Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. Several experimental treatments are now offered on a limited basis or are being studied in clinical trials. Treatment for breast cancer depends on the type and stage of cancer, age, risk factors, the size and shape of the breasts, and the patient's feelings about their body.
Treatment usually begins within a few weeks after diagnosis. Unless the cancer is detected at an extremely advanced stage and life is in immediate jeopardy, generally there is time to get a second opinion and discuss the various treatment options such as a combination of chemotherapy, radiation and surgery.
Other factors that affect treatment decisions include lymph node status, tumor size, tumor grade, tumor type, hormone receptors, HER2/neu, proliferation rate (growth rate), metastatic tests, and oncotype diagnoses (genetics).
A healthcare team for breast cancer patients may include surgeons, oncologists, plastic surgeons, radiation oncologists, as well as the individual's personal physician.
Surgery: Years ago, the only type of breast cancer surgery was radical mastectomy, which removed the entire breast along with chest muscles beneath the breast and all the lymph nodes under the arm. Today, this operation is rarely performed. Instead, the majority of women are candidates for breast-saving operations such as lumpectomy. Less radical mastectomies and mastectomy with reconstruction are also options.
Lumpectomy: This operation saves as much of the breast as possible by removing only the lump plus a surrounding area of normal tissue. Many women can have lumpectomies (often followed by radiation therapy) instead of mastectomies, and in most cases survival rates for both operations are the same. A more attractive physical appearance is also a positive with lumpectomy in contrast to a mastectomy, which removes breast tissue. However, a lumpectomy may not be an option if a tumor is deep within the breast, if the individual has already had radiation therapy, had two or more areas of cancer in the same breast that are far apart, had a connective tissue disease that makes the individual sensitive to radiation, or if they are pregnant.
Partial or segmental mastectomy: Partial mastectomy involves removing the tumor as well as some of the breast tissue around the tumor and the lining of the chest muscles beneath it. Some lymph nodes under the arm also may be removed. In almost all cases, a course of radiation therapy will follow the operation.
Simple mastectomy: A simple mastectomy is the removal of all the breast tissue including the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, further treatment with radiation to the chest wall, chemotherapy or hormone therapy may be necessary.
Modified radical mastectomy: A modified radical mastectomy involves the removal of the entire breast and some underarm (axillary) lymph nodes, but leaves the chest muscles intact, making breast reconstruction less complicated. Complications include severe arm swelling (lymphedema), which is a common complication of mastectomy. The lymph nodes will be tested to see if the cancer has spread.
Sentinel lymph node biopsy: In invasive cancer, lymph nodes must be examined due to the spread of breast cancer to the lymph nodes under the arm. Surgeons used to remove as many lymph nodes as possible, greatly increasing the risk of numbness, recurrent infections, and serious swelling of the arm. A procedure was developed to detect sentinel nodes, which are the first nodes to receive the drainage from cancerous breast tumors. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares many women the need for a more extensive operation, and greatly decreases the risk of complications.
Reconstructive surgery: Breast reconstruction is a possibility that most women who undergo mastectomy may choose, and a plastic surgeon will perform the procedure. Options include reconstruction with a synthetic breast implant or reconstruction using the patient's own tissue to rebuild the breast. These operations can be performed at the time of the mastectomy or at a later date. Implants may cause pain, swelling, bruising, tenderness or infection, and they do age over time requiring replacement. There is also a long-term possibility of rupture, deflation, contracture, hardening and shifting.
Reconstruction with a tissue flap: Known as a transverse rectus abdominis myocutaneous (TRAM) flap, this surgery reconstructs the breast using tissue, including fat and muscle from the patient's abdomen. Sometimes the surgeon may also use tissue from the back or buttocks. Because the procedure is fairly complicated, recovery may take six to eight weeks, and future adjustments to the breast may be necessary. Complications include the risk of infection and tissue death. If the individual has little body fat, this type of reconstruction may not be an option.
Deep inferior epigastric perforator (DIEP) reconstruction: In DIEP, fat tissue from the abdomen is used to create a natural-looking breast. But because the abdominal muscles are left intact, the patient is less likely to experience complications than with traditional breast reconstruction. There may also be less pain involved, and the healing time may be reduced. Active women in particular tend to opt for this procedure because it maintains the abdominal wall muscles.
Reconstruction of the nipple and areola: After initial surgery with either tissue transfer or an implant, further surgery may be performed to create a nipple and areola. Using tissue from elsewhere in the body, the surgeon first creates a small mound to resemble a nipple. The surgeon may then tattoo the skin around the nipple to create an areola. The surgeon may also take a skin graft from elsewhere on the body, place it around the reconstructed nipple to slightly raise the skin and then tattoo the skin graft.
Radiation therapy: Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation is administered by a radiation oncologist or technician at a radiation center. In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancers. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor that has spread to more than four lymph nodes in the armpit.
Radiation is usually started three to four weeks after surgery. The patient will typically receive treatment five days a week for five to six consecutive weeks. The treatments are painless and are similar to getting an X-ray. Each takes about 30 minutes, and side effects include fatigue, nausea, vomiting, weight loss, and loss of appetite.
In a small percentage of women, more serious problems may occur, including arm swelling, damage to the lungs, heart or nerves, or a change in the appearance and consistency of breast tissue. Radiation therapy may also make it somewhat more likely that an individual will develop another tumor.
