Breast cancer Alternative medicine

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor’s care.

Alternative medicine for fatigue
Many breast cancer survivors experience fatigue during and after treatment that can continue for years. Doctors aren’t sure what causes cancer-related fatigue and it can persist despite treatment. When combined with your doctor’s care, complementary and alternative medicine therapies may help relieve fatigue. Ask your doctor about:

■Gentle exercise. If you get the OK from your doctor, start with gentle exercise a few times a week and work your way up to more if you feel up to it. Consider walking, swimming, yoga or tai chi.
■Managing stress. Take control of the stress in your daily life. Try stress reduction techniques such as muscle relaxation, visualization and spending time with friends and family.
■Relaxation strategies. Balance activity with periods of relaxation. Try listening to music, writing in a journal, meditating or taking a warm bath.

Alternative medicine use and breast cancer

Of all the posts I and my cobloggers have written for SBM over the last 15 months, most provoke relatively few comments. However, a few stand out for having provoked hundreds of comments. The very first post that provoked hundreds of comments was Harriet’s excellent discussion of the International Network of Cholesterol Skeptics. In fact, Harriet seems to be quite good at writing posts that provoke a lot of comment, as another of her posts, specifically the one in which she discussed circumcision, also garnered hundreds of comments. However, to my great surprise, the one post that stands out as having received the most comments thus far in the history of SBM is one that I wrote. Specifically, it was a post I called Death by “alternative” medicine: Who’s to blame?, which has collected an astonishing 611 comments thus far. The topic of the post was a case report that I had heard while visiting the tumor board of an affiliate of my former cancer center describing a young woman who had rejected conventional therapy for an eminently treatable breast cancer and then returned two or three years later with a large, nasty tumor that was much more difficult to treat and possibly metastatic to the bone, which would make it no longer even potentially curable. My discussion centered on what the obligation of a physician is to such patients who utterly refuse the science- and evidence-based medicine that we know to be able to cure them of a potentially fatal disease, and I was not only surprised but somewhat taken aback by the vehemence of the discussion.

Since that post, I’ve always been meaning to take a look at what, exactly, the effect of choosing “alternative” medicine over “conventional” medicine is on the odds of survival for breast cancer patients. Even though intuitively one would hypothesize that refusing scientific medicine and relying on placebo medicine instead would have a detrimental effect on survival, it turns out that this question is not as easy to answer as you might think. For example, if you do a search on PubMed using terms like “alternative medicine,” “breast cancer,” and “survival,” the vast majority of the hits will be studies of complementary and alternative medicine (CAM) and breast cancer with little reference to what possible effect these therapies might have on survival. I can envision several reasons for this, the first being that–thankfully–relatively few women actually use alternative medicine exclusively to treat their breast cancer. Also, those that do probably drop off the radar screen of their science-based practitioners, and it is difficult, if not impossible, to capture data regarding their outcomes, given that they all too often stick with their alternative healers until the end. True, they may pop up again in their surgeon’s or primary care doctor’s office with huge, fungating tumors, only to be told that they have to undergo chemotherapy to shrink the tumor before any surgery is possible, after which they will often disappear again. Another important reason is that the natural history of breast cancer is extremely variable, from nasty, aggressive tumors that kill within months to indolent, slow-growing tumors that, even when metastatic, women can survive with for several years. (It is, of course, these women who usually show up in “alternative medicine” testimonials, because they can survive a long time with little or no treatment before their tumors progress.)

Because it’s important to understand the natural history of breast cancer, I’ll reference a classic study examining the natural history of untreated breast cancer. It was published in 1962 by H. J. G. Bloom, W. W. Richardson, and E. J. Harries, and examined data from Middlesex Hospital from 1805 to 1933 where 250 cases of untreated breast cancer were identified and studied. They calculated survival as the period of time from onset of symptoms to death. What they found was that 18% of the 250 patients survived five years; 3.6% survived 10 years; and 0.8% survived 15 years. Of note, it was 19 years before all patients were dead. Overall, the median survival was 2.7 years. A

It should be noted that all of these tumors were detected as (at the very minimum) lumps in the breast, given that there was no other way of detecting them at the time. However, the reason we go back to this study time and time again is because, at least in developed countries, it is the rare woman with breast cancer who does not undergo treatment of some kind for it. These days, most tumors are detected at far less advanced stages; indeed, most are detected by mammography. What that means is that, if such a study could be done today, it is very likely that lead time bias would significantly increase the apparent median survival, because increasingly tiny tumors are being found. It is also possible that a significant number of such small tumors may spontaneously regress, which further complicates the issue today, not to mention making it easier to find women who have rejected some or all of “conventional” medicine to treat their cancers and survived significant lengths of time to produce alternative medicine testimonials.

