Shorts

briefed by Jule Klotter

Blue Scorpion Venom Remedy for Cancer Pain

Escozul and Vidatox have relieved pain and improved life quality in thousands of cancer patients, according to Cuban research. Escozul contains peptides found in blue scorpion (Rhopalurus junceus) venom. Vidatox is a homeopathic preparation of the same peptides. Cuba’s LABIOFAM, a government-owned research institute, developed Escozul. As part of its research program, the institute provided Escozul to thousands of cancer patients worldwide free of charge until 2011.

A 2012 Italian case report, published in the Open Cancer Journal, offers an example of Escozul’s reported ability to relieve pain and improve life quality in cancer patients. L. DiLorenzo and colleagues present the case of a 69-year-old man who had previously undergone surgical treatment for gastric cancer. Late in 2009, the man experienced an inoperable relapse. In January 2010, he began opioid management for pain (7 out of 10 on the Pain Visual Analogical Scale). As the pain increased over the next seven months, doctors increased the medications that included the Fentanyl patch (50 mcg) and morphine. In September 2010, his family asked the doctors to try Escozul, an oral preparation. “After only 18 days,” the authors state, “he was able to stop opioid and he did not get any pain killer from November to the last week of February 2011. From October to February 2011 he achieved an unexpected good pain relief with an effectiveness of about 90% (Pain VAS of 7.5 was reduced to … about 1.5).” The patient died in March 2011 from a sudden myocardial infarction. Although the authors deplore the anecdotal quality of Cuba’s Escuzul research reports, their experience with this patient and a few others caused them to conclude: “ … this venom certainly warrants further investigation.”

As patient interest in Escozul increased, LABIOFAM researchers realized they could not meet the demand; it would deplete the blue scorpion population. Instead of creating and patenting a synthetic version of the peptides, researchers turned to homeopathy. They produced and began testing a highly-dilute/homeopathic version of Escozul, called Vidatox. The homeopathic version produced the same benefits. Cuban researchers report patient improvement in pain, inflammation, hematological parameters, appetite, and general health along with weight gain and increased desire to live. Like Escozul, Vidatox is effective for tumors of epithelial origin but not on lymphomas and leukemia, according to Alexis Diaz, master in experimental pharmacology at LABIOFAM. A study involving 845 people with advanced-stage breast, lung, colon, prostate, or cervical cancer found that 87% of the patients reported improved appetite and decreased pain after six months of treatment (five sublingual drops every 12 hours). Like the Italian patient, responders were able to stop using morphine. Vidatox is now available in South and Central American, Europe, Asia, Cuba, and the Caribbean region. It costs $250 (US) per month of treatment.

Di Lorenzo L, Palmieri C, Cusano A, Foti C. Cancer pain management with a venom of blue scorpion endemic in Cuba, Called Rhopalurus junceus “Escozul.” Open Cancer J. 2012;5:1–2. Available at http://italia.lifescozulcuba.com/paper_2012.pdf Accessed May 20, 2013.

ESCOZUL: frequently asked questions (FAQs) [Web page]. www.Escozul-Cancer.com. www.escozul-cancer.com/en/escozul-questions.html. Accessed June 5, 2013.

McLeod S. Effective cancer treatment with popular Cuban homeopathic drug Vidatox [blog entry]. Homeopathy Vancouver BC. November 8, 2011. https://littlemountainhomeopathy.wordpress.com/2011/11/18/effective-cancer-treatment-with-popular-cuban-homeopathic-drug-vidatox. Accessed June 5, 2013.

———. Vidatox for cancer: 2012 update [blog entry]. October 23, 2012. Homeopathy Vancouver BC. http://littlemountainhomeopathy.wordpress.com/2012/10/23/vidatox-for-cancer-2012-update. Accessed June 5, 2012.

Bt Crop Proteins Toxicity

For decades, farmers – including organic farmers – have sprayed Bacillus thuringiensis (Bt), a spore-forming bacterium, on crops as an insecticide. Bt produces crystal proteins (cry proteins) that are toxic to the larvae of many insect species. Bt is not viewed as a threat to mammals. Because of its perceived safety, the US Environmental Protection Agency (EPA) “ … has exempted Bt from food residue tolerances, groundwater restrictions, endangered species labeling and special review requirements,” according to a University of California-San Diego website.

