Written by Renata Filiaci, MS Health and Wellness

Introduction

Breast cancer history dates back to around 1,500 years B.C. Ancient Egyptians. In the current account, breast cancer is one of the most common diseases in the world as it is the second leading cause of death in women between the ages of 25 and 75 years. There are over 1.5 million new cases and 570,000 deaths per year due to breast cancer. Breast cancer can quickly metastasize to other nearby organs, such as to the bone, liver, lung, and brain, if not detected early on (Banasik & Copstead, 2019).

Many factors reside in the development of breast cancer. Although it is more predominant in women, men can develop breast cancer, yet it is rare. If there is a history of breast cancer in the family, half of the breast cancer predisposition syndromes are caused by BRCA1 and BRCA2 mutations in which there is a significantly higher risk of developing breast cancer. Men tend to be diagnosed at an older age if they inherited BRCA2 rather than BRCA1 gene mutation, which is likely to overexpress the estrogen and progesterone receptors (PRs) (Banasik & Copstead, 2019; Nounou, ElAmrawy, Ahmed, Abdelraouf, Goda, & Syed-Sha-Qhattal, 2015).

Ovarian and pituitary hormones, specifically ovarian hormone estrogen and pituitary hormones prolactin and growth hormones, play a significant part in the progression and development of normal mammary glands and breast cancer, in which the reproductive and endocrine systems are involved. Breast cancer patients have overly activated and amplified growth factor proteins, such as epidermal growth factor receptor and human epidermal growth factor receptor 2, which promote cell proliferation, cell invasion, angiogenesis, and increased apoptosis in healthy cells causing 20% to 30% of breast cancer cases. A woman’s risk of breast cancer increases with age especially women who’ve experienced early onset of menses and late menopause because of overexposure to estrogen and progesterone; the risk is two times more likely. However, the incidence of breast cancer in women between the ages of 25 to 30 is growing. Postmenopausal women taking estrogen replacement therapy have an increased risk due to hormonal exposure. Women who give birth younger than thirty five years as well as breastfeed postnatal have an overall protective effect against breast cancer (Sun, Zhao, Yang, Xu, Lu, Zhu, & Zhu, 2017; Subramani, Nandy, Pedroza, & Lakshmanaswamy, 2017; Shah, Rosso, & Nathanson, 2014).

Endocrine disrupters, such as the drug diethylstilbestrol, steroid hormones used for menopausal therapy, some forms of radiation, alcohol, tobacco smoke, and the sterilizing agents, can also influence the development of breast cancer. Chemical and environmental carcinogens affect endocrine tissues, and their corresponding secreted hormones which impact mammary gland growth or function as well as boost oxidative stress. This can involve DNA methylation, histone modification, or RNA mediated modifications; alteration in gene expression can promote tumor growth (Macon & Fenton, 2013). The impact of obesity on breast cancer is becoming widely known. It is now associated with a higher risk of developing breast cancer, particularly in postmenopausal and with hormone receptor‐positive and ‐negative disease women, due to insulin resistance and hyperinsulinemia as well as circulating proinflammatory cytokines which increase estrogens and inflammatory mediators (Picon-Ruiz, Morata-Tarifa, Valle-Goffin, Friedman, & Slingerland, 2017; Shah, Rosso, & Nathanson, 2014).

Various strategies of breast cancer classification and staging have evolved over the years. Intrinsic (molecular) subtyping is essential in clinical trials and keen understanding of the disease. Tumors are cells and extracellular matrix (ECM) that form tissues resembling organs, although structurally and functionally abnormal (Egeblad, Nakasone, & Werb, 2010). The stage is determined by the invasion of malignancy categorized into in situ carcinoma and invasive (infiltrating) carcinoma appearing in either lobular (lobular hyperplasia) or ductal (mammary ducts). Infiltrating/invasive carcinoma is further subclassified into mucinous (colloid), tubular, medullary, papillary, and cribriform carcinomas (Nounou, ElAmrawy, Ahmed, Abdelraouf, Goda, & Syed-Sha-Qhattal, 2015).

Allopathic diagnostic techniques to determine the stage of breast cancer proliferation range from mammography, magnetic resonance imaging, molecular breast imaging, HER-2/neu detection assay, and blood-based assay; if a tumor, mutation, or proliferation is discovered, a breast biopsy will be used to diagnose further. Treatment protocols typically are designed to remove or kill cancer cells by surgery, chemotherapy, immunotherapy, HER2-directed therapy, and radiotherapy. Adjuvant therapy modalities endocrine treatment, the purpose is to either balancing or blocking hormones (Shah, Rosso, & Nathanson, 2014; Nounou, ElAmrawy, Ahmed, Abdelraouf, Goda, & Syed-Sha-Qhattal, 2015).