With this background, I have found a couple of studies that can help answer the question. The first one was published in 2005 in the Annals of Surgery by a group in from Geneva University Hospitals. This study involved a search of Switzerland’s database between 1975 and 2000 and included 5,339 patients diagnosed with nonmetastatic breast cancer. The strength of this study is that the Geneva Cancer Registry includes data from all patients from the Geneva canton who underwent treatment and allowed the investigators to compare the outcomes of the women who refused to undergo surgery with curative intent with those who underwent surgery. In the Registry, there were identified 70 patients (1.3%) who refused surgery and concluded:

These women [those who refused surgery] were older, more frequently single, and had larger tumors. Overall, 37 (53%) women had no treatment, 25 (36%) hormone-therapy alone, and 8 (11%) other adjuvant treatments alone or in combination. Five-year specific breast cancer survival of women who refused surgery was lower than that of those who accepted (72%, 95% confidence interval, 60%–84% versus 87%, 95% confidence interval, 86%–88%, respectively). After accounting for other prognostic factors including tumor characteristics and stage, women who refused surgery had a 2.1-fold (95% confidence interval, 1.5–3.1) increased risk to die of breast cancer compared with operated women.

It is true that this is not a randomized study; rather, it is a retrospective study. Consequently, it’s impossible to rule out selection bias, but, as the authors point out, this is one case where doing a randomized study is completely unethical. Moreover, half the women accepted some form of other standard, effective treatm,ent, such as hormonal therapy alone. In any case, what this study shows is that women with no surgery can still live a long time, but are far more likely to die of their cancer than women who do undergo surgical extirpation.

As far as I can find, there is one study that specifically looked at the question of what happens to women who opt for alternative medicine instead of scientific medicine. This study, like the one I just cited, was published in the surgical literature, namely American Journal of Surgery. Given the nature of the question it was seeking to answer, its design is single-armed and retrospective, using prognosis estimated by Adjuvant! Online, an online tool into which clinicians can enter prognostic factors of a breast cancer at the time of presentation and come up with an estimate of chances of survival and recurrence with and without treatment. This, of course, is a weakness, but, again, randomizing patients to scientific medicine or alternative medicine would be completely unethical. In the case of such questions, we scientists have to make do with whatever methodology we can; i.e., do the best we can with what we have. Unfortunately, the study was also small, only 33 patients. Even so, given the huge difficulties involved in undertaking such a study, the investigators, who, as private practitioners operating a community practice in Eugene, OR, went above and beyond the call by trying to look at their data and answer this question. That their study has a number of shortcomings is not their fault; they appear to haved done the best they could with what they had, which includes patients who underwent a panoply of alternative therapies, including coral calcium, herbal therapy, mushrooms, high dose vitamins, whey, chelation therapy, hemlock, and coenzyme Q10.

The authors comment:

We found that the overwhelming majority of the patients who initially refused surgical treatment for breast cancer developed disease progression. Five of these patients ultimately underwent surgical resection. Of the other 6 patients, 5 had developed metastatic disease that precluded benefit from surgery. Furthermore, the disease progression caused by the delay in surgery was associated with an increase in the estimated 10-year mortality rate.

Patients who declined chemotherapy or hormone therapy faired slightly better. Optimism for this strategy should be severely tempered by the fact that the length of follow-up evaluation in these patients was relatively short, and these patients had early stage (I or II) disease. By software estimates, the 10-year mortality rate for these patients is still expected to be more than 50% higher than it would have been if the patients had taken their recommended therapy.

A number of patients who expressed their intention to pursue alternative therapies did not return for follow-up evaluation. Attempts were made to contact these patients. Those for whom follow-up evaluation was unavailable were excluded from this study. Although their omission may introduce a selection bias in the results, the effect of this bias is expected to be small because relatively few patients (14 of 47) were in this category.

I find two points important about this study. First, it confirms once again the importance of surgery as a therapeutic modality for breast cancer, especially early stage. Second, and more importantly, it strongly suggests that foregoing or delaying surgery or chemotherapy is at the very least associated with a significantly decreased chance of recurrence-free survival. The authors do note that it is impossible to tell whether this increase in mortality was solely due to delay or refusal of effective therapy or whether the modalities chosen were deleterious. My guess is that it was almost certainly due to the ineffectiveness of the alternative therapies chosen.

