical activity – either mild or intense and before or after menopause – may reduce breast cancer risk, but substantial weight gain may negate these benefits. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings indicate that women can reduce their breast cancer risk by exercising and maintaining their weight.
While studies have shown that physical activity reduces breast cancer risk, many questions remain. For example, how often, how long, and how intense does physical activity have to be to provide benefits? Also, do women with all body types experience a reduced risk when they exercise, and does exercise reduce the risk of all types of breast cancer?
To investigate, Lauren McCullough, of the University of North Carolina Gillings School of Global Public Health in Chapel Hill, and her colleagues looked for a link between recreational physical activity, done at different time points in life, and the risk of developing breast cancer.
The study included 1,504 women with breast cancer (233 noninvasive and 1,271 invasive) and 1,555 women without breast cancer who were 20 to 98 years old and were part of the Long Island Breast Cancer Study Project, an investigation of possible environmental causes of breast cancer.
Women who exercised either during their reproductive or postmenopausal years had a reduced risk of developing breast cancer. Women who exercised 10 to 19 hours per week experienced the greatest benefit with an approximate 30% reduced risk. Risk reductions were observed at all levels of intensity, and exercise seemed to preferentially reduce the risk of hormone receptor positive breast cancer (ER or PR positive), which is the most commonly diagnosed tumor type among American women.
"The observation of a reduced risk of breast cancer for women who engaged in exercise after menopause is particularly encouraging given the late age of onset for breast cancer," said McCullough.
When the researchers looked at the joint effects of physical activity, weight gain, and body size, they found that even active women who gained a significant amount of weight – particularly after menopause – had an increased risk of developing breast cancer, indicating that weight gain can eliminate the beneficial effects of exercise on breast cancer risk.
Source : Science Codex
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Night Shift Might Boost Women's Breast Cancer Risk: Study
Women who work the night shift more than twice a week might be increasing their risk for breast cancer, Danish researchers find. Moreover, the risk appears to be cumulative and highest among women who describe themselves as "morning" people rather than "evening" people, the researchers say.
"About 10 to 20 percent of women in modern societies have night shift work," said lead researcher Johnni Hansen. "It might therefore be one of the largest occupational problems related to cancer."
Right now, the reasons for these findings are uncertain.
"Night shift work involves exposure to light at night, which decreases the production of the night hormone melatonin that seems to protect against certain cancers," said Hansen, of the Institute of Cancer Epidemiology at the Danish Cancer Society, in Copenhagen.
In addition, light at night might introduce circadian disruption, where the master clock in the brain becomes desynchronized from local cellular clocks in different body organs, affecting the breast, he said.
"Repeated phase shifting may lead to defects in the regulation of the circadian cell cycle, thus favoring uncontrolled growth," Hansen said.
Also, sleep deprivation after night shift work leads to the suppression of the immune system, which might increase the growth of cancer cells, he added.
This is not the first time this association has been recognized. In 2007 the International Agency for Research on Cancer, part of the World Health Organization, said that working the night shift is "probably carcinogenic to humans," according to background information in the study.
The new study was published in the May 28 online edition of Occupational and Environmental Medicine.
To determine the effect of night shift work on the risk for breast cancer, Hansen's team collected data on more than 18,500 women who worked for the Danish Army between 1964 and 1999.
The researchers identified 210 women who had breast cancer and compared them to almost 900 similar women who did not have breast cancer.
All of the women were asked about their working patterns, lifestyles and other factors such as their use of contraceptives and hormone replacement therapy, and their sunbathing habits.
In addition, women were asked to classify themselves as "morning" or "evening" people.
In all, 141 women with breast cancer responded to the study questionnaires. In addition, 551 women who did not have breast cancer responded.
Among these women, the risk for breast cancer was increased 40 percent if they worked at night, the researchers found.
But for women who worked nights at least three times a week, and for at least six years, the risk was doubled, the findings showed.
Women who worked the night shift but who described themselves as morning people were at even higher risk of breast cancer. They were almost four times more likely to develop breast cancer as those who didn't work nights, according to the researchers.
In comparison, women who considered themselves evening people were twice as likely to develop breast cancer, they added.
Morning-preferring women who did not work at night had a lower overall risk of breast cancer than evening types, Hansen's team found.
"Since night shift work is unavoidable in modern societies, this type of work should be limited in duration and limited to less than three night shifts per week," Hansen said. "In particular, morning types should limit their night work," he added.
While the study found an association between night shift work and breast cancer, it did not prove a cause-and-effect relationship.
Men who work at night may also be at risk for prostate cancer, Hansen noted. This evidence comes from three small studies, he said.
Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said that "it's very hard to single out the causes of breast cancer and whether women on the night shift have a higher risk."
But there appears to be some truth to this, she added.
"Stress increases the risk of breast cancer and affects the body as a whole, and working at night can throw off your circadian rhythm and cause stress," Bernik said.
"This is another finding that breast cancer is caused by a multitude of different environmental and genetic influences, so this is probably a piece of the puzzle," she added.
An expert on environmental factors that affect cancer, Richard Stevens, from the department of community medicine at the UConn Health Center in Farmington, Conn., said that "the evidence is growing rapidly about light at night and, specifically, shift work and breast cancer."
"But, this is the first study about the morning/evening preference," he noted.
"If it's true that light at night increases the risk of disease, then there are very practical implications," Stevens said.
If lighting is really an issue in night work, it is known which wavelengths suppress melatonin the most, and lighting could be adjusted to eliminate those wavelengths, he explained.
