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Breast Cancer

Illustration

A healthy lifestyle offers protection now. What changes can you make to reduce your breast cancer risk or ease your treatment? According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Get a checkup
  • See your healthcare professional once a year for a breast exam and mammogram to detect disease before it becomes advanced
  • Cut back on cocktails, but not on nutrition
  • Limit your alcohol consumption and take a multivitamin containing folic acid to reduce alcohol-related breast cancer risk
  • Eat risk-reducing foods
  • Add plenty of fiber, tomato products, soy products, and fish to your diet
  • Prioritize exercise
  • Maintain a regular exercise program throughout your life
  • Seek support
  • If you have breast cancer, join a weekly patients’ group for social support
  • Mix in melatonin
  • If you have breast cancer, take 20 mg of this hormone at night under medical supervision to possibly help shrink tumors and slow progression

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full breast cancer article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About breast cancer

Breast cancer is a malignancy of the breast that is common in women and rare in men. It is characterized by unregulated replication of cells creating tumors, with the possibility of some of the cells spreading to other sites (metastasis).

This article includes a discussion of studies that have assessed whether certain vitamins, minerals, herbs, or other dietary ingredients offered in dietary or herbal supplements may be beneficial in connection with the reduction of risk of developing breast cancer, or of signs and symptoms in people who have this condition.

This information is provided solely to aid consumers in discussing supplements with their healthcare providers. It is not advised, nor is this information intended to advocate, promote, or encourage self prescription of these supplements for cancer risk reduction or treatment. Furthermore, none of this information should be misconstrued to suggest that dietary or herbal supplements can or should be used in place of conventional anticancer approaches or treatments.  

It should be noted that certain studies referenced below, indicating the potential usefulness of a particular dietary ingredient or dietary or herbal supplement in connection with the reduction of risk of breast cancer, are preliminary evidence only. Some studies suggest an association between high blood or dietary levels of a particular dietary ingredient with a reduced risk of developing breast cancer. Even if such an association were established, this does not mean that dietary supplements containing large amounts of the dietary ingredient will necessarily have a cancer risk reduction effect.

Most breast cancer is not hereditary, although a small percentage of women have a genetic weakness that dramatically increases their risk. Women with a strong family history of breast cancer may choose to explore the possibility of genetic testing with a geneticist, found on the staff of many major hospitals.

The incidence of postmenopausal breast cancer varies dramatically from one part of the world to the other, and those who move from one country to another will, on average, over time, begin to take on the risk of the new society to which they have moved. This evidence strongly suggests that most, though not all, breast cancer is preventable. However, great controversy exists about which factors are most responsible for the large differences in breast cancer incidence that separate high-risk populations from low-risk populations.

A few factors that affect the risk of having breast cancer are widely accepted:

  • The later the age of the first menstrual cycle, the lower the risk.
  • Full-term pregnancy at an early age (teens to early twenties) lowers the risk.
  • Being overweight increases the risk of postmenopausal breast cancer.
  • Use of hormone replacement therapy increases the risk, but this increase in risk has been reported to disappear shortly after hormone use is discontinued.
  • Being older at the time of the last menstrual cycle (early fifties or older) confers a higher risk compared with women who have had their last menstrual cycle at a younger age (late forties or earlier).

Several other factors may affect a woman’s risk of getting breast cancer. Many researchers and some doctors believe that long-term (greater than five years) use of oral contraceptives increases the risk of premenopausal breast cancer, but not the risk of postmenopausal breast cancer. Also, being overweight appears to slightly reduce the risk of premenopausal breast cancer, even though it increases the risk of postmenopausal breast cancer.

Almost all women with noninvasive breast cancer (ductal carcinoma in situ), along with a majority of women diagnosed with node-negative invasive breast cancer, are cured with appropriate conventional treatment. Even when breast cancer is diagnosed after it has spread to lymph nodes, many patients are curable. Once breast cancer has spread to a distant part of the body, conventional treatment sometimes extends life but cannot provide a cure.