Traditional modalities of treatment act by selectively killing cancer cells while also damaging the adjacent healthy cells, which can create immune system impairment. Chemotherapy and radiation are also accompanied by short-term and long-term adverse side effects, such as chemotherapy-induced nausea and vomiting, constipation, diarrhea, fatigue, central and peripheral neurotoxicity, and gastrointestinal disorders which may lead to anorexia, malabsorption, weight loss, anemia, and increased risk of sepsis. Depending on the pathogenesis of cancer, some patients receive chemotherapy, copious amounts other drugs, as well as drugs that are used in the approach to stabilize chemotherapy-induced adverse effects; these often cause patient discomfort and low quality of life or potentially death (Nurgali, Jagoe, & Abalo, 2018). Complementary and alternative medicinal protocols are becoming more prevalent as a treatment option for breast cancer. Always seek medical advice before beginning integrative therapies especially when receiving conventional medication; however, the purpose of this research monograph is to examine CAM treatment options for breast cancer.

Results

In the 1960s and 1970s, diet and cancer research turned toward human population studies, in which there is empirical evidence that the biological effect that reflects the original contents of nutrients and related substances in whole, intact food can control and even reverse disease development. The author, Campbell (2017), suggests there is a correlation between overconsumption of dietary fat, animal-based products, and processed foods with the development of breast cancer. The effect of nutrition on the initiation stage of breast cancer commonly concerns its impact on controlling the expression of these genes as well as the proliferation of genetic mutations from chemical and environmental carcinogens, which are apparent in diets that lack whole food, such as vegetables, fruits, omega-3 fatty acids, and unrefined grains (Campbell, 2017).

The authors, Limon-Miro, Lopez-Teros, and Astiazaran-Garcia (2017), reviewed clinical trials based on the dietary guidelines and lifestyles of breast cancer patients during and after antineoplastic treatment. Antineoplastic treatment is the systemic or delimited conventional treatment used to inhibit the growth of tumors, such as chemotherapy, hormone therapy, antibody therapy, surgery, and radiotherapy. During the prognosis of breast cancer, some women were shown to have high levels of visceral fat and body mass index, as well as smoke and, have little to no physical activity. Many women who have been diagnosed with breast cancer presented inadequate diet given that their intakes of fruit, legumes, and dark-green and orange vegetables were reduced. After receiving anticancer treatments, breast cancer patients’ nutritional status was reduced as they had lower body mass, a higher rate of toxicity, and loss of bone mineral content. More complications in recovery are attributed to malnutrition, in which a healthy weight and physical activity are encouraged. Through this review, it has been established that nutritional assessment and guidance, as well as physical activity, is imperative before diagnosis, during treatment, and after treatment, that means meeting daily dietary requirements by increasing nutritional quality with nutrient-dense foods, reducing simple sugars, and added fats and following a supervised exercise program (Limon-Miro, Lopez-Teros, & Astiazaran-Garcia, 2017). 

Specific herbs and plants, garlic, Echinacea, turmeric, burdock, green tea, black cohosh, ginseng, and flaxseed have been found to contain a plentiful variety of active phytochemicals such as carotenoids, flavonoids, ligands, polyphenolics, terpenoids, sulfides, lignans, and plant sterols, which are noted as bioactive compounds that prevent cancerous cell proliferation. For many women, mammography is unavailable in which prognosis is identified as too late making it harder to cure, and there are less pain assistance and comforting care. Echinacea and ginseng raise the number of natural killer cells and block the propagation and metastases of cancerous cells and also lessen the harmful consequence of radiotherapy and chemotherapy. Garlic works as an antioxidant by stimulating the lymphocytes and macrophages which interfere with tumor cell metabolism. Turmeric has anti-inflammatory properties that inhibit cancer proliferation during initiation, promotion, and propagation. Burdock has been used for many different types of cancer treatment because it relieves pain, lessens the tumor size and enhances survival rate. Green tea has anti-mutagenic activity by restricting cancer cells division as well as the immune system is stimulated. Black cohosh has been used for menopausal women because of its estrogenic and anti-estrogenic activity. Flaxseed has improved mammary glands morphogenesis preventing malignancies and the development of tumors (Shareef, Ashraf, & Sarfraz, 2016).

