LBBC Spring Conference Highlights by Marilyn S. Arnott, PhD

LBBC’s 1999 Spring Conference was enjoyed by well over 600 breast cancer survivors, their families and friends. As Renee Bernett, one of our volunteers put it, “Once again, I’m infused with hope, enthusiasm and encouraging prospects…” thanks to the excellent presentations by Drs. Raymond Chang and Larry Norton. The topic of the conference was “New Methods of Breast Cancer Treatment: From Conventional to Complementary Medicine.”

Dr. Chang led off with a very thorough discussion of alternative/complementary approaches to breast cancer treatment. Having been trained in both western and Chinese medicine, and having been a part of the dramatic changes that have occurred recently in efforts to integrate conventional and alternative medicine, he shared both general wisdom and details about specific aspects of alternative approaches. Dr. Chang started the Integrative Medicine Program at Cornell Medical College, and is currently Medical Director of the Meridian Medical Croup in New York City. Several people asked us to “write down everything he said” in the next newsletter. This would have exceeded the space available here, but we’ve tried to hit the highlights. Thanks to Joyce Gildea and Renee Bernett for their help in pulling this information together. You can hear the complete presentations of both speakers by ordering the audio cassettes from LBBC.

Why do people seek alternative care or complementary medicine?

  • To reduce side effects of conventional treatment
  • To reduce the complications of cancer itself
  • To reduce the risk of getting cancer, and the risk of recurrence
  • To improve the immune system
  • To provide primary treatment in conjunction with conventional treatment
  • To provide alternative approaches with minimal side effects, if conventional therapies have failed

What are some useful complementary treatment approaches?Diet/nutrition

Dr. Chang suggests broad principles rather than specific diets. For example, low fat, lots of fruits and vegetables. Individual foods, such as garlic and soy, can interfere with the growth of new blood vessels (anti-angiogenesis activity), at least in the laboratory. Laboratory studies of soy have shown it to have other beneficial properties, as well. It reduces the formation of new cancers, interferes with the growth of existing tumors, and encourages cancer cells to “grow up and behave themselves” (differentiation), It is an excellent source of protein. Because some of the components of soy (isoflavones) have weak estrogenic activity, women with estrogen receptor positive breast cancer should “not overdo it, ” but a cup of miso soup or a few pieces of tofu a day are OK.
Mind/body approaches

These form an integral part of healing. The landmark study by Dr. Spiegel of Stanford University 20 years ago showed that participation in support groups, psychotherapy, and self-hypnosis extended and optimized life for a group of women with stage IV breast cancer. Later studies have shown a similar effect for people with other cancers. There is no doubt that you can use mind/body techniques to alleviate the anxiety, stress and uncertainty that accompany a cancer diagnosis, and to help you get back to a normal-feeling life.
Supplements and nutraceuticals