Product ratings for breast cancer

Science Ratings Nutritional Supplements Herbs
2Stars

Folic acid (reduces risk in women who consume alcohol)

 
1Star

Coenzyme Q10

Conjugated linoleic acid

Melatonin

Vitamin D (reduces risk)

Coriolus versicolor

Eleuthero

European mistletoe

Green tea (reduces risk)

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

The diagnosis of breast cancer is usually begun at the time a painless one-sided lump is discovered by the woman or her physician. In recent years, the diagnosis of breast cancer often begins with suspicious findings from a routine screening mammogram accompanied by no symptoms. In more advanced cases, changes to the contour of the affected breast may occur, and the lump may eventually become immovable.

If breast cancer spreads to a distant part of the body (distal metastasis), symptoms are determined by the location to which the cancer has spread. For example, if breast cancer spreads to bone, it frequently causes bone pain; if it spreads to the brain, it generally causes neurological symptoms, such as headaches that do not respond to aspirin. When it has spread to a distant part of the body, breast cancer also eventually causes severe weight loss, untreatable fatigue-inducing anemia, and finally death.

Medical options

Prescription drug treatment known as chemotherapy is commonly offered to most breast cancer patients, even many women with early-stage (node-negative) disease. Most chemotherapy is administered after surgery, although women with large tumors are sometimes treated before surgery. The chemotherapy drugs most commonly used to treat women with breast cancer include combinations of the following drugs: cyclophosphamide (Cytoxan®, Neosar®), methotrexate (Folex®, Rheumatrex®), fluorouracil (5-FU, Adrucil®, Efudex®, Fluoroplex®), and doxorubicin (Adriamycin®, Rubex®, Doxil®). Tamoxifen, an anti-estrogen (Nolvadex®), is given to breast cancer patients whose disease is categorized as estrogen-receptor positive; other breast cancer patients generally do not receive tamoxifen. Some advanced breast cancer patients who have estrogen receptor-positive disease are also given aromatase-inhibitor drugs, which interfere with the body’s ability to make estrogen. These drugs include letrozole (Femara®), anastrozole (Arimidex®), formestane (Lentaron®), vorazole (Rizivor®), and exemestane (Aromasin®).

Increasingly, women with noninvasive breast cancer (ductal carcinoma in situ) are treated with a variety of surgical and radiation options depending upon several factors (called Van Nuys criteria) that determine their risk of developing invasive (potentially life-threatening) breast cancer. Lobular carcinoma in situ is generally not considered to be breast cancer, only a risk factor for developing breast cancer. Most women with invasive breast cancer are initially offered one of two options: either removal of the lump (lumpectomy) combined with removal of axillary (arm pit) lymph nodes followed by radiation, or removal of the breast (mastectomy) combined with removal of axillary lymph nodes. In a minority of cases, patients receiving mastectomy are advised to receive radiation after the mastectomy.

Dietary changes that may be helpful

The following dietary changes have been studied in connection with breast cancer.

Avoidance of alcohol
An analysis of studies using the best available methodology found that women who drink alcohol have a higher risk of breast cancer compared with teetotalers.1 Alcohol consumption during early adulthood may be more of a risk factor than alcohol consumption at a later age.2

Some,3 4 though not all,5 studies have reported that alcohol increases estrogen levels. Increased estrogen levels might explain the increase in risk.

In a preliminary report, drinkers with low intake of folic acid had a 32% increased risk of breast cancer compared with nondrinkers; however, the excess risk was only 5% in those drinkers who consumed adequate levels of folic acid.6 In the same report, women taking multivitamins containing folic acid and having at least 1.5 drinks per day had a 26% lower risk of being diagnosed with breast cancer compared with women drinking the same amount of alcohol but not taking folic acid-containing vitamins.7

Fiber
Insoluble fiber from grains delays the onset of mammary (breast) cancer in animals.8 In an analysis of the data from many studies, people who eat relatively high amounts of whole grains were reported to be at low risk for breast cancer.9

In some studies, the protective effect of fiber against the risk of breast cancer has been stronger in young women than in older women.10 This finding might occur because fiber has been reported to lower estrogen levels in premenopausal women but not in postmenopausal women.11 12 Other researchers, however, report that fiber appears to equally reduce the risk of breast cancer in women of all ages.13 One leading researcher has suggested the active components in fiber may be phytate and isoflavones, substances that may provide protection even in the absence of a decrease in estrogen levels.14 If these substances do protect against breast cancer, they might be as helpful in older women as in younger women.