US government agencies consider the Bt proteins produced by genetically-modified (GM) crops to be the same as natural Bt toxins. However, toxins produced by GM crops “ … are truncated, adapted and modified synthetic sequences [of natural Bt cry proteins]; consequently their activity is possibly quite different from the natural ones,” according to R. Mesnage and European colleagues. In addition, the toxins produced by GM plants “are in soluble forms, and thus already biochemically activated,” write Mesnage et al., citing a study by Hilbeck and Schmidt (Another view on Bt proteins – how specific are they and what else might they do? Biopet. Int. 2006;2[1]:1–50).

Mesnage et al. tested Cry1Ab and Cry1Ac, two of the Bt toxic crystal proteins found in GM crops, on human cells. The researchers observed respiration inhibition and plasma membrane alterations in human embryonic kidney cells that were exposed to CrylAb. In vitro testing, such as this, does not always predict in vivo responses. Mesnage and colleagues say, “In vivo implications should be now assessed. Our results raise new questions in the risk assessment of food and feed derived from genetically engineered plants.”

A 2013 in vivo study, conducted by Bélin Poletto Mezzomo and Brazilian colleagues, examined blood cells in Swiss albino mice. Groups of six mice were tube-fed a single Bt protein (Cry1Aa, Cry1Ab, Cry1Ac, or Cry2A) in distilled water. Control mice received filtered water (negative control) or cyclophosphamide (CP – positive control). Dosages were higher than typically consumed via diet. Groups received 27 mg/Kg, 136 mg/Kg, or 270 mg/Kg of a cry protein. (Amounts above 270 mg/Kg produced toxicity and death in earlier experiments.) In addition to testing different doses, the researchers used different time intervals. Mice were euthanized 24 hours, 72 hours, or seven days after receiving the cry protein. Also, combinations of two Bt proteins were tested at 270 mg/Kg and 24 hours.

Blood samples, collected after animals were euthanized, were analyzed with an automated hematologic analyzer and visually assessed for variation in blood cell size; change in red blood cell shape, color, and maturation; hemagglutination; and erythrocyte rouleaux. In addition bone marrow cells were removed and examined with a microscope. All Bt spore crystals significantly reduced mean corpuscular volume and bone marrow cell proliferation. The spore crystals also produced anemialike effects, such as increased microcytosis (abnormally small red blood cell) and hypochromia (deficient color). The cytotoxic effect on red blood cells became increasingly evident as time lengthened – even though “Bt toxins do not bioaccumulate in fatty tissue or persist in the environment.” The Brazilian researchers say, “This finding corroborates literature that demonstrated that alkali-solubilized Bt spore-crystals caused in vitro hemolysis in the cell lines of rat, mouse, sheep, horse, and human erythrocytes and suggested that the plasma membrane of susceptible cells (erythrocytes, in this case) may be the primary target for these toxins.”

In animal feeding studies using real-world GM exposure, Bt corn causes GI inflammation. A 2008 mouse study, led by A. Finamore, showed that young and old mice eating Bt MON810 maize displayed alterations in gut and peripheral immune response not found in controls. More recently, a 2013 feeding study, led by Judy A. Carman, found that weaned pigs eating GM soy and corn (including Bt) commercial feed displayed severe stomach inflammation at autopsy. In addition, the uteri of female pigs in the GM feed group weighed 25%more than uteri from female pigs in the control group. The control group ate a non-GM soy and corn feed. Veterinarians who performed the autopsies were blinded to the animals’ diet. More long-term, real-world studies are needed.

Cry1Ab has been found in the blood of Canadian women and in their babies – presumably due to diet. In 2011, Aziz Aris and Samuel Leblanc found the first evidence that Cry1Ab crosses the placenta. They measured Cry1Ab and metabolites of glyphosate and gluphosinate herbicides in the blood of 39 nonpregnant women and 30 pregnant women, and in the umbilical cord blood of their infants in Quebec, Canada. They reported finding Cry1Ab in 93%of the pregnant women, in 80%of their babies, and in 69%of blood samples from nonpregnant women. This Bt toxin caused microcytic hypochromic anemia in mice, “even at the lowest tested dose of 27 mg/Kg” in the Mezzomo-led Brazilian study.

In response to Canadian study, four Monsanto-employed researchers say that “the number of Cry1Ab detects is likely overstated … .” They also point out that “very little corn is consumed by humans in a raw state, and cooking denatures Cry1Ab protein eliminating its biological (insecticidal) activity.”

Genetically modified Bt was not supposed to affect mammals, according to the biotech industry. Clearly, the initial assumption that genetically modified Bt proteins function the same as natural Bt proteins is flawed. More long-term, independent research is needed.