Chemotherapy and other conventional protocols have various side effects due to efficacy in specifically targeting cancer. The use of herbal medicines and acupuncture in palliative care and as adjuvants provide treatment-related symptom control, alleviation of side effects from conventional medicine, and better quality of life. New randomized control trials of in vitro mechanistic and in vivo animal studies gathered by Liao, Apaya, and Shyur (2013) provide the usefulness of herbal medicine and acupuncture as adjuvants in breast cancer therapy. Chinese medicinal protocols, such as Danggui, Ren Shen, and Jia-wei-xiao-yao-san, have been used in preclinical and clinical practice to treat breast cancer and patients receiving conventional treatment. These herbs have shown to decrease treatment-associated toxicity, chemotherapy-related symptoms, and lower serum levels of inflammatory cytokines. Another Chinese herbal mixture, Yunzhi-Danshen, increased T-helper cells, which is beneficial for promoting immunological function. A capsule of dry powdered extracts from a combination of medicinal herbs called LSC101 protected against mild to moderate chemotherapy-induced anemia and neutropenia, reduce hematological toxicity, and promote recovery of hematopoietic function. Acupuncture is aimed at correcting imbalances regulated by an energy called “qi” disrupting the flow and growth of the disease. The use of acupuncture has become a clinical benefit for breast cancer patients because it reduces hot flushes, prevents nausea and vomiting, improves libido, increases energy, and improve the clarity of thought and sense of well-being after receiving high dose conventional treatment (Liao, Apaya, & Shyur, 2013).

Breast cancer and breast cancer treatment can cause uncontrolled stress which may hurt several biological systems as well as the quality of life in patients. The authors, Chaoul, Milbury, Sood, Prinsloo, and Cohen (2014) have found that mind-body techniques, such as meditation, yoga, tai chi, and qigong, have lowered stress and managed psychological challenges of diagnosis and treatment. The National Comprehensive Cancer Network states that all patients must detect their stress levels through the Distress Thermometer and approach stress with more than just general psychology and psychiatry. The majority of the studies reviewed on eight weeks of mind-body techniques with stage I-III breast cancer patients, as well as survivors, have found a significant reduction in self-reported levels of anxiety, depression, improvement in sleep quality, and reductions in inflammations and fatigue. Women receiving conventional treatment who practiced yoga, tai chi, or qigong found a greater sense of meaning in their illness as well as increased physical function and general health (Chaoul, Milbury, Sood, Prinsloo, & Cohen, 2014).

The researchers, Loganathan, Jiang, Smith, Jedinak, Thyagarajan-Sahu, Sandusky, Nakshatri, and Sliva (2014), examined the mushroom Ganoderma lucidum, also known as the reishi mushroom, and its constituents to suppress breast-to-lung cancer metastasis through the inhibition of pro-invasive genes. Breast to lung cancer metastasis is a significant reason for mortality within patients. The reishi mushroom has been noted to suppress proliferation and invasiveness of cancer cells due to its triterpenes and polysaccharides. This trial evaluated mice implanted with breast cancer into their mammary fat pads which were then administered with 100 mg extract every other day for four weeks. This treatment somewhat limited tumor growth but significantly inhibited the number of breast-to-lung cancer metastasis in the mice. Reishi mushroom extraction also regulated and silenced invasive behavior in MDA-MB-231 genes, which, if not controlled, are responsible for further cancer proliferation and metastasis (Loganathan, Jiang, Smith, Jedinak, Thyagarajan-Sahu, Sandusky, Nakshatri, & Sliva, 2014).

The endocannabinoid system in mammals has two natural ligand receptors, CB1 (neural) and CB2 (immune), which control many different therapeutic physiological functions when activated by the Cannabis sativa plant, one being the deregulation of breast cancer. Kiskova, Mungenast, Suvakova, Jager, and Thalhammer (2019) review and assess the use and effects of cannabinoids, delta-9-tetrahydrocannabinol (THC) and non-psychoactive cannabidiol (CBD), on breast cancer models, human and animal clinical trials. It has been established that CB2 receptor expression plays a crucial role in carcinogenesis and cancer progression; breast cancer cell lines express CB2 at high levels and are identified in 72% of carcinomas. After the authors reviewed multiple clinical studies, the pharmacokinetic properties of administered cannabinoid extraction blocked the expression of COX-2 and the proto-oncogene c-FOS and interfered with the EGF/EGFR pathway of hormone-sensitive breast cancers inducing apoptosis in cancer cells, reducing inflammation, and deregulating proliferation, migration, invasion, and angiogenesis (Kiskova, Mungenast, Suvakova, Jager, & Thalhammer, 2019).