More evidence of the uselessness of “alternative” medicine in breast cancer was published two years ago by Edzard Ernst, author of Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine, which Harriet reviewed about a month ago. In 2006, he wrote a review for the Breast Journal along with Katja Schmidt, MSc, C Psychol, and Michael Baum, MD, ChM, a review entitled Complementary/Alternative Therapies for the Treatment of Breast Cancer. A Systematic Review of Randomized Clinical Trials and a Critique of Current Terminology. The objective of the study was to examine all studies randomized clinical trials (RCTs) for “alternative cancer cures” (ACCs). Treatments examined included various methods of psychosocial support such as group support therapy, cognitive behavioral therapy cognitive existential group therapy, a combination of muscle relaxation training and guided imagery, the Chinese herbal remedy Shi Quan Da Bu Tang, thymus extract, transfer factor, melatonin, and factor AF2.

The first finding was that the methodological quality of the studies was, by and large, pretty low. The most common deficiencies included: lack of power sample calculation; small sample size; lack of adequate randomization and/or (patient and assessor or only assessor) blinding; and insufficient follow-up periods. It was noted that only one trial applied an intention to treat analysis. From the 15 studies Ernst examined, this is what was concluded:

The totality of the data fails to show a single intervention that would be demonstrably effective as an ACC. The paucity and the often-low methodological quality of the RCTs are as unexpected to us as they are disappointing. Most trails had small sample sizes; thus a type II error is conceivable. But even if this were true, one would be correct in stating that to date, no effective ACC has been identified.

A lot of this is, of course, true based on discussions of prior plausibility alone. One could argue that, given the poor quality of the studies examined by Ernst, there might be an effect that was missed. However, if an effect were missed, it would have to be small or, at most, moderate. That is not what is claimed for many of these ACCs. What is often claimed is a near-miraculous “cure” for cancer, which, if it were true, would be relatively easy to detect. As I’ve often argued about, for example, the Gonzalez regimen for pancreatic cancer, if such ACCs really were cures, it would actually be fairly easy to show. In the case of pancreatic cancer, for instance, just producing well documented case reports of a few five year survivors among patients with documented metastatic adenocarcinoma of the pancreas would, I daresay, make even Wally Sampson and Kimball Atwood sit up and take notice. Somehow, we never see this. Of course, what makes the question in breast cancer more difficult to answer is its highly variable natural history. In contrast, the vast majority of patients with pancreatic cancer die within the first year (more than half die within six months); fewer still live beyond two years; and very close to none live beyond three years. In contrast, lots of women with metastatic breast cancer live longer than two or three years; a few.

Finally, about five years ago, there was a study out of Norway that looked at the effect of alternative medicine on cancer survival. This study did not limit itself to breast cancer, but it is interesting and useful nonetheless. The hypothesis of the study was that the use of alternative medicine does not have any effect on the survival of cancer patients, and to test the hypothesis investigators studied data from surveys done by the Norwegian Board of Health, which asked patients standard demographic information, but then asked them about their use of alternative medicine as follows:

In the questionnaire presented to the patients, AM was defined as any treatment outside of mainstream therapy that had been used to treat their cancer. A multiple-choice list consisting of the best known and frequently used non-proven methods in Norway was presented. Patients also had the opportunity to add other types of alternative therapy in response to an open question.

The following alternative methods were described in the multiple choice questionnaire: Use of biological treatments, herbs, faith healing or healing by hand, homeopathy, reflexology (zone therapy), megadoses of vitamins, diet treatments, injection therapies such as iscador (a mistletoe preparation) and a Norwegian injection therapy called “Nitter therapy”. Nitter therapy consists of vitamin B12, gammaglobulins, tranexamic acid, multivitamins and nutritional supplements.

Modalities such as relaxation, psychotherapy, participation in a self-help group or changes in lifestyle activities that were used to reduce distress and to improve the patient’s subjective well being were not coded as AM.

I actually very much approve of the fact that the investigators did not define relaxation, psychotherapy, lifestyle changes, etc., as “alternative.”

A total of 515 patients were analyzed, and results were as follows:

In January 2001, survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 (22%) assessable patients used AM. During the follow-up period, 350 patients died. Death rates were higher in AM users (79%) than in those who did not use AM (65%). In a Cox regression model adjusted for demographic, disease and treatment factors, the hazard ratio of death for any use of AM compared with no use was 1.30, (95% Confidence Interval (CI) 0.99, 1.70; P=0.056), suggesting that AM use may predict a shorter survival. Sensitivity analyses strengthened the negative association between AM use and survival. AM use had the most detrimental effect in patients with an ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 (hazard ratio for USE=2.32, 95% CI, 1.44, 3.74, P=0.001), when compared with an ECOG PS of 1 or higher. The use of AM seems to predict a shorter survival from cancer. The effect appears predominantly in patients with a good PS.

