A retrospective case–control study of the use of hormone‐related supplements and association with breast cancer

Abstract

Hormone-related supplements (HRS), many of which contain phytoestrogens, are widely used to manage menopausal symptoms, yet their relationship with breast cancer risk has generally not been evaluated. We evaluated whether use of HRS was associated with breast cancer risk, using a population-based case-control study in 3 counties of the Philadelphia metropolitan area consisting of 949 breast cancer cases and 1,524 controls. Use of HRS varied significantly by race, with African American women being more likely than European American women to use any herbal preparation (19.2% vs. 14.7%, p 5 0.003) as well as specific preparations including black cohosh (5.4% vs. 2.0%, p 5 0.003), ginseng (12.5% vs. 7.9%, p < 0.001) and red clover (4.7% vs. 0.6%, p < 0.001). Use of black cohosh had a significant breast cancer protective effect (adjusted odds ratio 0.39, 95% CI: 0.22-0.70). This association was similar among women who reported use of either black cohosh or Remifemin (an herbal preparation derived from black cohosh; adjusted odds ratio 0.47, 95% CI: 0.27-0.82). The literature reports that black cohosh may be effective in treating menopausal symptoms, and has antiestrogenic, antiproliferative and antioxidant properties. Additional confirmatory studies are required to determine whether black cohosh could be used to prevent breast cancer. ' 2006 Wiley-Liss, Inc.Key words: breast cancer; prevention; complementary alternative medicine Hormone-related supplements (HRS) are widely used by women for the management of menopausal symptoms. While the specific contents of these preparations are unregulated by the Federal government, they generally contain phytoestrogens and other compounds that are thought to mimic the effect of endogenous estrogens. Commonly used preparations include herbal extracts of black cohosh (Cimicifuga racemosa), dong quai (Angelica sinensis), ginseng (Panax quinquefolius), red clover (Trifolium pretense) and yam (Discorea alata). Also available are preparations labeled as Biestrogen (Biest), dehydroepiandrosterone (DHEA), daidzein, Estrovin, genistein, Isoflavone, Promensil, Rejuvex, Remifemin, soy medications, steroid creams and Triestrogen. Many of these preparations contain a variety of herb-derived compounds, including those listed earlier. However, due to lack of standardization and government oversight, the concentrations and composition of these compounds varies widely.It has been suggested that women who have diets rich in phytoestrogens, including women from Asian countries, may be at decreased breast cancer risk.1,2 However, epidemiological evidence that phytoestrogen consumption is associated with modified cancer risk is largely limited to food intake, and has not revealed associations of specific compounds with breast cancer risk or protection. 2,3The mechanism of this putative breast cancer protective effect also remains unclear. It has been proposed that the relatively weaker estrogenic effect of phytoestrogens may compete with that of estradiol and have antiproliferative properties that ...

The Use of Herbal Preparations to Alleviate Climacteric Disorders and Risk of Postmenopausal Breast Cancer in a German Case-Control Study

“…To date, one observational study has investigated the invasive breast cancer risk with respect to menopausal HEP use (17). Concordant with our finding, a preventive effect of ever use of any HEP was observed in that study (OR, 0.65; 95% CI, 0.49-0.87), which was slightly larger than the effect in our study.…”

“…In a recent clinical study, an isopropanolic extract of black cohosh (Remifemin) had no effect on breast density or cell proliferation in postmenopausal women (16), whereas observational studies have shown protective effects on occurrence and recurrence of invasive breast cancer (17,18).…”

Terpenoids as potential chemopreventive and therapeutic agents in liver cancer

“…Cimicifuga racemosa (L) Nutt]. Recent studies indicate that black cohosh may have chemopreventive and chemotherapeutic potential [73,74] . Actein was found to inhibit the growth of p53-positive HepG2 cells with an IC50 value of 27 μg/mL [75] .…”

Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study

“…There are few reports of OBS use by breast cancer patients. In a casecontrol study [38], 17.2% of breast cancer cases were found to use hormone-related supplements, while as part of the HEAL study 34.7% of 502 postmenopausal women with in situ and invasive breast cancers reported taking at least one oestrogenic supplement since diagnosis [39]. Direct comparison between studies is, however, difficult due to differences in characterisation and grouping of supplements.…”