Animal Safety. Bacillus thuringiensis. www.bt.ucsd.edu/bt_safety.html. Accessed May 17, 2013.

Aris A, Leblanc S. Maternal and fetal exposure to pesticides associated to genetically modified foods in Eastern Townships of Quebec, Canada. Reprod Toxicol. 2011. doi:10.1016/j.reprotox.2011.02.004. Available at http://ddococktailhour.com/files/0/8/7/4/3/244299-234780/BTinpregnantwomen.pdf. Accessed May 20, 2013.

Carman JA, Vlieger HR, Ver Steeg LJ et al. A long-term toxicology study on pigs fed a combined genetically modified (GM) soy and GM maize diet.” J Org Syst. 2013;8(1):38–54. Available at www.gmojudycarman.org/new-study-shows-that-animals-are-seriously-harmed-by-gm-feed. Accessed June 12, 2013

Finamore A, Roselli M, Britti S, et al. Intestinal and peripheral immune response to MON810 maize ingestion in weaning and old mice [abstract]. J Agri Food Chem. Dec 10,2088;56(23):11533–11539. Available at www.ncbi.nlm.nih.gov/pubmed/19007233. Accessed June 11, 2013.

Goldstein DA, Dubelman S, Grothaus D, Hammond BG. Comment: Aris and Leblanc “Maternal and fetal exposure to pesticides associated to genetically modified foods in Eastern Townships of Quebec, Canada.” Reprod Toxicol. 2012:33;120–121. Available at http://www.ask-force.org/web/HerbizideTol/Goldstein-Comment-Aris-LeBlanc-Materinal-2011.pdf. Accessed May 20, 2013.

Mesnage R, Clair E, Gress S, Then C, Székács A, Séralini G-E. Cytotoxicity on human cells of Cry1Ab and Cry1Ac Bt insecticidal toxins alone or with a glyphosate-based herbicide. J Appl Toxicol. 2011. Available at http://gmoseralini.org. Accessed May 17, 2013.

Mezzomo BP, Miranda-Vilela AL, de Souza Freire I, et al. Hematotoxicity of Bacillus thuringiensis as spore-crystal strains Cry1Aa, Cry1Ab, Cry1Ac or Cry2Aa in Swiss albino mice. J Hemato Thromb Dis. 2013;1(1). Available at http://gmoevidence.com. Accessed May 17, 2013.

What is Bt? [Web page]. Bacillus thuringiensis. www.bt.ucsd.edu/what_is_bt.html. Accessed May 17, 2013.

The Economic Cost of Cancer

Cancer patients in western Washington State are 2.65 more likely to go bankrupt than age- and gender-matched controls living in the same zip code, according to a 2013 study led by Scott Ramsey. High treatment costs and lost income (when patients are unable to work) can seriously jeopardize the economic health of cancer patients and their families – even if medical insurance pays for much of the treatment. This study uses objective data to show that medical treatment costs for serious illnesses, such as cancer, contribute to bankruptcy risk in the US

The researchers used western Washington’s population-based cancer registry (part of National Cancer Institute’s Surveillance Epidemiology and End Results [SEER] program) to identify people diagnosed with cancer between January 1, 1995, and December 31, 2009. They excluded patients who were diagnosed before age 21, those with very early-stage cancer, and those whose cancer was determined after death. The researchers then looked for control subjects with the same gender, year of birth, and residential zip code using LexisNexis, a giant database containing public records. The researchers found control matches for 86%of the 228,430 eligible cancer patients (n = 197,840). The two matched cohorts were then run through US Bankruptcy Court records for western Washington.

In addition to finding higher bankruptcy rates among cancer patients, the researchers were able to identify subgroups that were particularly vulnerable. Bankruptcy rates were highest among people with lung cancer and thyroid cancer. Thyroid cancer is not as debilitating as lung cancer; but thyroid cancer tends to affect younger women. “Compared to men, younger women are more likely to live in single-income households and to have lower wages and lower rates of employment, and therefore less access to high-quality health insurance – leaving them more financially vulnerable,” the authors explain. Overall, cancer patients who were younger, female, and nonwhite with localized/regional stage disease at diagnosis had the greatest risk of filing for bankruptcy.

Cancer patients who were least likely to file bankruptcy in this study were aged 65 and older, the age group that receives Medicare and Social Security benefits. Generally, this group also has more assets than younger people. The authors say, “ … it is likely that having stable [and affordable] insurance (specifically, coverage not tied to employment) plays a major role in mitigating the risk of bankruptcy for those over age sixty-five.” But what happens when stable insurance is disrupted?