In other words, not surprisingly, use of alternative medicine is correlated with poorer surival in the patients with a good performance status and thus who are likely to have a more favorable prognosis. Patients with a poor performance status are more likely to undergo less aggressive therapy because they are less able to tolerate, for example, radical surgery or heavy-duty chemotherapy regimens.

The authors speculated about a number of reasons why use of alternative medicine might be associated with poorer survival. Obviously, it may not be causative. (Remember again that correlation does not necessarily equal causation. One possible explanation is that users of alternative medicine are less likely to undergo optimal medical therapy. One interesting possibility is that users of alternative medicine were more likely to be having severe symptoms, which led them to turn to “alternative medicine” to try to relieve their symptoms. In any case, this study had a number of problems, including a high attrition rate that could have resulted in significant selection bias.

Putting it all together, I conclude that there is no compelling evidence for a significant survival benefit due to any “alternative” therapy, nor is there good evidence for significant treatment effects. The studies that do purport to show an effect are virtually all plagued with methodological difficulties and tend to show effects that are barely above background noise. Even the much touted psychosocial support of late has failed to demonstrate any improvement in the survival of cancer patients. Moreover, although there is a relative paucity of studies, and they, too, are generally retrospective and difficult to interpret, what evidence is out there is that alternative medicine use among cancer patients is associated with an increased risk of dying from cancer, particularly when conventional therapy is eschewed. Taken together, these data make it very hard not to conclude that at best the vast majority of alternative therapies are either useless, no more than placebos, or might even be harmful. That is why they have no role in science-based medicine at present.

As Edzard Ernst put it:

The idea of an “alternative cancer cure” assumes that conventional oncology would not adopt a cancer treatment simply because it originates from an area outside of mainstream medicine. We feel that, should such a cure one day emerge, it would be investigated without delay by oncologists and adopted into routine care as soon as the data supporting it are convincing. Plant-based cancer medications such as Vincristin and Vinblastin (both extracted from the plant Vinca rosea) or Taxol (Taxus baccata) could be employed to back up this theory. It follows that the term ACC is and most likely will always be a contradiction in terms.

Or, as I frequently put it: There is no such thing as “alternative” medicine. There is medicine that is effective, medicine that is not, and medicine that has not been tested yet. Nearly all of so-called “alternative” medicine falls into one of the latter two categories, and those that have not been tested yet nearly all fall into the category of being so wildly improbable that testing them without more positive evidence makes no sense. In any case, as a cancer surgeon, I don’t care where a therapy came from. I really don’t. If someone could show me that reiki or homeopathy cures cancer, I’d use either. In the meantime, I will continue to argue that the very concept of “alternative” medicine is a potentially deadly false dichotomy for cancer patients.

REFERENCES:

1.H. J. G. Bloom,, W. W. Richardson, & E. J. Harries (1962). Natural History of Untreated Breast Cancer (1805-1933) British Medical Journal, 2, 213-221 DOI: PMC1925646
2.Chang, E., Glissmeyer, M., Tonnes, S., Hudson, T., & Johnson, N. (2006). Outcomes of breast cancer in patients who use alternative therapies as primary treatment The American Journal of Surgery, 192 (4), 471-473 DOI: 10.1016/j.amjsurg.2006.05.013
3.T Risberg, A Vickers, R.M Bremnes, E.A Wist, S Kaasa, & B.R Cassileth (2003). Does use of alternative medicine predict survival from cancer? European Journal of Cancer, 39 (3), 372-377
4.Verkooijen, H., Fioretta, G., Rapiti, E., Bonnefoi, H., Vlastos, G., Kurtz, J., Schaefer, P., Sappino, A., Schubert, H., & Bouchardy, C. (2005). Patients’ Refusal of Surgery Strongly Impairs Breast Cancer Survival Annals of Surgery, 242 (2), 276-280 DOI: 10.1097/01.sla.0000171305.31703.84