There are other things people can do to avoid the effects of light at night on health, he added.
"For example, for health in general, if you wake up during the night, stay in the dark; don't turn on the light. If you turn on the lights it will start suppressing melatonin immediately," Stevens said.
"There is a lot more involved than melatonin, but it's a good marker if your circadian rhythm is being changed," he said.
Studies are ongoing on the risk of night work and prostate cancer, Stevens noted.
Source : Medline Plus
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SABCS: IOM Lists Breast Cancer Risks in Environment
Women may be able to reduce their risk of breast cancer if they avoid a host of environmental exposures, including unnecessary ionizing radiation, combination hormone replacement therapy, and smoking, according to a new report from the Institute of Medicine. Leading a healthy lifestyle -- eating right and getting enough exercise -- as well as lowering alcohol intake can also diminish that risk, the IOM said in a report entitled "Breast Cancer and the Environment," which was released here at the San Antonio Breast Cancer Symposium.
There's consistent epidemiologic evidence that modifying these factors can lower cancer risk, committee chair Irva Hertz-Picciotto, MD, of the University of California Davis, and colleagues wrote, adding that there were 230,480 new cases of invasive disease in 2011.
Exposure to ionizing radiation can be minimized by avoiding unnecessary medical tests, such as CT scans, they wrote.
Current use of oral contraceptives, estrogen-progesterone hormone replacement therapy, and overweight and obesity among postmenopausal women have also been clearly linked with an increased risk of breast cancer, they noted.
The committee also warned of a possible increased risk of breast cancer from exposure to benzene, 1.3-butadiene, and ethylene oxide -- chemicals found in the workplace, gasoline fumes, car exhaust, and cigarette smoke -- although the evidence for a link with breast cancer is more limited or contradictory for those substances, they noted.
On the plus side, the committee noted, there's good evidence that hair dyes and non-ionizing radiation from cell phones and other electronics have no impact on a woman's chances of developing breast cancer.
The "jury is still out" as to whether bisphenol A (BPA), pesticides, cosmetics, and dietary supplements, as well as overnight shift work, can dial up the risk.
Specifically for BPA, the researchers wrote, there are animal or mechanistic data that suggest biological plausibility, but there's not enough evidence of harm in human studies.
They acknowledged that there's no evidence as to the degree of risk reduction any of these avoidance measures might confer but suggested research along those lines.
They also offered several other research recommendations, such as more work on understanding the etiology of breast cancer and its development over a lifetime in order to provide phased prevention strategies.
"Breast cancer develops over many years, so we need better ways to study exposures throughout women's lives," Hertz-Picciotto said in a statement. "We also need improved methods to test for agents that may be contributing to breast cancer risk and to explore the effects of combined exposures."
The team also called for more research into the mechanisms of action for possible associations with cancer and studying populations that may have higher exposures, such as occupational cohorts.
Source : MedPage Today
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Breast cancer + Household Cleaning Products
House-proud women who like to keep their homes clean and fragrant may be at greater risk of breast cancer, research suggests.
Scientists found significant links between the disease and women's use of cleaning products, air fresheners and mould removers.
General use of cleaners doubled the risk of breast cancer in women who used them the most, experts found.
Among the different kinds of products, air fresheners and mould and mildew removers had the strongest association.
In contrast, mothballs, pesticides and insect repellents had little impact on breast cancer risk.
US researchers conducted telephone interviews with 787 women aged 60 to 80 years old in Cape Cod, Massachusetts, with breast cancer and 721 healthy women also in that age range.
The women were asked about their use of cleaning products and pesticides, and split into four groups ranging between high and low users. Cancer rates for the different groups were then compared.
Study leader Dr Julia Brody, from the Silent Spring Institute in Newton, Massachusetts, said: "Women who reported the highest combined cleaning product use had a doubled risk of breast cancer compared to those with the lowest reported use.
"Use of air fresheners and products for mould and mildew control were associated with increased risk. To our knowledge, this is the first published report on cleaning product use and risk of breast cancer."
Air fresheners were found to double breast cancer risk among women in the highest-use group, as did weekly use of mould and mildew-removing agents.
Many pesticides, household cleaners and air fresheners contain ingredients known to trigger breast cancer in animals, said the researchers.
Some were also made with endocrine (hormone) disrupting chemicals (EDCs) that could theoretically affect the growth of oestrogen-sensitive breast cancer cells.
Hormone-disruptors such as synthetic musks and phthalates were commonly used in air fresheners, said the scientists. Air fresheners may also contain chemicals called terpenes which can react with ozone in the air to form cancer triggers such as formaldehyde, benzene and styrene, they added.
"Although exposure levels may be low and EDCs are typically less potent than endogenous hormones, limited knowledge of product formulations, exposure levels and the biological activity and toxicity of chemical constituents alone and in combination make it difficult to assess risks associated with product use," the researchers wrote.
The scientists acknowledged that their results might be swayed by "recall bias" because they depended on answers to questions.
For instance, women who blamed chemical pollutants for their breast cancer might be more likely to report high usage of cleaning products.
However, Dr Brody said it was also true that women with cancer, who thought a lot about the likely cause of their disease, may be more likely to recall their use of cleaners accurately.
Such uncertainty could be avoided by a "prospective" study which followed the fate of a study group over a period of years.
"Because exposure to chemicals from household cleaning products is a biologically plausible cause of breast cancer and avoidable, associations reported here should be further examined prospectively," the researchers concluded.
Source : Sydney Morning Hearld 20/7/2010
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