Discussion

Through surmountable research, complementary and alternative medicinal treatments (CAM) are being used as adjuvant therapy because they provide anti-proliferative, anti-tumor, chemoprotective attributes and increase the quality of life. Breast cancer can be caused by many different factors; however, the integrative perspective points out that diet, genetics, and hormone levels are the main factors as to why breast cancer develops. Although half of the breast cancer predisposition syndromes are caused by genetic mutations, CAM protocols could get to the root of the cause of breast cancer and monitor the levels of hormones before the development of breast cancer occurs. CAM protocols are a natural, cheap, and useful source for the prevention and treatment of oxidative stress and breast cancer.

Considering diet and lifestyle play a critical role in the development of cancer, primarily when associated with a genetic predisposition, when performing annual physicals, screening for breast cancer, and assessing diet before, during, and anti-cancer treatment, physicians should educate patients on proper nutrition and physical activity. Proper nutrition is an adequate diet of whole foods, such as vegetables, fruits, omega-3 fatty acids, and unrefined grains with limiting the consumption of dietary fat, animal-based products, and processed foods. Physicians should be more apt to giving meal plans and essential dietary guidelines as well as physical education during appointments to possibly prevent obesity based chronic illness, developing cancer, and becoming malnourished due to conventional medicinal treatment.

Many CAM options could be given for palliative care before and after treatment. Within educating patients on dietary guidelines, physicians could also give herbal and botanical extracted alternatives as a protocol for women with breast cancer due to the therapeutic effects of natural plants. Natural plant products can potentially increase survival rate and prevention from cancer in areas where detection is unavailable or unattainable. Plants could also be used to regulate hormone production if women have overexposure to estrogen and progesterone during their lifetime. As physicians, treating the patient as a whole is presumably necessary when treating breast cancer, especially since there are many causes to development.

It is essential that the standard of care in oncology include distress screening and the delivery of different techniques outside of conventional medicine like acupuncture and mind-body therapies, which have been proven to reduce stress, fatigue, depression, anxiety, inflammation, and standard treatment symptoms. Failure to do so within an allopathic treatment center could compromise the health and quality of life of a breast cancer patient much more rapidly. Practicing mind-body techniques could give a whole new sense to the term ‘illness’ as well as increase the chance of survival due to overall better wellbeing.

Oral administration of reishi mushroom extract should be taken if the breast cancer gene mutation exists in both men and women. If taken regularly with proper diet, breast cancer might not have the opportunity to proliferate. Also, considering it suppresses and inhibits breast cancer cells to metastasize, this could limit mortality within highly invasive breast cancer patients, especially in areas with limited access to healthcare. Another promising agent for inhibiting breast cancer progression is the application of cannabinoids. Both of these CAM routes can reduce inflammation which might stop cancer from generating altogether. All CAM therapies should be discussed in all healthcare facilities as it could change the medical industry as a whole as well as the way physicians treat women who are at high risk of developing breast cancer.

Conclusions/RecommendationsBreast cancer is the second leading cause of death in women; there are over 1.5 million new cases and 570,000 deaths per year due to breast cancer. There are an array of potential causes in the development of breast cancer, such as BRCA1 and BRCA2 gene mutation in both men and women, prolonged exposure to estrogen and progesterone, endocrine disruptors, and lifestyle factors. Modern conventional medicine is surgery, chemotherapy, immunotherapy, HER2-directed therapy, and radiotherapy. However, allopathic treatment can present adverse side effects, poor quality of life, and decreased immune function leading to death.

Although a patient should seek a medical physician before using CAM therapies, there has been succinct research evaluating its use on patients with breast cancer by improving symptoms and quality of life, regulating hormone pathways, and reducing chemotherapy side effects and cancer proliferation. The research recommends lifestyle changes, such as weight loss, avoidance of alcohol consumption and smoking, and incorporating physical activity. Natural medicines, including herbal supplements and extracts, have active phytochemicals that reduce cancer/tumor growth and oxidative stress. Mind and body practices can increase the quality of life in patients receiving conventional medicine. Also, when given cannabinoids, CB2 receptors in the endocannabinoid system regulate hormone-sensitive pathways in breast cancer as well as impair tumor generation and progression. These evaluations bring in the idea that CAM therapies could be given as treatment or as palliative adjunct modalities.

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