The mandated “sequester” cuts that took place April 1, 2013, spotlighted the vulnerability of Medicare and another financial aspect of cancer treatment: the cost of chemotherapy drugs. Some oncology clinics reported that they would have to turn away Medicare cancer patients being treated with expensive drugs because of reductions in Medicare reimbursements, according to the Washington Post. “’The drugs we’re going to lose money on we’re not going to administer right now,’” a clinic administrator told the Post. Some cancer drugs cost over $100,000 per year of treatment. Over 100 cancer specialists have asked pharmaceutical companies to lower prices. “Prices for the drugs are twice as high in the United States as in many other countries, which often apply some government pressure or price controls to keep drug costs down,” according to a New York Times article.

As part of their analysis, Ramsey and colleagues looked at the effect of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005. This legislation was designed to make it more difficult for people to discharge debts. The number of personal bankruptcies fell drastically after the law passed – 2.0 million in 2005 to less than 600,000 in 2006. Since the initial decline, however, the law has not prevented people with major medical bills from filing for bankruptcy protection. The authors report, “By 2009, the end of our study period, bankruptcy rates for cancer patients were approaching levels seen prior to implementation of the 2005 bankruptcy law, with a strong upward trend.”

The term cost-benefit takes on new meaning when practitioners become aware that expensive treatment can push patients and their families into bankruptcy. “We believe that cancer care facilities and oncology practitioners should assess the financial health of their patients as a matter of course,” the authors state. “ … this study underlines the importance for cancer care providers of carefully considering the use of services that have limited evidence of substantial benefit and potential high out-of-pocket costs.”

Pollack A. Doctors denounce cancer drug prices of $100,000 a year. New York Times. April 25, 2013. Available at http://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html?pagewanted=all&_r=0. Accessed May 17, 2013.

Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff. 2013;32(6). doi:10.1377/hlthaff.2012.1263. Available at http://cdn.getoutofdebt.org/wp-content/uploads/2013/05/bankruptcy-and-cancer.pdf Accessed June 5, 2013.

Steele MF. Cancer patients unintended victims of budget cuts. HealthDay News. April 4, 2013. Available at http://www.webmd.com/cancer/news/20130404/cancer-patients-may-be-unintended-victims-of-budget-cuts. Accessed June 5, 2013.

Curcumin Anticancer Effects

Curcumin, the compound that gives turmeric (Curcuma longa) its yellow color, has multiple therapeutic biological effects, according to a 2012 review paper by Subash C. Gupta and colleagues at the University of Texas M. D. Anderson Cancer Center (Houston, Texas). Laboratory experiments have revealed that curcumin interferes with the process of tumor formation in multiple ways, such as modulating cellular reproduction and regulating tumor suppressor pathways. Rodent studies indicate that curcumin protects against colon, esophageal, lung, kidney, stomach, liver, mouth, breast, bladder, leukemia, skin, small intestine, pancreatic, brain, and prostate cancers. The compound also increases cancer cell death. In vitro tests show that curcumin induces apoptosis in a variety of tumor cells. Studies in which human cancers (i.e., cholangiocarcinoma, lymphoma, melanoma, and prostate, pancreatic, colorectal, hepatocellular, breast, ovarian, and bladder cancers) have been transplanted into laboratory animals show further evidence of curcumin’s potential for treating cancer. In addition to preventing and treating cancers, curcumin has anti-inflammatory and antioxidant effects, promotes wound healing, and works as an antiparasitic, antimalarial, and antibacterial agent.

About 50 phase I/II clinical trials have been completed, according to Gupta and colleagues. Results attest to the compound’s safety, and the FDA has categorized it as “generally regarded as safe.” Trials also indicate therapeutic effects for several conditions including cancer; inflammatory conditions; skin, eye, and neurological disorders; diabetic nephropathy; and pain. More evidence is needed before the FDA will approve its use as a treatment.

Before curcumin can become a reliable therapy, researchers must find a way to increase its bioavailability. Most trials that show therapeutic efficacy use high amounts of curcumin or turmeric. One study found that taking curcumin with piperine (the primary active compound in pepper) increased bioavailability by 2000%. Without piperine, a 2 gram dose of curcumin produced “either undetectable or very low” serum curcumin levels. Japanese researchers are testing a proprietary curcumin product (Theracurmin) that produced significantly higher median curcumin serum levels than a single 8 gram dose of conventional curcumin. Gupta and colleagues say, “Other promising approaches to increase the bioavailability of curcumin include use of nanoparticles, liposomes, micelles, phospholipids complexes, and structural analogues.”