Alternative medicines interventions are not widely taught or used in medical schools and U.S. hospitals. Definitions of alternative medicine vary but can include relaxation, massage, megavitamins, spiritual healing, folk remedies, herbal medicines, chiropractic, lifestyle and commercial diets, energy healing, homeopathy, hypnosis, biofeedback, and self-prayer. Surveys suggest 10-50% of the world wide population use alternative medicines at an estimated cost of $21-$33 billion in 1997. Approximately 65% of the patients paid for treatment themselves without insurance coverage. There has been a 380% increase of herbal medicine use and 130% increase of high dose vitamins use, reflecting increasing availability in stores.1

Up to 50% of cancer patients use complementary and alternative medicines. Surveys found the majority of users do not tell their physicians and have concurrent conventional treatments. Approximately 10% of cancer patients use alternative medicines instead of mainstream medicine. Examples include laetrile, metabolic diets, shark cartilage, high-dose vitamins, and electromagnetics.2 Studies have found that breast cancer patients were more likely to use alternative therapies in conjunction with conventional treat-ments.3 Newly diagnosed early-stage breast cancer patients on standard therapies who reported depression, fear of recurrence, more physical symptoms, and lower scores for mental health were more likely to use alternative medicines. Therefore the use of complementary and alternative medicine could represent a marker for potential psychosocial distress.4

In 1992, the NIH established the Office of Alternative Medicine to study unconventional medical practices. In 1998, it was renamed as the National Center for Complementary and Alternative Medicine and now supports ten research centers.2

Diet and Nutrition Cures

The theory supporting certain diets reducing cancer risk has been expanded to include cancer cures. Macrobiotic diets are popular and focus on the interplay of food, lifestyle, environment, and the individual to create health/disease. Orthomolecular medicine focuses on high dose vitamins and selected nutrients to aid the body’s immune system. Linus Pauling popularized the consumption of high-dose vitamin C. However, studies did not show any superiority of vitamin C consumption to placebo.

Individual practitioners develop metabolic therapies. These treatments are combinations of diet, vitamins, minerals, enzymes, and detoxification regimens that aim to correct physiological imbalances. For example, the Gerson regimen consists of hourly consumption of crushed fruits and vegetables, and coffee enemas are used to remove dead cells and toxins. Patients also receive nutritional supplements. Detoxification regimens are also available in health food stores and books. These regimens utilize laxatives that can be dangerous when taken regularly.5

Mind-Body Techniques

Mind-body techniques focus on using the mind to heal the body. An example is Bernie Siegel’s Exceptional Cancer Patients Program, which combines meditation, visualization, therapy, support groups, and other exercises. Studies show no difference in length of survival of breast cancer patients who utilize mind-body techniques. However, some physicians accept their use because they improve the patient’s psyche.2

Biologic Treatments

Biologic treatments are invasive and utilize biologically active compounds. The best known is antineoplastons (peptides) developed by Stanislaw Burzynski. Antineoplastons were purported to slow or reverse tumor growth. The National Cancer Institute and Burzynski were to start clinical trials but failed to agree on a protocol and patient selection criteria. Other research at the Burzynski Research Institute raised criticisms that the treatments were toxic and useless.5

Shark cartilage gained interest as an antiangiogenic compound after the book “Sharks Don’t Get Cancer” was published, but a recent phase I-II trial showed no benefit. Shark cartilage protein was deemed too large to be absorbed and are excreted.6,7

Traditional Chinese medicine includes herbal remedies and acupuncture/acupressure. Acupuncture/ acupressure is based on the principle that energy courses through the body and disease causes blockage that can be unblocked by healers.2 Acupuncture has been used as an adjunct in the treatment of postoperative and chemotherapy nausea and vomiting. Studies of acupuncture in pain management have shown pain relief and narcotics use reduced as well as effects on regeneration of nerve tissue in patients with peripheral neuropathy.8

Traditional Chinese herbal therapies have been purported to augment the immune function, ameliorate the effects of chemotherapy, and prevent cancer. Herbal agents have been reported to increase the CD4/CD8 ratio and T cell count. They also have effects on cytokine levels. However studies have been inadequate in terms of design and size to document clinical efficacy and further trials are needed. Herbs in the role of supportive therapy can help to restore peripheral blood counts and ease nausea and vomiting. In China, long-term prospective trials with herbs and cancer prevention showed some benefit in patients with cirrhosis with fewer cases of hepatocellular carcinoma. Also, patients with epithelial dysplasia had a lower rate of esophageal cancer in the treatment group versus the untreated control group. One study conducted in Beijing with 184 breast cancer patients reported results of 88.8% 5-year survival in patients taking an herbal remedy.8

There is concern that herbal medicines may have adverse effects on cancer treatments. Some herbs can photosensitize the skin to radiation, and some cause blood pressure swings. Others have anticoagulant effects and need to be discontinued prior to surgery.2

In 1993, the Canadian Breast Cancer Research Institute established the Task Force on Alternative Therapies and researched six popular treatments used by Canadian cancer patients.