Consuming a diet high in insoluble fiber is best achieved by switching from white rice to brown rice and from bakery goods made with white flour or mixed flours to 100% whole wheat bread, whole rye crackers, and whole grain pancake mixes. Refined white flour is generally listed on food packaging labels as “flour,”“enriched flour,”“unbleached flour,”“durum wheat,”“semolina,” or “white flour.” Breads containing only whole wheat are usually labeled “100% whole wheat.”

Vegetarianism
Compared with meat eaters, most,15 but not all,16 studies have found that vegetarians are less likely to be diagnosed with cancer. Vegetarians have also been shown to have stronger immune functioning, possibly explaining why vegetarians may be partially protected against cancer.17 Female vegetarians have been reported to have lower estrogen levels compared with meat-eating women, possibly explaining a lower incidence of breast cancer that has been reported in vegetarian women.18

Fruits and vegetables
An analysis of 17 studies on breast cancer risk and diet found that high consumption of vegetables was associated with a 25% decreased risk of breast cancer compared with low consumption.19 The same report analyzed 12 studies that found high consumption of fruit was associated with a 6% reduction of breast cancer incidence compared with low consumption. However, when data from only the eight largest and best studies were combined, high intake of fruits and/or vegetables did not correlate with protection from breast cancer.20 Therefore, the protective effect of fruit and vegetable consumption against breast cancer remains unproven.21

Tomatoes
Tomatoes contain lycopene—an antioxidant similar in structure to beta-carotene. Most lycopene in our diet comes from tomatoes, though traces of lycopene exist in other foods. Lycopene has been reported to inhibit the proliferation of cancer cells in test tube research.22

A review of published research found that higher intake of tomatoes or higher blood levels of lycopene correlated with a reduced risk of a variety of cancers in 57 of 72 studies. Findings in 35 of these studies were statistically significant.23 Evidence of a protective effect for tomato consumption was strongest for cancers other than breast cancer (prostate, lung, and stomach cancer), but some evidence of a protective effect also appeared for breast cancer.

Meat and how it is cooked
Most,24 25 but not all,26 studies show that consumption of meat is associated with an increased risk of breast cancer. This association probably depends in part on how well the meat is cooked. Well-done meat contains more carcinogenic material than does lightly cooked meat.27 Evidence from preliminary studies shows that women who eat well-done meat have a high risk of breast cancer.28 Genetic factors may determine which women increase their risk of breast cancer by eating well-done meat.29

Fish
Fish eaters have been reported to have a low risk of breast cancer.30 The omega-3 fatty acids found in fish are thought by some researchers to be the components of fish responsible for protection against cancer.31

Coffee, unrelated to risk
Coffee drinking has been reported to increase breast pain associated with noncancerous lumps in the breast—a group of conditions commonly called fibrocystic breast disease. The presence of some forms of fibrocystic breast disease have been reported by some researchers to increase the risk of breast cancer.32 As a result of these separate findings, some women may be concerned coffee drinking might increase the risk of breast cancer. However, most research has shown that coffee drinkers are at no higher risk of breast cancer than are women who do not drink coffee.33 34 35

Olive oil
Olive oil consumption has been associated with a reduced risk of breast cancer in several preliminary reports.36 37 38 Oleic acid, the main fatty acid found in olive oil, does not appear to be the cause of this protective effect,39 and scientists now guess that some as-yet undiscovered substance in olive oil might be responsible for the apparent protective effect of olive oil consumption.40

The dilemma over dietary fat
Olive oil and fish are two sources of dietary fat considered potentially helpful in protecting against breast cancer.41 42 43 44 Each has been discussed separately above. The information below discusses fat sources that some researchers are concerned might increase the risk of cancer.