Chemotherapy: Chemotherapy uses drugs to destroy cancer cells and is given by mouth or into the veins. Chemotherapy for breast cancer may be used to cure the cancer, stop cancer from spreading to other parts of the body, slow cancer growth, kill cancer cells, and relieve the symptoms of breast cancer. Breast cancer patients who undergo chemotherapy may be given one drug or a combination of two or more drugs during treatment. A chemotherapy regimen is usually tailored specifically to the breast cancer patient. In general, chemotherapy for breast cancer patients is typically given in three to six month courses. These courses may occur daily, weekly, monthly or on some other schedule, depending on the body's response to the drugs. Chemotherapy sessions are not usually continuous, typically including rest cycles because chemotherapy drugs target both healthy and cancerous cells. Physicians have a variety of ways to monitor the effects of chemotherapy on the patient's cancer, including physical examinations, blood tests, CT scans, MRI scans, and x-rays.
For many women, chemotherapy causes unwanted side effects including hair loss, nausea, vomiting, and fatigue. Another side effect called "chemobrain" may occur. Chemobrain is the term for cognitive changes that occur during and after cancer treatment. Women undergoing adjuvant chemotherapy may have trouble finding words, a poor memory, decreased learning, processing speed, and ability to multitask. Up to one-third of people undergoing cancer treatment will experience cognitive impairment, though some studies report that at least half the participants have memory problems. Memory changes often continue for at least a year or two after treatment and may last longer.
Premature menopause and infertility also are potential side effects of chemotherapy. The older the individual is when treatment begins, the more likely they are to develop menopausal problems.
Commonly used chemotherapy drugs include CMF therapy that consists of cyclophosphamide (Cytoxan®), methotrexate (Mexate®, Folex®), and fluorouracil (Fluorouracil®, 5-Fu, Adrucil®). CAF therapy consists of cyclophosphamide, doxorubicin (Adriamycin®), and fluorouracil. AC therapy includes doxorubicin (Adriamycin®) and cyclophosphamide. Other combinations include doxorubicin (Adriamycin®) and cyclophosphamide with paclitaxel (Taxol®), doxorubicin (Adriamycin®), followed by CMF, and cyclophosphamide, epirubicin (Ellence®), and fluorouracil. Other chemotherapy drugs commonly used for treating women with breast cancer include docetaxel (Taxotere®), vinorelbine (Navelbine®), and gemcitabine (Gemzar®), and capecitabine (Xeloda®).
Abraxane® (paclitaxel protein-bound particles for injectable suspension): Abraxane® was approved by the U.S. Food and Drug Administration (FDA) in 2005 to help treat women with advanced breast cancer who have not responded well to combination chemotherapy, or who have relapsed within six months of chemotherapy. Abraxane® is similar to the drug Taxol® but it is not required to be dissolved in a toxic solvent prior to administration. This solvent can cause allergic reactions in some patients, and to counteract these reactions patients are often treated with steroids and antihistamines. Patients receiving Abraxane® do not need these pre-medications. Side effects of Abraxane® may include neutropenia (a reduction in white blood cell count), anemia (a decreased number of red blood cells and a reduced volume of hemoglobin, the protein within red blood cells that carries oxygen), infections, edema (swelling), nausea, vomiting, diarrhea, nerve damage, and severe pain in the muscles or joints.
Adriamycin® (doxorubicin): Adriamycin® is a chemotherapy drug commonly used to treat breast cancer and other cancers. Adriamycin® first disrupts, and then destroys the growth of cancer cells. It is usually administered intravenously (through the vein). Common side effects may include decreased white blood cell count with increased risk of infection, decreased platelet count with increased risk of bleeding, loss of appetite, darkening of nail beds and skin creases of hands, hair loss, nausea and vomiting, and mouth sores. Patients should be tested for heart problems before beginning Adriamycin® and should be continuously monitored for developing problems during treatment.
Aredia® (pamidronate disodium): Breast cancer has the potential to spread to almost any area of the body. After the axillary (armpit) lymph nodes, bone is the most common place to which breast cancer can spread. Aredia® reduces bone complications and bone pain in patients whose breast cancer has spread to the bone. Clinical studies have shown that patients who are given Aredia® tend to experience a delay in or reduction of bone pain, fractures, and other bone complications than patients who do not receive Aredia®. Aredia® is usually administered by intravenous injection. Possible side effects include fever, fatigue, nausea and vomiting, initial bone pain, lack of appetite, and anemia (decrease in red blood cells).
Arimidex® (anastrozole): Arimidex® was FDA approved in 1996 to treat advanced (metastatic) breast cancer in patients who have not responded well to treatment with the drug tamoxifen. Clinical trials are currently underway to determine whether women with advanced breast cancer would benefit more from taking Arimidex® than tamoxifen. Arimidex® is usually taken orally, and possible side effects include general feelings of weakness, decreased energy levels, headache, nausea, mild diarrhea, increased or decreased appetite, sweating, hot flashes, vaginal dryness, and temporary hair thinning.
Aromasin (exemestane): Aromasin® (exemestane) was FDA approved in 1999 to treat advanced (metastatic) breast cancer in post-menopausal women. Aromasin® works by binding to the body's aromastase enzyme, an enzyme responsible for producing the hormone estrogen. Many breast cancer cells depend on estrogen to grow and multiply quickly. Once Aromasin® has binded to the aromastase enzyme, estrogen cannot be produced by the enzyme. This lack of estrogen "starves" cancer cells preventing them from growing. Aromasin® is usually taken orally, and possible side effects include hot flashes, nausea, fatigue, increased sweating, and increased appetite.
Cytoxan® (cyclophosphamide): Cytoxan® (cyclophosphamide) is a chemotherapy drug commonly used to treat breast cancer and other cancers. Cytoxan® first disrupts cancer cells and then destroys them. Cytoxan® is given by mouth or intravenously (through the vein) over 30-60 minutes. Common side effects may include decreased white blood cell count with increased risk of infection, hair loss, nausea and vomiting, loss of appetite, sores in mouth or on lips, diarrhea, and ceasing of menstrual periods.