Essiac is an herbal mixture widely used in Canada for 70 years. Essiac was developed by Rene Caisse, a nurse who obtained the recipe from a woman who said it cured her breast cancer. Ingredients include burdock root, Indian rhubarb, sheep sorrel, and the inner bark of slippery elm. It is reported to boost the immune system, increase appetite, reduce pain, improve quality of life, reduce tumor size, and increase survival. Essiac is now marketed as an herbal tea to reduce nausea, vomiting, and diarrhea. Ingredients have been studied and seem to help with quality of life but no clinical benefits of improved survival or tumor regression have been shown. Of note, it contains high levels of anthraquinone (adriamycin is an anthraquinone derivative).9

Green tea has been used in China and Japan for 5000 years as a stimulant and a digestive remedy. It has 10-80 mg of caffeine thus its use should be limited to 2 cups/day in pregnant and nursing women and cardiac patients. Epidemiological studies on green tea and cancer prevention suggested regular consumption might moderately reduce cancer risk, especially cancer of the upper digestive tract. In terms of cancer treatment, a few animal studies showed decreased tumor growth and reduced incidence of skin cancer development in animals exposed to skin carcinogens. Decreased metastatic potential and suppression of chromosomal mutations induced by carcinogens were also observed. However, the mechanism of action is not fully understood, and further research is necessary.10

Iscador is an extract of European mistletoe. Mistletoe is used in anthroposophic medical clinics in Switzerland and Germany. It is legally prescribed in South Africa and several European countries. Anthroposophy is the philosophy that blends science and spiritual principles and applies them to cancer treatment. Mistletoe is thought to have controlling properties that are deficient in cancer. It is reported to reduce tumor size, stimulate the immune system, and revert cells to more differentiated forms. Mistletoe is used in cervical, ovarian, breast, gastric, colon, and lung cancer to improve quality of life and survival. Laboratory studies showed increased DNA stability, decreased cell growth, and, in animal models, increased immune function. Clinical studies in Europe have shown improvements in quality of life, survival, and immune function. However, these studies had design limitations, and more research is necessary. Iscador is injected into the abdominal wall subcutaneously near the tumor site, and side effects include local inflammation at injection site.11

Oncologist Dr. Joseph Gold studied substances that can block gluconeogenesis since cancer cells get energy from anaerobic metabolism. He found hydrazine sulfate to be most effective and used it initially in breast cancer, sarcoma, Hodgkin, and other lymphomas. Gold advocated using hydrazine sulfate in conjunction with conventional therapies to get an enhanced effect. Hydrazine sulfate can normalize metabolism in cancer patients with cachexia. Clinical studies in Russia reported improvement in well-being, tumor stabilization, and survival. Results of U.S. studies showed zero to minimal effects. Side effects include nausea, pruritus, peripheral neuropathy, and drowsiness. Hydrazine, the metabolite of hydrazine sulfate, is liver toxic.12

Diets high in vitamins A, C and E may reduce the risk of some cancers but the specific agent for the protective effect is unknown. Therefore, nutritionists recommend fresh foods including fruits and vegetables instead of diet supplements. However many people take daily vitamin supplements. Cancer patients usually take daily doses greatly exceeding recommended daily intake. Proponents of mega dose vitamins based their recommendations on lab studies showing tumor suppression, positive immune function effect, and induction of cell differentiation.

Vitamin A’s precursor is beta-carotene. Vitamin A and beta-carotene are proposed as chemoprophylactic agents for cancer based on epidemiological studies that showed higher cancer risk in populations with low dietary intake and low serum levels. Lab studies showed that retinoids enhance immune response, slow tumor growth, and decrease tumor size. In breast cancer, retinoids attach to receptors on breast cancer cells and influence gene expression and cell proliferation. Beta-carotene can increase production and tumoricidal activity of human monocytes, lymphocytes, and macrophages. Retinoids with interferons inhibit proliferation of malignant cells. Pre-clinical study with vitamin A analog (fenretinide) showed that it may be beneficial in the prevention and treatment of breast cancer. It has cytostatic activity in human cancer cell lines and inhibitory effect in rat studies. There is possible synergism between fenretinide and tamoxifen.

