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 ...