Breast Cancer

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Not only will conventional treatment vary from one person to the next, but integrative breast cancer care will vary and should be individualized.

Key Points

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Before investigating integrative care in breast cancer, we recommend reviewing integrative cancer care in general.

  • Integrative cancer care means skillful choices in both conventional and complementary cancer therapies.
  • Breast cancer is many different diseases. Not only will conventional treatment vary from one person to the next, but integrative breast cancer care will vary

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Women with breast cancer use integrative therapies more often than any other group of people with cancer.

But despite the widespread use of integrative breast cancer therapies, informed guidance in integrating conventional and complementary breast cancer care is difficult if not impossible to find.

This 40-page summary of science-informed integrative breast cancer care is designed to provide that informed guidance.

Integrative breast cancer care has a remarkable amount to offer you. It can add to your treatment, help with side effects, benefit your quality of life, help you get well again, and reduce your risk of recurrence. Psychologically and spiritually, it can have transformative effects.

Let’s be clear: integrative cancer care means skillful choices in both conventional and complementary cancer therapies.

The very first step is deciding what your goals are. Your goals will guide you in choosing both conventional and complementary therapies. No matter what conventional therapies you choose, our 7 Healing Practices can be beneficial in many ways—physical, emotional, mental and spiritual. They are the foundation to strengthen you for rigorous conventional therapies, reduce side effects, build health and help reduce the risk of recurrence.

Diagnostic Testing

Advanced and non-standard diagnostic tests, some specific for breast cancer, are available. These tests can often identify specific therapies that will be most effective. Some require pre-planning for collection and shipping of live tissue samples. See Diagnostic Approaches and De-escalation of DCIS Treatment (below).

Beyond the 7 Healing Practices you will find many specific integrative therapies to explore. Don’t let the number of choices deter you. We’ve arranged them in an easy order to consider, starting with those with the greatest safety, efficacy, and ease of access. Also, don’t overlook our special category of Off-label, Overlooked or Novel Cancer Approaches (we call them ONCAs). They have a lot to offer even if lifestyle changes seem too hard at this point.

I’ve known quite a few 20-year survivors of metastatic breast cancer—and I have known hundreds of women who have far outlived a metastatic prognosis.

We hope to help you live as well as you can for as long as you can with the optimal combination of conventional and complementary therapies. We hope to help you find a way to integrate the therapies that serve you best. That is how the best integrative oncologists do it—and we wish the best for you. Take it slow. Start with the simple things, like our seven healing practices, and move slowly toward the more complex decisions.

Don’t try to take all this in one bite. Take small bites, and come back as you are ready for more.

We do this for you. We hold you in our thoughts and prayers,

Michael Lerner

Integrative Care in Breast Cancer

Breast cancer is actually many different diseases. Conventional treatments vary. Integrative care should also be individualized. For example, some complementary therapies that enhance immune function in some breast cancers may heighten cancer progression in others.

Getting your diagnosis right is critical to conventional treatment decisions. Unfortunately, accurate reading of pathology reports is often a weak link in cancer treatment, with unacceptably high error rates in some hospitals.

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Clinical Practice Guidelines

Further Clinical Practice Guidelines

The Society for Integrative Oncology (SIO), the leading organization of its kind, has conducted a monumental review of randomized control trials of complementary therapies in breast cancer care.1 From this review, SIO created integrative care guidelines.

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Integrative Programs, Protocols and Medical Systems

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Examples of Integrative Approaches

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Block Center Program Supplements

Supplements used in the 2009 study of advanced metastatic breast cancer patients:17

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The Block Center for Integrative Cancer Treatment (BCICT)

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Bastyr Integrative Oncology Care: A Naturopathic Oncology Approach

Bastyr Breast Cancer Study Supplements

No one "Bastyr protocol" exists, as researchers continue to investigate and refine approaches. Supplements used in one Bastyr protocol for breast cancer:20

Expand list

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Dr. Kleef: Hyperthermia, Immunology and Integrative Oncology Program

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The Ecology of Breast Cancer

The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing by BCCT advisor Ted Schettler, MD, MPH, is one of the best sources of information on lifestyle and environment in relation to breast cancer risk and outcomes.