Ellence® (epirubicin): Ellence® was approved by the FDA in 1999 to treat early-stage breast cancer after breast surgery (lumpectomy or mastectomy) in patients whose cancer has spread to the axillary (underarm) lymph nodes. Ellence® helps reduce the likelihood that breast cancer will return, and improves a patient's chances of survival. Ellence® is given intravenously (through the vein) in combination with other chemotherapy drugs, such as cyclophosphamide and fluorouracil. Possible side effects include nausea, vomiting, diarrhea, inflammation of the mouth (stomatitis), hair loss, and reduction in white blood cells (myelosuppression).
Fareston® (toremifene): Similar to tamoxifen, Fareston® is an anti-estrogen (SERM, selective estrogen-receptor modulator). Fareston® binds to estrogen receptors on breast cancer cells preventing them from growing and dividing. Advanced breast cancer patients are usually prescribed one 60 milligram tablet of Fareston® daily. Possible side effects include hot flashes, nausea, weight gain, allergic reactions (such as skin rashes), and headache.
Femara® (letrozole): Femara® was approved by the FDA in 1997 to help treat advanced (metastatic) breast cancer in women whose breast cancer tumors have not responded well to tamoxifen. Femara® works by reducing the total amount of estrogen in the body (circulating estrogen levels), thereby limiting the amount of estrogen that can affect breast cancer cells. In post-menopausal women, the body produces estrogen from other hormones known as androgens by an enzyme called aromatase. Femara® is an aromatase inhibitor and blocks aromatase from converting androgen into estrogen, thus lowering the amount of estrogen in the body. Possible side effects may include musculoskeletal pain (pain in the skeleton or legs, arms or back), nausea, headache, joint pain, fatigue, and difficulty breathing.
Herceptin® (trastuzumab): Herceptin® is FDA approved to treat advanced metastatic breast cancer in women who over-express the HER2 gene. HER2 (also written HER-2/neu) is a growth factor found on the surface of cells that plays a key role in regulating cell growth. Some women are born with or experience a mutation of the HER2 gene throughout their lifetime. When altered, extra HER2 receptors may be produced. This over-expression of HER2 causes cells to grow, divide, and multiply more rapidly than normal , which can lead to breast cancer. Women who over-express the HER2 gene tend to have aggressive breast cancers that spread quickly to other regions of the body. Herceptin® seeks out HER2 and attaches itself to the protein receptor on the surface of cells. By binding to the cells, Herceptin® has been reported to slow the growth and spread of tumors that have an overabundance of HER2 protein receptors. Herceptin® is usually given intravenously in an outpatient clinical setting. Possible side effects include weakening of the heart muscle, reduction of white blood cells (leukopenia or neutropenia), diarrhea, anemia, and abdominal pain or infection.
Megace® (megestrol): Megace® is used to treat advanced breast cancer, typically in women who do not respond well or become resistant to tamoxifen. Megace® is a synthetic form of the hormone progesterone. Progesterone is normally secreted by the corpus luteum of the ovary and placenta, and then acts to prepare the uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote development of secondary sexual characteristics. Progesterone also counteracts some of the negative effects of estrogen (many breast cancers depend on estrogen to grow and reproduce). Because Megace® is considered non-toxic, there are few documented side effects associated with the drug. The most common side effect is fluid retention.
Nolvadex® (tamoxifen): Tamoxifen has been the most commonly prescribed drug to treat breast cancer since its approval by the U.S. Food and Drug Administration (FDA) in the 1970s. Tamoxifen is an anti-estrogen and works by competing with the hormone estrogen by binding to estrogen receptors in breast cancer cells. By blocking estrogen in the breast, tamoxifen helps slow the growth and reproduction of breast cancer cells. In 1998, tamoxifen became the first drug to be approved by the FDA to prevent breast cancer after research showed it reduced the chances of developing breast cancer by 50% in high risk women. Tamoxifen is taken orally, and possible side effects include hot flashes, irregular menstrual cycles, unusual vaginal discharge or bleeding, and irritation of skin around the vagina.
Taxol® (paclitaxel): Taxol® was isolated from a Pacific yew tree and first approved by the FDA in 1992 to treat advanced (metastatic) breast cancer. In 1999, the FDA also approved Taxol® to treat early stage breast cancer in patients who have previously received chemotherapy with the drug doxorubicin. Taxol® is called a mitotic inhibitor because it interferes with cells during mitosis (cell division). Taxol® is usually given intravenously over one or more hours. Possible side effects include a reduced white blood cell count (myelosuppression), hair loss (alopecia), and numbness in the extremities (peripheral neuropathy).
Taxotere® (docetaxel): Taxotere®
(generic name, docetaxel) is a cancer drug that resembles Taxol® in chemical structure. Taxotere®
was FDA approved in 1996 to treat advanced breast cancer in patients who have not responded well to chemotherapy with the drug doxorubicin. In 1998, it was also approved by the FDA to treat breast cancer that has spread into other areas of the breast or to other parts of the body after treatment with standard chemotherapy. Docetaxel inhibits the division of breast cancer cells by acting on the cell's internal skeleton. The drug is usually given intravenously (through the vein) once every three weeks. Each treatment typically takes around one hour, though the dosage will vary depending on the patient's medical situation. Other medications may be used to counter the side effects of Taxotere®; for example, dexamethasone is commonly used to prevent fluid retention. Other possible side effects include decrease in white blood cells (leukopenia), fever (often a warning sign of infection), fluid retention, allergic reactions, and hair loss.