High-fat diets increase the risk of mammary cancer in animals.45 From country to country, breast cancer risk in women is proportionate to the level of total fat consumed in the diet.46 Estrogen levels, body weight, and breast density have all been reported to decrease when women are put on low-fat diets—all changes that are thought to reduce the risk of breast cancer.47 48 49 50 Moreover, breast cancer patients have been reported to reduce their chances of survival by eating a diet high in saturated fat.51 (Saturated fat is found mostly in meat and dairy fat.) Similarly, breast cancer patients have been reported to be at increased risk of suffering a recurrence if they eat higher levels of fatty foods, such as butter, margarine, red meat, and bacon.52

Analysis of human trials, using a research design dependent on the memories of subjects, also has shown women consuming high-fat diets to be at high risk of breast cancer.53 In some cases, the correlation has been quite strong.54 However, most,55 56 57 but not all,58 “prospective” studies—which avoid problems caused by faulty memories—have not found any association between fat intake and the risk of breast cancer.

Why do some research findings suggest that fat increases the risk of cancer and other studies find no association? Some studies finding dietary fat unrelated to cancer risks have not factored out the effects of olive oil or fish fat; both may protect against cancer.59 60 61 62 Adding them to the total dietary fat intake and then studying whether “more fat causes more cancer” is therefore misleading. Some studies finding no association between fat intake and breast cancer have made one or both of these errors.63 64

Scientists know cancers caused by diet most likely occur many years after the causative foods are regularly consumed. When one group of researchers compared dietary intakes to cancer rates occurring ten years after the consumption of food, and also eliminated from consideration the effect of fat from fish consumption, they found a high degree of correlation between consumption of animal fat (other than from fish) and the risk of breast cancer death rates for women at least 50 years of age.65

In the debate over whether dietary fat increases breast cancer risks, only one fact is indisputable: women in countries that consume high amounts of meat and dairy fat have a high risk of breast cancer, while women in countries that mostly consume rice, soy, vegetables, and fish (instead of dairy fat and meat) have a low risk of breast cancer.66

The complex relationship between soy consumption and risk
Asian countries in which soy consumption is high generally have a low incidence of breast cancer. However, the dietary habits in these countries are so different from diets in high-risk countries that attributing protection from breast cancer specifically to soy foods on the basis of this evidence alone is premature.67 Similarly, within a society, women who frequently consume tofu have been reported to be at low risk of breast cancer.68 Consumption of tofu might only be a marker for other dietary or lifestyle factors that are responsible for protection against breast cancer.

Genistein, one of the isoflavones found in many soy foods, inhibits proliferation of breast cancer cells in test tube studies. Most animal studies report that soybeans and soy isoflavones protect against mammary cancer.69 However, the protective effect in animals have occurred primarily when soy has been administered before puberty.70 If the same holds true in humans, consuming soy products in adulthood might provide little, if any, protection against breast cancer.

The findings of several recent studies suggest that consuming soy might, under some circumstances, increase the risk of breast cancer.71 72 73 74 75 When ovaries were removed from animals—a situation related to the condition of women who have had a total hysterectomy—dietary genistein was reported to increase the proliferation of breast cancer cells.76 When pregnant rats were given genistein injections, their female offspring were reported to be at greater risk of breast cancer.77 Although premenopausal women have shown decreases in estrogen levels in response to soy consumption,78 79  proestrogenic effects have also been reported.80 When premenopausal women were given soy isoflavones, an increase in breast secretions resulted—an effect thought to elevate the risk of breast cancer.81 In yet another trial, healthy breast cells from women previously given soy supplements containing isoflavones showed an increase in proliferation rates—an effect that might also increase the risk of breast cancer.82

The commonly held belief that consuming soybeans or isoflavones such as genistein will protect against breast cancer is, therefore, far from proven.83 84 85 86 87 Possibly, consuming soybeans in childhood may ultimately be proven to have a protective effect.88 Doing the same in adulthood, however, may have very different effects.89 90 91 92 93

Some scientists, at least under some circumstances, remain hopeful about the potential for soy to protect against breast cancer. These scientists recommend consumption of foods made from soy (such as tofu), as opposed to taking isoflavone supplements. Several substances in soybeans other than isoflavones have shown anticancer activity in preliminary research.94

Reduction in sugar
Preliminary studies have reported associations between an increased intake of sugar or sugar-containing foods and an increased risk of breast cancer,95 though this link does not appear consistently in published research.96 Whether these associations exist because sugar directly promotes cancer or because sugar consumption is only a marker for some other dietary or lifestyle factor remains unknown.