Clinical studies showed that retinol levels are lower in cancer patients versus controls. Plasma level increases with supplementation but the therapeutic effects are unclear. 13-cis-retinoic acid with inter-feron-alpha had positive effects in cervical cancer. Other retinoids and interferon are useful in cutaneous malignancies. However, there was an increased risk of lung cancer in smokers receiving beta-carotene and vitamin A. Vitamin A can cause headaches, irritability, peri-oral dermatitis, desquamation, and mega doses can cause liver damage. Beta-carotene is less toxic.13

Vitamin C is known to have effects on immune function, and it is believed that the body requires more vitamin C during physical or chemical stress. Epidemiological studies showed reduced risk of some cancers in populations with high vitamin C intake. This may be due to vitamin C’s antioxidant effect or its ability to block N-nitrosamines formed in the stomach after ingestion of certain foods. There is a close association between high vitamin C levels and reduced risk of stomach cancer. In animal studies, tumor regression, tumor growth inhibition, and increased survival have been noted. However, two randomized studies in patients with advanced cancer had negative results.

Mega dose vitamin C can cause stomach irritation, headache, rash, and increased oxalate deposition in bladder/kidneys. Vitamin C can interfere with medications including anticoagulants, iron, vitamin B12, and vitamin E. High doses in pregnancy can lead to vitamin C deficiency in the newborn.13

Vitamin E is a fat-soluble vitamin that is found in many foods. The most common form in the Western diet is alpha-tocopherol. Low serum levels are associated with slightly increased cancer risk but the data are limited and inconsistent. The mechanism of action is poorly understood, but cancer prevention and treatment may be related to lipid antioxidant properties. Lab study with human breast cancer cell lines showed that vitamin E inhibited cell proliferation. Studies with benign breast disease and vitamin E supplements showed no benefit.

There are no in vivo or clinical studies.

There are no serious side effects with vitamin E supplementation in most adults but high levels can affect absorption of vitamins A and K. It should be used with caution in patients on anticoagulant therapy or those with vitamin K-related clotting disorders.13

Patients have been advised to take the Hoffer regimen, a combination of vitamins A, C, and E and selenium. Some studies have reported benefits with combination therapy but results are questioned due to weakness in the study methodology.13

Canadian scientist Gaston Naessens examined blood from healthy and cancer patients and saw “somatids” in cancer patients. He described two life cycles: microcycle (seen in healthy individuals) and macrocycle (seen in cancer). He theorized that environmental factor initiates macrocycle, and the somatids start to secrete toxic substances that interfering with immune cells and allow proliferation of primitive cells. These cells deplete the rest of the body of nitrogen and, he developed 714-X to interfere with somatidian macro-cycle. The base is a camphor compound with added nitrogen to satisfy nitrogen requirement of cancer cells thereby freeing the body’s nitrogen for immune cells. It is injected into lymph nodes in the groin.

A few studies with animals have shown no beneficial effect of 714-X. Cancer and AIDS patients have reported increased survival and quality of life. It is increasingly being used in breast and prostate cancer patients. Camphor has been shown to improve immune function, promote enzymatic breakdown of carcinogens, and increase susceptibility of cancer cells to radiation. However, camphor can have toxic effects when ingested.14

Jacobson et al reviewed the literature from 19801997 on clinical research with breast cancer patients and complementary and alternative medicine. They looked at studies designed to show 1) alteration of disease progression, 2) alleviation of symptoms of breast cancer, 3) relief of treatment side effects, and 4) improvement of immune function. They found 51 citations fitting their criteria. Modalities include 1) diet, nutrition, and lifestyle changes, 2) herbal medicine: iscador and other concoctions, 3) mind/body control: support groups, psychotherapy, and hypnosis, 4) pharmacologic/biologic treatment: antineoplaston, melatonin, laetrile, and hydrazine sulfate, and 5) energy therapy. There were no data about essiac, 714-X, macrobiotic diets, or shark cartilage. Two studies showed positive effects of melatonin on metastatic cancer (< 25% lesion increase and increased complete/partial response). Another study found that melatonin potentiates tamoxifen.15

Patients turn to complementary and alternative medicine to relieve side effects of cancer treatments. These include acupuncture for nausea/vomiting, massage for reduction of lymphedema, and mind/body techniques to reduce pain/stress. Despite anecdotal reports that show benefit with these alternative treatments, clinical studies have yet to provide clear answers. Though few alternative treatments have been shown to have definitive therapeutic effects on breast cancer, physicians should be aware of their use to facilitate open discussion with patients who choose to utilize these treatments.

REFERENCES

1.Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998 Nov 11;280(18):1569-1575.