Xeloda® (capecitabine): Xeloda® has been FDA approved since April 1998 as a treatment for advanced breast cancer in patients who have not responded well to chemotherapy that included Taxol® and Adriamycin®. Xeloda works by converting to a substance called 5-fluorouracil in the body. In some patients, Xeloda helped shrink tumor size by killing cancer cells. Side effects may include diarrhea, nausea and vomiting, stomatitis (sores in mouth and throat), loss of appetite or decreased appetite, and excessive water loss from the body (dehydration). Some of the side effects from Xeloda® may become severe. Patients should report any side effects to their physicians immediately. Xeloda® is taken orally and is usually prescribed in a 21-day cycle (14 days of treatment followed by a seven-day rest period).
Zoladex® (goserelin acetate): Zoladex® is FDA approved to treat advanced breast cancer and prostate cancer. Zoladex® works by blocking estrogen from breast cancer cells (and blocking testosterone in men) thereby starving these cells. The drug is typically given by injection under the skin (subcutaneously). Zoladex® is a systemic treatment and cannot distinguish between normal cells and cancer cells; therefore, a variety of side effects are possible, including hot flashes, decreased sexual desire, absence of menstruation, vaginal dryness, and breast swelling or tenderness.
Zometa® (zoledronic acid): Zometa® was approved by the FDA in 2002 to treat breast cancer that has spread to the bone (a condition commonly referred to as bone metastases). Zometa® is also FDA-approved to treat multiple myeloma (a type of bone cancer), all other solid tumors, and bone metastases resulting from prostate cancer. Zometa® belongs to a class of drugs called bisphosponates, which may be helpful in bone metastases by slowing the destruction of bone cells in breast cancer patients. Zometa® may also prevent cancer cells from growing in bone. Studies involving more than 3,000 patients taking zometa® have shown an approximate 14% decrease in the number of patients with bone problems, compared to those who did not take zometa®. Zometa® is administered intravenously and takes approximately 15 minutes after preparation. Possible side effects include pain nausea and vomiting, fever, fatigue, and constipation. Women who are pregnant or breastfeeding should avoid zometa®. In rare cases, Zometa® can cause injury to the kidneys.
Medications for side effects of chemotherapy: Some patients who experience certain side effects of chemotherapy may be prescribed medications to counteract these effects. Several drugs are now available for use alone or in combination to help reduce a few of the most common side effects, such as nausea, vomiting, and fatigue.
Anzemet (dolasetron mesylate): Anzemet® helps prevent and relieve nausea and vomiting from surgery or chemotherapy. Researchers believe that nausea and vomiting during chemotherapy is associated with the release of serotonin from special cells in the small intestine. Anzemet® blocks these nerve endings in the intestine and prevents signals to the central nervous system. Anzemet® is available in tablet form and by injection.
Compazine® (prochlorperazine): Prochlorperazine helps control nausea and vomiting after surgery or chemotherapy. Prochlorperazine is available in capsule, tablet, and liquid form, and by suppository or injection. Prochlorperazine can cause drowsiness and may interact with other medications or alcohol.
Kytril® (granisetron hydrochloride): Kytril® is an anti-nausea medication FDA approved for patients undergoing chemotherapy. Kytril® is typically given 60 minutes before chemotherapy. In some cases, a second dose is given about 12 hours after the first dose. Kytril® is available in tablet form and by injection.
Phenergan® (promethazine): Promethazine has sedative, antihistamine, and mild anti-nausea properties. It may be used to help prevent or treat nausea due to chemotherapy. Promethazine may be available in tablet form or as an oral syrup, suppository or injection.
Procrit® (epoetin alfa): Procrit® helps the body produce more red blood cells, which helps relieve fatigue due to chemotherapy. Since chemotherapy affects both normal and cancerous cells, it can decrease the number of red blood cells, which leads to anemia (feeling of extreme tiredness).
Zofran® (ondansetron): Zofran® helps to relieve nausea and vomiting associated with chemotherapy. Zofran® is available in pill form, as a liquid solution, and by injection. The first dose of Zofran® (tablet form) is usually administered 30 minutes before chemotherapy and then at regular intervals for one to two days after chemotherapy.
Patients who experience low blood cells counts during chemotherapy may also be given medications to help raise blood cell or platelet counts. For example, patients who suffer from neutropenia, a decrease in the number of neutrophils (a type of white blood cell), may be given certain growth factors, such as the granulocyte-macrophage colony stimulating factor (GM-CSF, sargramostim, or Leukine®) or granulocyte colony stimulating factor (G-CSF, filgrastim, or Neupogen®).
High-dose chemotherapy: High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells. Studies have reported that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast cancer.
New clinical trials: A number of new approaches to treating cancer are being studied, with an emphasis on methods that can successfully treat women or extend their survival with minimal side effects. Among these are drugs that block the biochemical switches that cause normal cells to turn cancerous. A procedure known as anti-angiogenesis, which targets the blood vessels that supply nutrients to cancer cells, is also being studied. Nonsurgical methods being studied to remove breast tissue include techniques that use heat or cold to kill cancer cells deep within the breast, leaving only minimal scars.
(DCIS): Treatment of DCIS may include breast-conserving surgery with or without radiation or hormone therapy, and total mastectomy with or without hormone therapy.
(LCIS): Treatment of LCIS may include biopsy to diagnose LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. Tamoxifen may be used to reduce the risk of developing breast cancer. Bilateral prophylactic mastectomy is a treatment choice sometimes used in women who have a high risk of getting breast cancer.
Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer: Treatment of stage I, stage II, stage IIIA, and operable stage IIIC breast cancer may include breast-conserving therapy to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy or a modified radical mastectomy with or without breast reconstructive surgery. Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy, systemic chemotherapy with or without hormone therapy, hormone therapy, and the monoclonal antibody Herceptin® combined with systemic chemotherapy.