Dr. Schettler proposes that individual body terrain is shaped across the lifespan by all levels, from individual to societal. “Efforts to change the design of that terrain can continue throughout life, so that breast cancer or its recurrence after initial treatment is less likely."24

The Ecology of Breast Cancer

Integrative Therapies in Breast Cancer

7 Healing Practices: The Foundation

Adding Up Benefits

Studies show that while a single lifestyle practice—such as a healthy diet or exercise—show benefit, combining practices is even more powerful.25

Breast cancer patients who adopted a healthier diet and regular exercise lowered their risk of relapse by nearly half, an effect seen in both obese and nonobese women.26

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The 7 Healing Practices listed here all promote wellness and tend to make your body terrain less hospitable to the development and progression of cancer. Some practices address cancer symptoms and side effects.

Eating Well

Dietary Fats: Healthier Choices

For most cancers, in general the recommendation is to eat a low-fat diet consisting of healthy fats (olive oil, nut oils, fish oils) and reduce the unhealthy fats (saturated fats found especially in red meat, trans-fats, and high amounts of omega-6 fatty acids). Limit total fat to 20 to 35 percent of dietary calories.

Different types of dietary fat have different health impacts:

  • Polyunsaturated fatty acids are necessary, but typical Western diets have too large a ratio of omega-6 compared to omega-3 fatty acids. Some preliminary research suggests that though omega 6 oils have pro-inflammatory effects, they may also have anticancer properties.28
  • Eat quality sources of omega 6 fatty acids, such as whole grains and small amounts of cold-pressed (preferably organic) vegetable oils such as sunflower, grapeseed and soybean oil.
  • Eat fewer foods that contain high amounts of omega-6s:
    • Heat-extracted vegetable oils (those that are not expeller or cold-pressed)
    • Conventionally-raised meat, poultry and eggs
    • Processed and fast foods (which often use these oils)
  • Replace some of the high omega-6 oils with monounsaturated fatty acids such as extra virgin olive oil.
  • Eat low-fat dairy products instead of high-fat options to reduce total calories and saturated fats.
  • Eat less red meat and avoid processed meats, which are higher in saturated fats.
  • Eat more foods containing omega-3s, such as walnuts and wild-caught salmon and sardines.

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Moving More

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Managing Stress

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Sleeping Well

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Creating a Healing Environment

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Sharing Love and Support

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Exploring What Matters Now

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Beyond the 7 Healing Practices: Further Integrative Therapies

Complementary therapies and lifestyle practices can be useful to enhance treatment effects, improve quality of life and possibly even extend life for those with breast cancer.

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Therapies are grouped according to their effects:

  • Treating the cancer
  • Managing side effects and promoting wellness
  • Reducing risk

We present natural products and off-label, overlooked and novel cancer approaches (ONCAs) in six groups:

  1. Good clinical evidence of efficacy & safety, easy access
  2. Good clinical evidence of efficacy & safety, limited access
  3. Limited clinical evidence of efficacy but good safety, used in leading integrative programs
  4. Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit
  5. Especially promising preclinical or emerging clinical evidence of efficacy and safety
  6. Evidence of no efficacy or may be dangerous

Within each section, we list only groups containing applicable therapies.

Other integrative therapies and approaches are described but not categorized. See the full summaries as linked for more information on each of these therapies.

Cells, Animals and People

Studies on human cells can be helpful in finding effects of drugs, radiation, natural compounds and other potential therapies on tumors. However, isolated cells or tissues in a highly controlled lab may behave very differently from tumors and other cells in real human beings.

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We limit our presentation here to therapies with clinical evidence—studies involving cancer patients—and not solely cell or animal evidence (see at right). Preclinical evidence is included in therapy summaries on this site for those who wish to assess that.

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

The role of each of the 7 Healing Practices in arresting or reducing breast cancer growth and spread is described above.

Conventional Breast Cancer Therapies

Conventional treatment for breast cancer is becoming more and more specific, depending on the type, stage and characteristics of a person’s cancer. For a growing number of women, treatment is effective or even curative, especially in the case of early-stage cancer.

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Natural Products

BCCT advisor Debu Tripathy, MD, writes that “herbal and botanical agents have significant potential as bioactive agents that can affect cellular pathways involved in breast cancer, but may also cause side effects and drug interactions. . . Caution should be exercised when used with other treatments.”110

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely used in integrative cancer protocols and traditional medical systems.

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Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Read more

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

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Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for treating the cancer

Expand list

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Group 6: Evidence of no efficacy or may be dangerous

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Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

Off-label drug use involves a physician prescribing a drug for a disease or condition not approved by the FDA. Prescribing drugs off-label is legal if sufficient evidence indicates its usefulness for the condition or disease prescribed. However, different state medical boards have varying standards regarding off-label use of specific drugs

Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Read more

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Read more

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

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Diets and Metabolic Therapies

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Therapies Using Heat, Cold, Sound, Light or Cutting-edge Radiotherapy

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Managing Side Effects and Promoting Wellness

Compelling evidence shows that stress reduction significantly improves quality of life after initial treatment of breast cancer and beyond.