Lifestyle changes that may be helpful

The following lifestyle changes have been studied in connection with breast cancer.

Exercise and prevention
Girls who engage in a significant amount of exercise have been reported to be less likely to get breast cancer as adults.97 Although some doctors speculate that exercise in preadolescent girls might reduce the risk of eventually getting breast cancer by reducing the number of menstrual cycles and therefore exposure to estrogen, these effects may occur only in girls engaging in very strenuous exercise.98

Most,99 100 but not all,101 studies find that adult women who exercise are less likely to get breast cancer. Women who exercise have also been reported to have a reduced risk of high-risk mammography patterns compared with inactive women.102

Exercise in adulthood might help protect against breast cancer by lowering blood levels of estrogen or by helping maintain ideal body weight. In addition to the preventive effects of exercise, aerobic exercise has been reported to reduce depression and anxiety in women already diagnosed with breast cancer.103

Smoking and risk
Some studies have found an association between smoking and an increased risk of breast cancer, including exposure to secondhand smoke.104 However, several reports have either found no association105 or have reported an association between smoking and an apparent protection against breast cancer.106 Some of the studies reporting that smoking is detrimental have found that exposure to cigarette smoke during childhood appears to be most likely to increase the risk of breast cancer.107

The mind-body connection
In some studies, the risk of breast cancer has been reported to be higher in women who have experienced major (though not minor) depression in the years preceding diagnosis.108 Some,109 110 but not all,111 studies have found that exposure to severely stressful events increases a woman’s chance of developing breast cancer. In one study, breast cancer patients exposed to severely stressful events, such as death of a spouse or divorce, had more than five times the risk of suffering a recurrence compared with women not exposed to such stressors.112 Although stress has long been considered as a possible risk factor, some studies have not found significant correlations between psychological stressors and breast cancer risk113 or the risk of breast cancer recurrence.114 Similarly, experiencing psychological distress (independent of external stressors) has, in some reports, not been associated with a reduction in survival or the risk of suffering a breast cancer recurrence.115

Exposure to psychological stress has been reported to weaken the immune system of breast cancer patients.116 Strong social support has been reported to increase immune function in breast cancer patients.117 These findings suggest a possible way in which the mind might play a role in affecting the risk of a breast cancer recurrence.118 119

In one study, breast cancer patients with strong social support in the months following surgery had only half the risk of dying from the disease during a seven-year period compared with patients who lacked anyone to confide in.120 After 10121 and 15 years,122 breast cancer patients with a helpless and hopeless attitude or with an attitude of stoicism were much less likely to survive compared with women who had what the researchers called a “fighting spirit.” In a five-year study, the same helpless/hopeless attitude correlated with an increased risk of recurrence or death in breast cancer patients, but a “fighting spirit” did not correlate with special protection against recurrence or death.123 One trial reported that psychological therapy for hopeless/helpless breast cancer patients was capable of changing these attitudes and reducing psychological distress in only eight weeks.124

Several trials using a variety of psychological interventions have reported increased life expectancy in women receiving counseling or psychotherapy compared with women who did not receive psychological intervention125 —even in women with late-stage disease.126 In a now-famous trial, late-stage breast cancer patients in a year-long, 90-minute-per-week support group lived on average twice as long as a group of similar patients who did not receive such support.127

Finally, relaxation training has been reported to reduce psychological distress in breast cancer patients,128 and group therapy and hypnosis have reduced pain in late-stage breast cancer patients.129

Even extensive psychological support (weekly peer support, family therapy, individual counseling, and use of positive mental imagery) has not led to a clear increase in breast cancer survival in every study.130 Why some studies clearly find mind-body connections in regard to breast cancer risk, recurrence, or survival, while other studies find no such connection, remains unclear.

Overweight and risk
Being overweight increases the risk of postmenopausal breast cancer, a fact widely accepted by the research community. Overweight does not increase the risk of premenopausal breast cancer and even may be associated with a slightly reduced risk of breast cancer in young women.131

Vitamins that may be helpful

The following nutritional supplements have been studied in connection with breast cancer.