Stage IIIB and inoperable stage IIIC breast cancer: Treatment of these categories of breast cancer
may include systemic chemotherapy, systemic chemotherapy followed by surgery (breast conserving therapy or total mastectomy) with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
Stage IV and metastatic breast cancer: Treatment of stage IV or metastatic breast cancer may include hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin®), radiation therapy and/or surgery for relief of pain and other symptoms, and new high-dose chemotherapy with stem cell transplants are being tested in clinical trials. Bisphosphonate drugs can be given to reduce bone disease and pain when cancer has spread to the bone.
Inflammatory breast cancer (IBC):
Treatment of inflammatory breast cancer may include systemic chemotherapy, systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), lymph node dissection, followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given. Monoclonal antibody therapy including lapatinib (Tykerb®) and trastuzumab (Herceptin®) may be given.
Recurrent breast cancer: Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast or chest wall may include surgery (radical or modified radical mastectomy), radiation therapy, or both, systemic chemotherapy or hormone therapy, and clinical trials of trastuzumab (Herceptin®) combined with systemic chemotherapy are currently being done.
with breast cancer: More than 1,000 men in the United States are diagnosed with breast cancer every year. While men are 150 times less likely to develop breast cancer than women, male breast cancer should not be ignored. Usually, the first sign is a lump in the breast, which tends to be misdiagnosed. In general, men are diagnosed at a later stage of the disease; however, when matched against women with the same stage and age, the prognosis for men is the same. Any mass in the breast of a man should be thoroughly examined. The risk for developing breast cancer is higher for men with enlargement of the breast tissue (gynecomastia). A modified radical mastectomy is the usual course of treatment for men. Radiation may also be given. Almost 90% of men with breast cancer have the type of tumors that respond to hormone therapy.
Male breast cancer is similar to female breast cancer in that the information on symptoms, diagnosis, treatment, and living with the disease is the same. Men, however, do not need routine screening.
Follow-up: Follow-up will require frequent medical visits, often every three to four months for the first five years after the initial diagnosis. Follow-up visits should focus on determining whether cancer has appeared in the opposite breast, in the same breast, or in areas other than the breasts. In general, signs and symptoms often lead to the diagnosis of a recurrence. It is important to inform the physician about any changes in health such as coughing, dizziness, headaches, or pain no matter how minor they seem.
Prognosis: Thirty percent of patients without node involvement and 75% of patients with node involvement at diagnosis will develop metastatic disease (cancer that has spread to other tissues). Metastatic disease generally develops within five years after the initial diagnosis, although it can occur as many as 10 or more years later. Metastatic disease (Stage IV) is incurable, and the five-year survival rate is about 5 to 10%.
Unclear or conflicting scientific evidence
Acupuncture: Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits Evidence from several small studies supports the use of acupuncture at a specific point on the wrist (P6) which helps reduce the nausea and vomiting associated with chemotherapy. Electroacupuncture has been studied to treat vasomotor symptoms in breast cancer patients, but more studies are needed.
Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Preliminary research suggests that aloe may help prevent or aid in the regression of cancerous tumors. Additional research is needed in this area. Caution is advised when taking aloe supplements due to a number of adverse effects including a laxative effect, cramping, dehydration and drug interactions. Aloe should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
American pawpaw: Evidence supporting the use of the American pawpaw (Asimina triloba) tree for the treatment of cancer in humans is largely anecdotal and subjective. However, use in humans has reported minimal side effects, and evidence from animal and in vitro studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer., but well-designed studies regarding the long-term effects of pawpaw extracts have not been conducted. Pawpaw should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions that were observed by Stanislaw Burzynski, MD, PhD in the late 1970s and found to be absent in the urine of cancer patients. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available no clear conclusion can be drawn.
Arabinoxylan: Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract. Arabinoxylan has been found to improve immune reactions in diabetes and cancer patients. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible. Arabinoxylan should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage) with the intention to improve quality of life or well-being. There is not enough scientific evidence in this area to form a firm conclusion about the effectiveness of aromatherapy. Essential oils should not be used internally.
Art therapy: Art therapy involves the application of a variety of art modalities including drawing, painting, clay and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that family caregivers of cancer patients may benefit from art therapy to help them cope with the stress of care giving. Possible benefits include reduced stress, lowered anxiety, increased positive emotions and increased positive communication with cancer patients and healthcare professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population.
Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries due to its immune enhancing properties. Although early laboratory and animal studies report increased immune cell function and reduced cancer cell growth associated with the use of astragalus, there is no reliable human evidence in these areas. A recent study reports that astragalus-based Chinese herbal medicine may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. Astragalus is also sometimes used with the intention to reduce side effects of cancer treatments, such as fatigue and weight loss. Due to a lack of well-designed research, a firm conclusion cannot be drawn. Caution is advised when taking astragalus supplements due to the number of possible adverse effects. Astragalus should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Bee pollen: Bee pollen is considered a highly nutritious food because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects associated with cancer treatment. Additional studies are needed before a firm recommendation can be made. Caution is advised when taking bee pollen supplements as allergic reactions may occur in sensitive individuals. Bee pollen should not be used if the patients is pregnant or breastfeeding unless otherwise directed by a doctor.