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Wellness During Tamoxifen Treatment
Click the image to open this patient handout on wellness during tamoxifen treatment.

Handout in French

The role of each of the 7 Healing Practices in managing symptoms, improving quality of life and promoting wellness is described above.

Conventional Therapies

Vaginal moisturizers and vaginal rings supplying low-dose estrogen are used to address sexual discomfort and difficulties. Although these are conventional therapies, they may not be included in many conventional treatment programs unless or until a patient expresses a need.

Natural Products

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely use—d in integrative cancer protocols and traditional medical systems.

Read more

Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Read more

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Read more

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for managing side effects and promoting wellness

Read more

Group 6: Evidence of no efficacy or may be dangerous

Read more

Off-label, Overlooked or Novel Cancer Approaches (ONCAs)

Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Read more

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Read more

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Read more

Diets and Metabolic Therapies

Read more

Mind-Body Approaches

Mind-body approaches including music therapy, meditation and yoga have been shown to improve side effects and symptoms as described on these summaries:

Energy Therapies

Energy therapies with evidence for improving side effects and symptoms include these:

Manipulative and Body-based Methods

Therapies Using Heat, Cold, Sound, Light or Cutting-edge Radiotherapy

Palliative Care

If you have advanced, incurable cancer that has stopped responding to conventional treatment, your oncologist, if pushed, will likely offer you more chemotherapy to try, even when it is unlikely to work and may worsen the quality of your life or even hasten death. This may be a time to push for your physician to be honest and to talk about realistic hope for quality of life, as so much more can be done for you with good palliative care. Furthermore, many patients receiving good palliative care as well as integrative approaches may actually live longer than expected. Such approaches described above include the Block Center for Integrative Cancer Treatment and the Bastyr Integrative Oncology Research Clinic approach.

See Palliative Care.

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Risk Factors

Generally accepted individual risk factors for breast cancer include these, with varying levels of association:482

      • Genetic factors and family history of breast cancer
      • Pregnancy history (late age first pregnancy or having no children)
      • Menstrual history (early age of puberty or later age of menopause)
      • Dense breast tissue
      • Chest radiation
      • Recent oral contraceptive use
      • Combination hormone therapy
      • Cigarette smoking
      • Alcohol consumption

Lifestyle and environment influence the risks of developing breast cancer and of recurrence after treatment.

Although these are important, they do not fully explain why many people develop breast cancer. Lifestyle and environment influence the risks of developing breast cancer and of recurrence after treatment.

It Takes a Village (or a Whole Country) to Reduce the Risk of Breast Cancer

Reducing these risk factors “cannot be accomplished by individuals alone. Public health strategies to re-shape the terrain are essential.” Many of these can only partially be addressed by changes in individual behavior. Multi-level public-health and policy interventions at the population level are also necessary in order to re-design system conditions in more favorable ways.

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From Dr. Ted Schettler's The Ecology of Breast Cancer:483

Breast cancer risk factors help shape conditions that foster vulnerability to the disease and less favorable outcomes. Risk factors for which the strength of evidence varies from strong to probable to plausible:

Expand list

The role of each of the 7 Healing Practices in reducing the risks of breast cancer development and recurrence is described above. Three further factors—alcohol use, breast feeding and adult body weight—are discussed here.


Alcohol Intake

Alcohol consumption is a recognized risk factor—among those with the strongest evidence—for developing breast cancer.484

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Breastfeeding

Breastfeeding brings many benefits to the mother as well as the infant, including reducing the mother’s risk of breast cancer.488

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Adult Body Weight

In the Nurses' Health Study, a large, prospective cohort study spanning decades, weight gain after age 18 is associated with higher risk after menopause among women who have never used hormone therapy. Women who had lost more than 10 kilograms (22 pounds) since menopause and maintained their weight loss had a lower risk of breast cancer than women with stable weight since menopause.490

See Healthy Living.

Therapies to Reduce Risk

Natural Products

Group 1: Good clinical evidence of efficacy & safety, easy access

These therapies may be widely used in integrative cancer protocols and traditional medical systems.