Folic acid
Among women who drink alcohol, those who consume relatively high amounts of folate from their diet have been reported to be at reduced risk of breast cancer, compared with women who drink alcohol but consumed less folate, according to a preliminary study.132 In a similar report, consumption of folic acid-containing supplements was associated with a lower risk of breast cancer in women who drank alcohol, compared with women who drank alcohol but did not take such supplements.133

The damaging effect alcohol has on DNA—the material responsible for normal replication of cells—is partially reversed by folic acid. Therefore, a potential association between both dietary folate and folic acid supplements and protection against breast cancer in women who drink alcohol is consistent with our understanding of the biochemical effects of these substances. A combined intake from food and supplements of at least 600 mcg per day was associated with a 43% reduced risk of breast cancer in women who consumed 1.5 drinks per day or more, compared with women who drank the same amount but did not take folic acid-containing supplements.134

No research has yet explored the effect of folic acid supplementation in people who have already been diagnosed with cancer. Cancer patients taking the chemotherapy drug methotrexate must not take folic acid supplements without the direction of their oncologist.

Selenium
The association between relatively higher blood levels of selenium and lower risks of cancer in men has been fairly consistent.135 136 137 However, most,138 139 140 141 though not all,142 studies have found selenium status to be unrelated to cancer risk in women, particularly in relation to cancers that strike only women. In fact, a few studies have reported that exposure to higher amounts of selenium143 —including selenium from supplements144 —is associated with a higher risk of several cancers in women, though these studies have been criticized.145

In a famous double-blind trial that reported dramatic reductions in the incidence of lung, colon, and prostate cancers as a result of selenium supplementation, of the few women who got breast cancer during the trial, more were taking selenium than were taking placebo, though this difference may well have been due to chance.146 Thus, the findings of this famous trial also do not support the idea that selenium supplementation protects against breast cancer.147

In contrast, animal studies generally find that selenium helps protect against mammary cancer,148 149 and associations between higher selenium status and decreased risk of breast cancer in women have also occasionally been reported.150 151 Despite these hopeful findings, most studies suggest that higher selenium status confers no protection against breast cancer.152 153 154 155 156 157 158

Vitamin E
Although some preliminary evidence suggests that vitamin E may protect against breast cancer,159 160 most research does not suggest a protective effect.161 162 163 In a preliminary study, women taking vitamin E supplements had the same risk of breast cancer as did other women.164 However, in one study, women with of low blood levels of bothselenium and vitamin E had a tenfold higher risk of breast cancer compared with women having higher levels of both nutrients.165 Although vitamin E and selenium function together in the body, the meaning of this dramatic finding is not clear;most studies examining the effects of vitamin E or selenium separately have suggested that neither protects against breast cancer.

Although one form of vitamin E—alpha tocopheryl succinate—has been touted as a potential treatment for women with breast cancer, only test tube studies suggest that it may have anticancer activity,166 and no trials have been conducted in breast cancer patients.

Vitamin D
Breast cancer rates have been reported to be relatively high in areas of low exposure to sunlight.167 Sunlight triggers the formation of vitamin D in the skin, which can be activated in the liver and kidneys into a hormone with great activity. This activated form of vitamin D causes “cellular differentiation”—essentially the opposite of cancer.

The following evidence indicates that vitamin D might have a protective role against breast cancer:

  • Synthetic vitamin D-like molecules have prevented the equivalent of breast cancer in animals.168
  • Activated vitamin D appears to have antiestrogenic activity.169
  • Both sunlight and dietary exposure to vitamin D have correlated with a reduced risk of breast cancer.170

Activated vitamin D
Activated vitamin D comes in several forms. One of them—1,25 dihydroxycholecalciferol—is an exact duplicate of the hormone made in the human body.