Bitter melon: Bitter melon (Momordica charantia) is used in the traditional Avurvedic form of medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, is reported to possess anti-cancer effects in laboratory studies. Potential anti-cancer effects have not been studied appropriately in humans. Caution is advised when taking bitter melon supplements, as numerous adverse effects including blood sugar lowering and drug interactions are possible. Bitter melon should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Black cohosh: Black cohosh (Actaea racemosa) is used for pre- and postmenopausal symptoms such as hot flashes and irritability. A recent study found that the use of black cohosh had a significant breast cancer protective effect. Additional confirmatory studies are required to determine whether black cohosh could be used to prevent breast cancer. Caution is advised when taking black cohosh supplements, as numerous adverse effects including drug interactions are possible. Black cohosh should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but is processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in populations. This research has yielded conflicting results with some studies suggesting benefits, and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea rather than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic or cancer causing, although the effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer remains undetermined.
Bromelain: Bromelain is a sulfur-containing proteolytic digestive enzyme that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients when they took the supplements for many months or years. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Bromelain should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit. A few studies suggest that cat's claw may also boost the immune system. Caution is advised when taking cat's claw supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Cat's claw should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Coenzyme Q10 (CoQ10): CoQ10 is produced by the human body and is necessary for the basic functioning of cells. Age and diseases such as cancer may cause decreases in this important cofactor. Although supplementation of CoQ10 has been reported to improve general health, it has not been proven to reduce cancer, and it has not been compared to other forms of breast cancer treatment. Although its use is not clearly defined, CoQ10 levels are generally decreased in breast cancer patients; therefore, further testing needs to be done.
Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer. Copper is potentially unsafe when used orally in higher doses than the RDA (recommended daily allowance). Copper supplements should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Cranberry: Several laboratory studies have reported positive effects of proanthocyanidins, flavonoid components of cranberry (Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and pomegranate on health. Based on a small amount of laboratory research, cranberry has been proposed for cancer prevention. Studies are needed in humans before a recommendation can be made.
Echinacea: The evidence from a small number of randomized trials evaluating efficacy of echinacea in the treatment of radiation-induced leukopenia (decrease in white blood cells) is equivocal. Studies have used the combination product Esberitox®, which includes extracts of echinacea (Echinacea purpurea and pallida) root, white cedar(Thuja occidentalis) leaf, and wild indigo (Baptisia tinctoria)root. Caution is advised when taking echinacea supplements, as numerous adverse effects including drug interactions are possible. Echinacea should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Essiac®: Essiac® contains a combination of herbs, including burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is thought to be effective in cancer therapies, although any current evidence is lacking. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac® has been tested in rigorous human cancer trials, although some components have anti-tumor activity in laboratory studies. Caution is advised when taking Essiac® supplements, as numerous adverse effects including drug interactions are possible. Essiac® should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Evening primrose oil: Not enough information is available to advise the use of evening primrose oil for breast cancer. People with known or suspected breast cancer should consult with a qualified healthcare professional about possible treatments.
Flaxseed: There is a lack of information from human studies indicating that flaxseed is effective in preventing or treating breast cancer.
Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early evidence suggests focusing may improve the mood and body attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.
Folic acid: Folic acid or folate is a water-soluble B vitamin needed for human health. Preliminary evidence surrounding the use of folate seems promising for decreasing the risk of breast, cervical, pancreatic and gastrointestinal cancer. Currently, there is insufficient evidence available to recommend folate supplementation for any type of cancer prevention or treatment. Please follow the advice of a qualified healthcare provider in this area. Folic acid may mask the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin B12 deficiency and may lead to neurological damage.
Gamma linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate GLA may have anti-tumor activity and may be used as an adjunct agent to a chemotherapy regimen. Clinical trials have been conducted in treatments of breast, colorectal, and liver cancer. Caution is advised when taking GLA supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. GLA should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum), particularly aged garlic, may reduce the risk of developing several types of cancer. Some studies use multi-ingredient products so it is difficult to determine if garlic alone may play a beneficial role. Further well-designed human clinical trials are needed to conclude whether eating garlic or taking garlic supplements may prevent or treat cancer. Caution is advised when taking garlic supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Garlic should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Ginseng: Several human studies suggest that Asian ginseng (Panax ginseng) may reduce the risk and progression of various organ cancers, especially if ginseng powder or extract is used. Results may have been affected by other lifestyle choices in people who use ginseng, such as exercise or dietary habits. Asian ginseng is also reported to help protect against radiation damage, increase immunity and well-being, and decrease fatigue. Additional trials are necessary before a clear conclusion can be reached. Caution is advised when taking ginseng supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Ginseng should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use in health and longevity, dating back to China approximately 5,000 years ago. Although used for centuries to help prevent diseases, the relationship of green tea consumption and human cancer remains inconclusive. Evidence from well-designed clinical trials is needed before a firm recommendation can be made in this area. Caution is advised when taking green tea supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Green tea should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor. Caffeine-free supplements are available.
Healing touch (HT): Preliminary data suggests HT may be of benefit in cancer patients for inducing relaxation and improving quality of life. However, due to weaknesses in design and the small number of studies, data is insufficient to make definitive recommendations. Studies with stronger designs are needed.
Hoxsey formula: "Hoxsey formula" is a misleading name, because it is not a single formula, but rather is a therapeutic regimen consisting of an oral tonic and topical (on the skin) preparations. The tonic is individualized for cancer patients based on general condition, location of cancer, and previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added such as licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating), and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and contains trichloroacetic acid. There are no well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Hoxsey formula should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia (muscle wasting) associated with cancer, and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss or improving survival in adults. The National Cancer Institute (NCI) sponsored studies of hydrazine sulfate that claimed efficacy in improving survival for some patients with advanced cancer. Trial results found that hydrazine sulfate did not prolong survival for cancer patients. The U.S. Food and Drug Administration (FDA) has received requests from individual physicians for approval to use hydrazine sulfate on a case-by-case "compassionate use" basis on the chance that patients with no other available effective therapy might benefit. The overall controversy in the use of hydrazine sulfate is ongoing, and relevance to clinical practice is unknown. The use of hydrazine sulfate needs to be evaluated further before any recommendations can be made. Side effects have been reported such as nausea, vomiting, and dizziness.
Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4). The potential role of non-radioactive iodine in cancer care remains unknown. Antioxidant and anti-tumor effects have been proposed based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Overall, no clear conclusion can be drawn based on the currently available evidence. Iodine should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Lavender: Perillyl alcohol (POH), derived from lavender (Lavendula officinalis), might be beneficial in the treatment of some types of cancer. This research has focused on cancers of the pancreas, breast, and intestine. Preliminary small studies in humans suggest safety and tolerability of POH, but effectiveness has not been established.
Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Several laboratory and human studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. Research in animals and observations of large human populations have examined the relationship between developing breast cancer and tomato intake or lycopene levels in the body. Due to a lack of well-designed human research using lycopene supplements, the issue remains unclear.
Maitake mushroom: Maitake is the Japanese name for the edible fungus Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended. Caution is advised when taking maitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Maitake should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced stage malignancies, including brain, breast, colorectal, gastric, liver, lung, pancreatic, and testicular cancer, as well as lymphoma, melanoma, renal cell carcinoma, and soft-tissue sarcoma. Currently, no clear conclusion can be drawn in this area. There is not enough definitive scientific evidence to discern if melatonin is beneficial against any type of cancer, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects. Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding unless otherwise advised by a doctor.
Milk thistle: Milk thistle (Silybum marianum) has been used medicinally for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human breast, cervical, and prostate cancer cells. There is also one report of a patient with liver cancer who improved following treatment with milk thistle. This research is too early to determine firm conclusions, and the effects have not been shown in high-quality human trials. Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used in pregnancy or breastfeeding unless otherwise directed by a doctor.
Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Extracts have been studied for a variety of human cancers including bladder, breast, cervical, CNS, colorectal, head and neck, liver, lung, lymphatic, ovarian, and renal (kidney) cancers as well as melanoma and leukemia. However, efficacy has not been conclusively proven for any one condition. In fact some studies have shown a lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed. Caution is advised when taking mistletoe supplements, as numerous adverse effects including nausea, vomiting, and drug interactions are possible. Mistletoe should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Oleander: Laboratory studies of oleander (Nerium oleander) suggest possible anti-cancer effects, although reliable research in humans is not currently available. There are reports that long-term use of oleander may have positive effects in patients with leiomyosarcoma, Ewing's sarcoma, prostate, or breast cancer, but more research is needed. Caution is advised when taking oelander supplements, as numerous adverse effects including drug interactions are possible. Oleander should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Omega: Omega-3 fatty acids are essential fatty acids found in some plants and fish. There should be a balance of omega-6 and omega-3 fatty acids for health. Several population (epidemiologic) studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing breast, colon, or prostate cancer. Randomized controlled trials are necessary before a clear conclusion can be drawn. Caution is advised when taking omega-3 supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Omega-3 supplements should not be used if the patient is pregnant or breastfeeding unless otherwise by a doctor.
Physical therapy: Physical therapy was first documented in China around 3000 BC with the use of joint manipulation and massage to relieve pain. The goal of physical therapy or physiotherapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Physical therapy programs are often used following mastectomy (breast cancer surgery), which may include arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema (swelling), and education about arm function. One study suggested that immediate postoperative physical therapy may increase shoulder range of motion, but more high quality trials are needed.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy can enhance cancer patients' quality of life by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. Studies conflict on whether therapy improves self-esteem, death anxiety, self-satisfaction, etc. While some patients seek psychotherapy in hopes of extending survival, there is no conclusive evidence of effects on medical prognosis.
Prayer: Initial studies in patients directed with cancer (such as leukemia) report variable effects on disease progression or death rates when intercessory prayer is used. Better quality research is necessary before a firm conclusion can be drawn.
Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. One clinical trial and two case reports exist on advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. Results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed to confirm these results and potential side effects. Caution is advised when taking reishi supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Reishi should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Resveratrol: Resveratrol is an antioxidant found in over 70 plant species including nuts, grapes, pine trees, certain vines and red wine. It has been reported effective in stopping the growth of breast cancer cells in laboratory studies. The effects of resveratrol on breast cancer in humans cannot be adequately assessed from trials using foods, wine or combination products containing resveratrol and other substances. Well-designed clinical trials of resveratrol alone are needed. Caution is advised when taking resveratrol supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Resveratrol should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific oceans, and the North and Baltic seas. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. Currently, there are no reliable human studies available to support a recommendation for use in cancer. Caution is advised when taking bladderwrack supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Bladderwrack should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Shark cartilage: For several decades, shark cartilage has been proposed as a cancer treatment. Studies have shown shark cartilage or the shark cartilage product AE-941 (Neovastat®) to block the growth of new blood vessels, a process called "anti-angiogenesis," which is believed to play a role in controlling growth of some tumors. There have also been several reports of successful treatments of end-stage cancer patients with shark cartilage, but these have not been well-designed or included reliable comparisons to accepted treatments.
Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies that promote their products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer, and patients are advised to check with their doctor and pharmacist before taking shark cartilage. Caution is advised when taking shark cartilage supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Shark cartilage should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Shiitake mushroom: Shiitake (Lentinus edodes) has been taken orally to boost the immune system, decrease cholesterol levels, and for anti-aging purposes. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal and human studies of lentinan have shown positive results in cancer patients when used in addition to chemotherapy drugs. Further well-designed clinical trials on all types of cancer are required to confirm these results. Caution is advised when taking shiitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Shiitake should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Soy: Soy (Glycine max) contains compounds that have reported efficacy against tumors. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anti-cancer effects, such as blocking new blood vessel growth (anti-angiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Several large population studies have asked women about their eating habits, and reported higher soy intake (such as dietary tofu) to be associated with a decreased risk of developing breast cancer. This type of research can only be considered preliminary, because people who choose to eat soy may also partake in other lifestyle decisions that may lower the risk of cancer and be the cause of the benefits seen in these studies (for example, lower fat intake, more frequent exercise, lack of smoking). Until better research is available, it remains unclear if dietary soy or soy isoflavone supplements increase or decrease the risk of developing breast cancer. Caution is advised when taking soy supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Soy should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th century China. Tai chi techniques aim to address the body and mind as an interconnected system, and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility and strength. Tai chi chuan has been studied in breast cancer patients to improve functional capacity (specifically aerobic capacity, muscular strength, and flexibility). Larger studies are needed to make a firm recommendation.
Traditional Chinese Medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.
Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Although TENS has been used with some success in pain associated with cancer, there is not enough reliable evidence to draw a firm conclusion in this area.
Thiamin (Vitamin B1): Thiamin deficiency has been observed in some cancer patients, possibly due to increased metabolic needs. It is not clear if lowered levels of thiamin in such patients may actually be beneficial. It remains unclear if thiamin supplementation plays a role in the management of any particular type(s) of cancer.
Turmeric: Turmeric (Curcuma longa) is commonly used for its anti-inflammatory properties. Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently, it remains unclear if turmeric or curcumin has a role in preventing or treating human cancers. There are several ongoing studies in this area. Caution is advised when taking turmeric supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Turmeric should not be used if the patient is pregnant or breastfeeding unless otherwise directed by a doctor.
Vitamin A: Vitamin A is a fat-soluble vitamin, which is derived from retinoids and carotenoids. Retinoids like retinal and retinoic acid are found in animal sources (like the liver, kidney, eggs and dairy products). Carotenoids like beta-carotene are found in plants like dark or yellow vegetables and carrots. Research results are not clear as to whether vitamin A is beneficial in the treatment or prevention of breast cancer. Patients receiving chemotherapy or radiation therapy for cancer should speak with their doctor(s) before taking antioxidants such as vitamin A during treatment, due to possible interference. Vitamin A toxicity can occur if taken at high dosages, and caution should be used with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
Vitamin B12: Vitamin B12 (or cyanocobalamin) is an essential water-soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meats, and dairy products. Researchers at Johns Hopkins University report that women with breast cancer tend to have lower vitamin B12 levels in their blood serum than do women without breast cancer. In a subsequent review of these findings, it was hypothesized that vitamin B12 deficiency may lead to breast cancer because it could result in less folate being available to ensure proper DNA replication and repair. Higher dietary folate intake is associated with a reduced risk of breast cancer. The risk may be further reduced in women who also consume high amounts of dietary vitamin B12 in combination with dietary pyridoxine (vitamin B6) and methionine. However, there is no evidence that dietary vitamin B12 alone reduces the risk of breast cancer.
Vitamin E: There is no reliable scientific evidence that vitamin E is effective as a treatment for any specific type of cancer. Vitamin E has been suggested as a possible therapy for the prevention or treatment of breast cancer. Published studies have included measurement of vitamin E levels, laboratory experiments, and population studies. One study of oral vitamin E reports a very small reduction in hot flash frequency (approximately one less hot flash per day), but no preference among patients for vitamin E over placebo. Caution is merited in people undergoing treatment with chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anti-cancer effects of these therapies. This remains an area of controversy and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies in cancer patients report enhanced quality of life, lower sleep disturbance, decreased stress symptoms and changes in cancer-related immune cells after patients received relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.
Fair negative scientific evidence
PSK: The available evidence does not support the use of PSK, in conjunction with hormone therapy, chemotherapy, and/or surgery, to increase survival rates in breast cancer patients.
Physical activity: Regular exercise may reduce the complications of breast cancer and reduce the risks of developing the disease. Large studies support household activity as being associated with a significantly reduced risk of breast cancer in postmenopausal and premenopausal women.
Diet: Reducing fat and red meat while increasing vegetables and whole grains may reduce the chances of developing breast cancer. One large study of almost 2500 women found that a lifestyle intervention reducing dietary fat intake, with modest influence on body weight, might improve relapse-free survival of breast cancer patients receiving conventional cancer management. In one study, during 12 years of follow-up of 90,659 premenopausal women, the greater the red meat intake correlated with an elevated risk of breast cancers that were estrogen and progesterone receptor positive, but not to those that were estrogen and progesterone receptor negative.
An increase in fiber has also been reported to reduce the chances of developing breast cancer.
The phytochemical (plant-chemical) indole-3-carbinol, found in cruciferous vegetables like cabbage and broccoli might directly contribute to breast cancer protection. An increase in soy and soy products as source of isoflavones was found to be inversely associated with high mammographic density, a marker for breast cancer risk. Estrogenic activity by soy may be linked to breast cancer development in some studies, with other studies reporting no correlation between dietary phytoestrogens and breast cancer.
Weight loss: A lower body mass index (BMI) has been correlated with a lower chance of developing breast cancer.
Decrease alcohol consumption: Although a glass of wine may be beneficial for heart health, findings from a prospective study suggest that moderate alcohol consumption may increase the risk of breast cancer risk. It should be noted that some components of alcoholic beverages, such as hops have estrogenic activity, which may be linked to breast cancer development in some studies. However, some studies have reported no correlation between dietary phytoestrogens and breast cancer.