Read more

Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Read more

Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety

Other therapies with preclinical evidence only for reducing risk

Read more

Read more

Group 6: Evidence of no efficacy or may be dangerous

Read more

Off-label, Overlooked and Novel Cancer Approaches (ONCAs)

Group 2: Good clinical evidence of efficacy & safety, limited access

Some may require a prescription, for example.

Read more

Group 4: Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit

May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.

Read more

Diets and Metabolic Therapies

Read more

Breast Cancer and Surgery

An update to this section will include information on preparing for surgery and preventing infection. Look for it this summer.

Having breast cancer surgery and possible reconstruction may involve extra consideration and care. Planning ahead to minimize pain or discomfort and reduce the risk of infection can bring a happier experience and better clinical outcome.

Hormone Therapy before Surgery

From medical advocate, breast cancer survivor and BCCT advisor Gwendolyn Stritter, MD

Anti-estrogen therapy, typically started after surgery, prevents breast cancer relapse and death in ER+ cancers. However, some patients do not relapse even if they do not take anti-estrogen medication. Other patients will relapse despite taking them. This means a significant number of patients taking anti-estrogens suffer from the adverse effects of treatment without the benefit of improved outcomes. Taking anti-estrogens before surgery enables your healthcare team to determine if you would respond to such treatment. This can save five to 10 years of ineffective therapy for those who would not respond. Another benefit of neoadjuvant hormone therapy: good outcomes despite less aggressive surgery, such as lumpectomy instead of mastectomy.

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Breast Reconstruction: Now More Options


Dr. Deb's operating room flash mob before her double mastectomy

Two basic types of breast reconstruction are available after mastectomy:

      1. Breast implants
      2. Flap reconstruction using tissue from your own body to reconstruct the breast

Further options are available within those two categories. To learn more about the standard post-mastectomy breast reconstruction options, see an online decision aid called BRECONDA: Breast Reconstruction Decision Aid. Note that this aid does not mention prepectoral implants.

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Recovery and Remission Maintenance

BCCT does not recommend any particular remission maintenance approach. The strategies provided here are supported by evidence of improved outcomes.

Balancing Terrain

Several imbalances in your terrain can make the body more susceptible to infection, slower to heal wounds and/or more hospitable to cancer. Chronic inflammation, insulin resistance/glycemia, obesity and imbalanced stress chemistry may be particularly important to balance in relation to surgery, wound healing and reducing recurrence risk. For more information, see Body Terrain and the Tumor Microenvironment.

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Post-Treatment Monitoring

When you have finished treatment, discuss and develop a survivorship plan with your cancer treatment team. Your survivorship plan includes instructions and a schedule for follow-up visits, plus testing and guidance on lifestyle and other self-care practices to help you recover and prevent recurrence. The type of testing and monitoring done to assess your response to treatment and pick up on recurrence depend on your specific cancer, treatment and risk for recurrence.

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DCIS Treatment

From medical advocate, breast cancer survivor and BCCT advisor Gwendolyn Stritter, MD

60 percent of the patients with DCIS would not progress to invasive breast cancer even without any treatment whatsoever.

De-escalation of DCIS Treatment

60 percent of the patients with DCIS would not progress to invasive breast cancer even without any treatment whatsoever. But not knowing which patient will progress, combined with the potential for metastasis in those who do progress, has understandably led oncologists to overtreat everyone in the hopes of improving the survival of the 40 percent who are at risk.

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Low-dose Tamoxifen and DCIS

It turns out that the dose of tamoxifen you are taking may be much higher than needed. This research figured prominently at the December 2018 San Antonio Breast Cancer Symposium—for good reason. It was recently published in the Journal of Clinical Oncology.

First, some background. Conventional medical research, especially cancer research, has a notable deficiency: a strong tendency to test only the “maximally tolerated dose” of any given research drug. This approach is lots cheaper and lots easier than testing two to four other doses to find the sweet spot (maximal effectiveness, minimal side effects). Accordingly, it has been known for quite a while that the standard dose of tamoxifen—20 mg—may be much higher than that necessary to prevent non-invasive breast “pre-cancers” such as DCIS, LCIS and atypical ductal hyperplasia (ADH) from progressing to invasive breast cancer.

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Taking Care of Your Heart: Cardiac Toxicity and Breast Cancer Treatment

With contributions from BCCT Advisor Jen Green, ND, FABNO

Caring for your heart is an important part of your wellness plan. According to a 2018 review, following diagnosis, 35 percent of deaths in breast cancer patients are related not to breast cancer, but to cardiovascular disease.621

People with breast cancer who are undergoing chemotherapy such as anthracylines (including Adriamycin/doxorubicin), targeted agents such as Herceptin/trastuzumab, and radiation therapy to the chest are at risk for heart damage. Risk is even higher for those receiving anthracyclines plus Herceptin or anthracyclines plus chest radiation.