The following preliminary, non-clinical evidence supports the idea that activated vitamin D may be of help to some breast cancer patients:

  • In combination with tamoxifen, a synthetic, activated-vitamin D-like molecule has inhibited the growth of breast cancer cells in test tube research.171
  • Synthetic vitamin D-like molecules induce tumor cell death in breast cancer cells.172
  • Activated vitamin D suppresses the growth of human cancer cells transplanted into animals.173
  • In test tube research, activated vitamin D has increased the anticancer action of chemotherapy.174

In a preliminary trial, activated vitamin D was applied topically to the breast, once per day for six weeks, in 19 patients with breast cancer.175 Of the 14 patients who completed the trial, three showed a large reduction in tumor size, and one showed a minor improvement. Those who responded had tumors that contained receptors for activated vitamin D. However, other preliminary reports have not found that high levels of these receptors consistently correlate with a better outcome.176 177 178

With a doctor’s prescription, compounding pharmacists can put activated vitamin D, a hormone, into a topical ointment. Due to potential toxicity, use of this hormone, even topically, requires careful monitoring by a physician. Standard vitamin D supplements are unlikely to duplicate the effects of activated vitamin D in women with breast cancer. The patients in the breast cancer trial all had locally advanced disease.

Melatonin
Melatonin has been reported to have anticancer activity against breast cancer cells in most179 180 though not all181 test tube studies. In a preliminary trial, breast cancer patients were studied who previously had responded either not at all or only temporarily to treatment with the drug tamoxifen.182 During the trial, these women were given tamoxifen again, this time with added melatonin. Blood levels of IGF-1, a marker for progression of breast cancer, declined significantly. Of fourteen patients, four showed evidence of tumor shrinkage that lasted an average of eight months.

Most cancer trials studying the effects of melatonin have used 20 mg of melatonin per 24 hours, all taken at bedtime.183 184 185 186 187 188 189 190 191 192 193 194 No one should take such a high amount of this hormone without the supervision of a healthcare professional.

Coenzyme Q10 (CoQ10)
French researchers have reported that the lower the blood level of CoQ10 in breast cancer patients, the worse the chance of remaining free of disease.195 For several years, researchers from Denmark and the United States have been studying the effects CoQ10 in a group of 32 breast cancer patients who were either at high risk of suffering a recurrence or had already been diagnosed with advanced disease.196 After 18 months, only one patient had suffered a recurrence, all were still alive, those who did not have advanced disease at the beginning of the trial had not progressed to advanced disease, one patient with advanced disease had stabilized, and two patients with advanced disease had significantly improved.197 Patients continued to do well after two years of supplementation,198 and after three to five years, surprising improvements were reported in two patients who had had advanced disease at the beginning of the trial.199

At first, 90 mg of CoQ10 per day was used. In subsequent reports, the amount of CoQ10 was increased until some women were receiving 390 mg per day.200 Initially, the CoQ10 was accompanied by the use of many other supplements.201 The researchers of this trial have attributed the therapeutic effects observed primarily to CoQ10 and, in later reports, no further mention of other supplements was made.202 203 204

This preliminary investigation has been conducted with no control group, and published reports have provided only sketchy details about the conditions of most of the women being studied. Some of the patients were given conventional treatments along with CoQ10. Therefore, CoQ10 remains unproven as a cancer treatment.

Fiber
Although fiber is available in supplement form (such as Metamucil®), most fiber consumption results from eating food. Preliminary evidence suggests that high fiber consumption may reduce the risk of breast cancer. See the discussion of fiber and possible prevention of breast cancer in Dietary changes, above.

Indole-3-carbinol
Cruciferous vegetables—broccoli, Brussels sprouts, cauliflower, and cabbage—contain a substance called indole-3-carbinol (I3C). In preliminary research, I3C has been reported to affect the metabolism of estrogen in a way that might protect against breast cancer,205 an idea supported by animal206 and test tube research.207 No research trials have yet investigated the effects of I3C supplementation in women with breast cancer.

Diindolylmethane
Diindolylmethane is a substance also found in cruciferous vegetables. Test tube208 and animal studies209 suggest that it may help protect against breast cancer. However, no clinical trials with cancer patients given diindolylmethane have yet been published.

Calcium D-glucarate (D-Glucaric acid)
Calcium D-glucarate is available as a supplement, and it is also found in fruits and vegetables in a slightly altered form—D-glucaric acid.210 Preliminary evidence suggests that calcium D-glucarate indirectly helps the body lower its burden of estrogen, an effect that may reduce the risk of breast cancer.211 Although animal research supports such a possibility,212 no human trials have been published to evaluate whether calcium D-glucarate has a therapeutic or preventive effect.