2.Cassileth BR. Complementary and alternative cancer medicine. J Clin Oncol. 1999 Nov;17(11 Suppl):44-52.

3.VandeCreek L, Rogers E, Lester J. Use of alternative therapies among breast cancer outpatients compared with the general population. Altern Ther Health Med. 1999 Jan;5(1):71-76.

4.Burstein HJ, Gelber S, Guadagnoli E, Weeks JC. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med. 1999 Jun 3;340(22):1733-1739.

5.Cassileth BR. Complementary and alternative cancer medicine. Alternative Cancer Treatments. Scientific American. 1996 Sep.

6.American Cancer Society: Shark cartilage/angiogenesis. American Cancer Society, Report no. 8100. 1992. Atlanta (GA).

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Breast cancer Alternative medicine

Ralph W. Moss, Ph.D. – “Conventional cancer therapy is so toxic and dehumanizing that I fear it far more than I fear death from cancer. We know that conventional therapy doesn’t work–if it did, you would not fear cancer any more than you fear pneumonia. It is the utter lack of certainty as to the outcome of conventional treatment that virtually screams for more freedom of choice in the area of cancer therapy. Yet most alternative therapies regardless of potential or proven benefit, are outlawed, which forces patients to submit to the failures that we know don’t work, because there’s no other choice.”

Linda Page, N.D. Ph.D – “Of the women in menopause today, about half start synthetic hormone replacement, but only half of those stick with it because of the side effects or fear of cancer risk. The threat of breast and uterine cancer is dramatically increased with HRT”.
An Australian team from the University of Queensland see little, if any, benefit in screening women under 50 years of age, but they do point out some of the serious negative effects – later ill effects from the radiation they are exposed to during the mammogram, the possibility that an existing tumor may spread due to the pressure exerted on the breast during screening, and the anxiety caused by frequent false- positive results. The Canadian researchers point out that a false-positive result may not only produce great stress, but may also lead to unnecessary biopsies and surgery. They also point out that mammography misses 10-15 per cent of early breast cancers thus providing a false sense of security.

Dr. Mercola

How Mammography Increases Your Cancer Risk – X-rays and other classes of ionizing radiation have been, for decades, a proven cause of virtually all types of biological mutations. When such mutations are not cell-lethal, they endure and accumulate with each additional exposure to x-rays or other ionizing radiation. X-rays are also an established cause of genomic instability, often a characteristic of the most aggressive cancers. Additionally, radiation risks are about four times greater for the 1 to 2 percent of women who are silent carriers of the A-T (ataxia-telangiectasia) gene, which by some estimates accounts for up to 20 percent of all breast cancers diagnosed annually.

When everything is taken into account, reducing exposure to medical radiation such as unnecessary mammograms would actually likely reduce mortality rates. The practice of screening mammography itself poses significant and cumulative risks of breast cancer, especially for premenopausal women. Making matters even worse, false positive diagnoses are very common – as high as 89 percent – leading many women to be unnecessarily and harmfully treated by mastectomy, more radiation, or chemotherapy. There are instances where mammography may be warranted. But the fact remains that there are other technologies that are proven to be more effective, less expensive, and completely harmless, that can save far more lives.

Now, imagine being able to look inside yourself and be able to get as much as 10 years warning that something is about to develop, giving you ample time to PREVENT the cancer from forming in the first place by taking the appropriate lifestyle changes that can radically change your health. That technology already exists, and has been available since the 1960s.

Dr. Len Saputo explores the latest findings on the effectiveness and shortcomings of various detection methods used by the mainstream medical community, including mammography, clinical breast exams, ultrasound, and to a lesser extent, magnetic resonance imaging (MRIs) and PET scans.

Danish researcher Dr. Peter Gotzsche first made this claim in a study published in “The Lancet” in October 2006. Gotzsche had re-analyzed the studies originally done on the benefits of mammograms and found them unconvincing. Since then, other doctors have begun to assert that in addition to failing to offer protection, mammograms — which involve exposing patients to radiation —may actually increase women’s risk of cancer. “The latest evidence shifts the balance towards harm and away from benefits,” said Dr. Michael Baum of University College in London. Gifford-Jones also points to other risks, from the physical to the psychological. According to some authorities, the squeezing of women’s breasts during mammograms may rupture blood vessels, causing cancer to spread to other parts of the body and actually increasing a patient’s risk of death. He also pointed to the trauma suffered by women who receive false positives from their mammograms, and to the dangerous sense of security felt by those who receive false negatives.