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“Heart Healthy” Lifestyle Choices

Some complementary therapies may be helpful, starting with “heart healthy” lifestyle choices including the 7 Healing Practices of eating well, moving more, managing stress and sharing love and support (see also the descriptions above).

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Natural Therapies Protective during Adriamycin/Doxorubicin Treatment

Studies on herbs or natural supplements show how these have helped reduce heart damage from Adriamycin/doxorubicin. Please connect with an integrative oncology professional or naturopathic physician for specific guidance. Also see Quality and Sources of Herbs, Supplements and Other Natural Products.

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Natural Therapies Protective during Treatment with Herceptin/Trastuzumab, Perjeta/Pertuzumab or Kadcyla/Trastuzumab Emtansine

Studies of these herbs or natural supplements show improvements in heart strength/ejection fraction. These may be useful if heart strength is reduced from Herceptin or Kadcyla treatment. Please connect with an integrative oncology professional or naturopathic physician for specific guidance. Also see Quality and Sources of Herbs, Supplements and Other Natural Products. Also see Quality and Sources of Herbs, Supplements and Other Natural Products.

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Commentary

BCCT advisor Gwen Stritter, MD, February 1, 2019: As a breast cancer medical advocate, I find there are certain areas that patients are really grateful to learn about. I have included a few in sections above: hormone therapy before surgery, regional anesthesia for mastectomy and de-escalation of DCIS treatment.

BCCT advisors Gwen Stritter, MD, and Jen Green, ND, FABNO, May 9, 2019: Impact of curcumin on tamoxifen effectiveness

Many are aware that tamoxifen is what we call a pro-drug. A pro-drug is ineffective until specific enzymes in your body activate it. Tamoxifen is metabolized to endoxifen, the effective drug that prevents ER+ breast cancer patients from relapse.

An enzyme called CYP2D6 is responsible for the magic that changes tamoxifen to endoxifen. The activity of this enzyme varies from individual to individual. Part of the variance is due to genetics—some people are born with hyperactive CYP2D6; others have an enzyme that is very sluggish. Many medications—antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) amongst a host of others—as well as assorted foods and dietary supplements can either activate or slow down CYP2D6.

When this information first started causing a stir in the breast cancer world roughly 10 years ago, researchers hypothesized that taking tamoxifen with a CYP2D6 inhibitor would cause a increase in breast cancer relapse. As it turned out, further clinical research did not bolster this theory,657 leading to a new one: genetics, drugs and dietary intake have complex interactions with the body’s enzyme system. They activate some enzymes and inhibit others. This results in a variable net effect on the concentration of important drugs. In a 2016 study, the cause of low endoxifen levels could not be identified over 50 percent of the time.658

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BCCT advisor Lise Alschuler, ND, FABNO, August 9, 2018: There are instances when I use specific mushrooms, for instance: Coriolus (or Trametes) versicolor (turkey tail) for breast cancer, Agaricus blazeii for ovarian cancer and chaga mushroom for melanoma. However, it is a very valuable and reasonable strategy to use a blend that includes mushrooms, each of which is standardized to its polysaccharides and beta-glucans. The key is to use a hot water extract of the fruiting bodies or a full-spectrum extract (includes mycelium) that clearly identifies on its label the quantity of mushroom extract.

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BCCT advisor Keith Block, MD, advises patients on heart-damaging medications to take 200 mg or even considerably more of CoQ10 per day.664 Many heart patients are also on statins. Block says, “Because statins deplete coenzyme Q10 from your muscle cells, particularly your heart, I advise patients on statins to take at least 30 mg of coQ10 per day.“665

BCCT advisor Ted Schettler, MD, March 4, 2019: Lavender oil (as with some other essential oils) has estrogenic properties at some concentrations.666 It might be wise to avoid skin application of lavender oil in the setting of an estrogen positive breast cancer diagnosis.

Written by Laura Pole, RN, MSN, OCNS; Nancy Hepp, MS; and Michael Lerner, PhD. Reviewed by Ted Schettler, MD, MPH; and Gwendolyn Stritter, MD; most recent update on September 14, 2019.

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More Information

General Breast Cancer Resources

Treatment Resources

Resources on Reconstruction Options and Risk of Infection

Resources on Reducing Risk of Surgical Infection

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