IP-6
IP-6 (also called inositol hexaphosphate, phytate, or phytic acid) is found in many foods, particularly oat bran, wheat bran, and unleavened (flat) bread. Until recently, most IP-6 research focused on interference with the absorption of minerals—a side effect of consuming IP-6. More recently, however, animal studies have found that IP-6 has anticancer activity.213 No human trials using IP-6 supplements to prevent or treat breast cancer have yet been published.

Soy isoflavones, including genistein
No research has directly investigated whether soy isoflavone supplements prevent breast cancer or help people already diagnosed with this disease. Nonetheless, considerable preliminary information has been gathered about the relationship between soy isoflavones and breast cancer. For more information, see the discussion about soy in Dietary changes, above.

Conjugated linoleic acid
Preliminary animal and test tube research suggests that CLA might reduce the risk of cancers at several sites, including breast, prostate, colorectal, lung, skin, and stomach.214 215 216 217 Whether CLA will have a similar protective effect for people has yet to be demonstrated in human research.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

The following herbs have been studied in connection with breast cancer.

Garlic and onion
Preliminary studies hunting for associations between consumption of garlic (Allium sativum) and onion(Allium cepa) and a reduced risk of breast cancer have produced only mixed results;218 219 thus, there is no proof that consumption of either food helps prevent the risk of breast cancer.

Cloud mushroom (Coriolus versicolor)
Coriolus is a Chinese mushroom that has been reported to improve parameters of immune function.220 A Japanese extract from this mushroom called Polysaccharide Krestin (PSK) has been studied in many trials with cancer patients, often in conjunction with conventional treatment.221 222 223 224 225 226 227 228 229 PSK’s effects in women with breast cancer have been somewhat inconsistent. One double-blind trial reported that some groups of women with breast cancer, given PSK along with chemotherapy, had better outcomes than those who took chemotherapy alone.230 Another double-blind trial reported 81% survival in breast cancer patients given PSK plus chemotherapy, compared with 65% in those given chemotherapy alone, though this difference did not quite reach statistical significance.231 A third double-blind trial did not find PSK to be beneficial for women with breast cancer.232

PSK is not readily available in the United States and is available in Japan only by prescription. Although hot water-extracted products made from Coriolus versicolor are available in the United States without prescription, the extent to which these herbal products produce the effects of Japanese PSK remains unknown.

Eleuthero (Eleutherococcus senticosus, Acanthopanax s.)
Also known as Siberian ginseng, eleuthero has been shown to enhance immune function in preliminary Russian trials studying people with cancer, particularly breast cancer.233 234 These trials typically used 1to 2 ml of a fluid extract taken three times per day for at least one month. Most of the people in these trials were also treated with chemotherapy, radiation therapy, and/or surgery.235 236 Several of the Russian trials showed fewer side effects from conventional therapies among those who also took eleuthero extracts. No information is available on the ability of eleuthero to prevent cancer, nor have clinical trials yet explored whether eleuthero extracts affect either recurrence of breast cancer or survival in women with breast cancer.

European mistletoe (Viscum album)
Special extracts of European mistletoe injected under the skin has been studied in several positive and negative double-blind trials with cancer patients.237 238 239 240 241 A double-blind trial of women with breast cancer (all treated with chemotherapy) found that those who received mistletoe injections had improved immunity and quality of life compared with those who took placebo.242 The use of oral mistletoe preparations has not been studied in breast cancer patients. Mistletoe injections (usually of a product called Iscador®) are available only through physicians and are not readily available in the United States. It is unknown if American mistletoe (Phoradendron leucarpum) would provide the same effect as European mistletoe.

Green tea
In one Japanese study, green tea consumption was associated with increased survival time and decreased spread of cancer to lymph nodes in women with early stages of breast cancer, but not in breast cancer patients with more advanced disease.243 Recurrence rates were found to be lowest in those who drank at least five cups per day.244 Despite these associations, however, no proof yet exists that green tea consumption helps breast cancer patients or helps healthy women prevent breast cancer.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

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