These constitute a confusing array of products you can buy in your local health food store. Dr. Chang stressed the importance of understanding what each product you take is supposed to do for you.. .a very tall order, that is best accomplished with the help of a healthcare professional who is trained and experienced in this area, A product should interfere with one or more specific steps in the development, growth and spread of cancer, or should help your body fight the cancer in some well-defined way. If you are actively fighting cancer, Dr. Chang recommends against taking multivitamins or other mixtures, because it’s more difficult to adjust the amounts of individual substances you need, and they often have things in them that you should avoid altogether.Supplements include relatively simple, well-defined molecules like vitamins and minerals, While many brands are available in your local health food store, they are manufactured by only a few large facilities, so there is little difference among them. Nutraceuticals include complex substances derived from plant (botanicals or herbs) and animal sources (e.g., cartilage, thymus extracts, etc.), Because the preparation methods are not standardized, different brands and even different batches of the same brand can have widely different properties and activities.Dr. Chang discussed the use of Vitamin to relieve hot flashes arising either from chemotherapy treatments that put you into early menopause, or from tamoxifen therapy. While Vitamin F doesn’t work for everyone, it’s a good, estrogen-free approach that works for many women. There are many different forms of vitamin E: alpha-tocopherol, beta-tocopherol, gamma-tocopherol, tocotrienols, for example. Although many capsules contain alpha-tocopherol alone, it is preferable to take “mixed tocopherols’ or “naturally occurring vitamin E.”, Read the label carefully. And be aware that Vitamin E’s antioxidant effect can interfere with radiation’s ability to kill cancer cells.Coenzyme Q10 (CoQ10) is a small molecule that helps certain enzymes produce energy. This process occurs in nearly every cell in the body and is particularly important in the heart muscle. Taking CoQ10 may partially protect the heart against damage caused by high doses of some chemotherapy drugs, like adriamycin.Selenium is an essential trace mineral with anti-oxidant properties. In the laboratory, selenium interferes with the development of new cancers. Prevention trials in humans suggest that supplementing selenium in the diet may protect against some types of cancer: primary liver cancer in a high-risk population in China; lung, prostate, colorectal cancer in a group of patients in the U.S. who had been treated for skin cancer. The latter trial demonstrated no reduction in recurrence of the patients’ skin cancers, and an unsettling, although not statistically significant, increase in breast cancer. (Editor’s note: The numbers of breast cancer cases in the control and selenium groups were too small to have statistical significance. Nevertheless, Dr. Chang cautions women with a history of breast cancer, or at high risk for breast cancer, against selenium Supplementation.) Selenium is included in some alternative cancer treatments, but there is no trial proving that selenium improves the course of breast cancer.
Other supplements include
  • Vitamin D – clearly important in maintaining healthy bones, and laboratory studies suggest a role in fighting cancer;
  • Vitamin C – no evidence that it helps fight breast cancer, but moderate amounts (1000 mg per day) are not harmful;
  • Niacin and copper promote new blood vessel growth in the laboratory helping tumors grow larger, so avoid these;
  • Boron – a mineral that elevates estrogen levels, so should not be taken if you are trying to keep your estrogen levels down.
Plant products form the foundation of many traditional approaches. Because herbs are not regulated as drugs in the US, there is a temptation to self-medicate. While herbs have relatively few side effects, it is important to remember that they do have biological activities, Consulting with someone who has formal training and experience In the use of herbs for medicinal purposes can help you identify useful products and avoid things that might be harmful to you. For example, there are many mushrooms (e.g., shiitake, reishi) that are useful in treating cancer, although there are inadequate studies with a widely advertised mushroom product, the Maitake D fraction. Many herbs have weak estrogenic activity. These include ginseng (Asian “red” and American), peony, red clover, black cohosh, flax, licorice, angelica (commonly known as Dang Quai or Dong Gui), bupleurum (“Cai Hu”), and many other herbs used in women’s formulae, PMS formulae, menopause formulae, etc. Women who have had an estrogen receptor positive tumor and women at high risk for developing breast cancer would be wise to avoid these products. Enzymes from plants like pineapples (bromelain) and papaya (papain) are used in Europe to – treat cancer in the alternative medicine setting. These preparations inhibit cell stickiness and limit cancer progression. Other botanicals, such as una de gato, pau d’arco, and noni juice, are advertised as cancer cures, but there are no convincing studies to back up these cIaims.The hormone melatonin “gets no respect” in the U.S., probably because it is available without a prescription, and is relatively inexpensive. Several controlled trials in Italy and England have shown that melatonin is effective against many types of cancer, in combination with chemotherapy radiation therapy, and immunotherapy. Based on these studies, melatonin is used in Europe as a prescription drug to treat cancer, Shark cartilage is a different story. Injected into laboratory animals, it has proven effective in cutting off the blood supply to tumors (anti-angiogenic activity).. It is available in pill, capsule and flavored powder forms. So far, cancer trials in humans have been disappointing. One possible explanation for the lack of activity in people is that the antiangiogenic factors in shark cartilage are small proteins which, if swallowed, are largely digested in the stomach before they have a chance to get into the blood, A phase III trial is currently underway to see if an extract that is placed under the tongue has cancer fighting activity, by getting directly into the blood without going through the stomach, The shark cartilage story illustrates the fact that even if a product works in the laboratory, that doesn’t necessarily translate immediately into a useful product for people.
In summary…
Finally, Dr. Chang urges you always to work with conventional medicine. Talk with your doctor to encourage an open mind towards alternative treatments. Much of today’s acceptance of these approaches has come from the consumers, the patients. The choice of an overall program should be based on the type and stage of cancer and the goals of treatment (e.g., for alleviation of side effects or for prevention of cancer), choosing agents with the most evidence of their effectiveness, and at the lowest cost. “Ultimately, Dr. Chang believes that “integration of the natural, complementary modalities and conventional modern medicine will lead to healing and the saving of lives.