Borger JE. How curcumin protects against cancer. Life Extension. Collector’s Edition 2012;117–124.

Gupta SC, Patchva S, Koh W, Aggarwal BB. Discovery of curcumin, a component of the golden spice, and its miraculous biological activities. Clin Exp Pharmacol Physiol. March 2012;39(3):283–299. Available at http://europepmc.org/articles/PMC3288651/reload=1;jsessionid=eqk2uOp3llwcXOfuu81E.6 Accessed May 20, 2013.

Kanai M, Otsuka Y, Otsuka K, et al. A phase I study investigating the safety and pharmacokinetics of highly bioavailable curcumin (Theracurmin^® ) in cancer patients. Cancer Chemother Pharmacol. March 30, 2013; online publication. Available at http://www.bioclinicnaturals.com/images/PIM/BioclinicCanada/Products/164__Theracumin%20in%20Cancer%20Phase%20I%202013.pdf.pdf. Accessed May 20, 2013.

Homeopathic Medicines

and

Cancer

Specific homeopathic medicines inhibit tumor growth in animals, according to multiple experiments conducted at India’s Amala Cancer Research Centre (Amala Nagar, Thrissur, Kerala). Indian researchers are investigating the effects of highly dilute, potentized preparations of Ruta (rue), Hydrastis (goldenseal), Lycopodium (club moss), and Thuja (arbor vitae/cypress). A 2007 study, led by K. B. Hari Kumar, tested the medicines’ ability to inhibit liver cancer in rats fed N’-nitrosodiethylamine (NDEA) and sarcoma in mice injected with 3-methylcholanthrene (3-MC). Six groups of 15 rats were given 2.5 mL of NDEA, five days a week for 20 weeks. Rats in five of the groups also received a daily dose of Ruta 200C, Lycopodium 200C, Hydrastis 200C, Thuja 200C, or ethanol (the carrier for the homeopathic medicines), following the same schedule. A seventh group (n = 6) received no treatment or NDEA. The control groups (NDEA alone and NDEA + ethanol) “showed extensive areas of necrosis, hemorrhage and multiple foci of carcinomatous changes.” In comparison, rats treated with any of the four homeopathic medicines had fewer tumor nodules than the controls. Of particular note, the Ruta group “retained the normal morphology of the liver with small necrotic masses seen in the large lobe of some animals.”

In the sarcoma experiment, three groups of mice were given one subcutaneous injection of 3-MC. The control group received no further treatment. The other two groups were given a daily dose of either Ruta 200C or a homeopathic preparation of Phosphorus 1M, six days a week for 20 weeks. The mice were observed for an additional 10 weeks. All 20 mice in the 3-MC control group developed sarcomas by the end of the 16th week. In comparison, 4 of 20 mice treated with Phosphorus 1M and three of 20 treated with Ruta developed sarcomas within the same time period. At study’s end, a total of 5 Phosphorus-treated mice and 6 in the Ruta group had developed sarcomas. The homeopathics also increased survival time: 14 of 20 Phosphorus-treated mice and 9 of 20 Ruta-treated mice were alive at the end of 30 weeks. All 20 control mice were dead by the end of week 20.

Another 2007 Indian study, this one led by E. S. Sunila, performed several experiments with mice to evaluate the effects of Ruta 200C, Hydrastis 200C, Thuja 1M, Lycopodium 1M, and Hydrastis 1M on solid tumor formation and metastasis. (1M is a more dilute, higher-potency preparation than 200C.) In the first experiment, three groups of mice (eight mice/group) were injected with Ehrlich Ascites Carcinoma cells in the peritoneal cavity. One group acted as a control. The other two groups were given an oral dose of either Ruta 200c or Hydrastis 1M, once a day for 10 days, beginning 24 hours after the injection. “Administration of Ruta 200c increased the lifespan of tumour bearing animals by 49.7% whereas the Hydrastis 1M increased the lifespan by 69.4%,” write the authors.

In another experiment, three groups of mice (eight mice/group) were injected with Dalton’s lymphoma ascites (DLA) cells in a hind leg. One group acted as a control. The other two groups were given an oral dose of either Ruta 200c or Hydrastis 200c, once a day for 12 days, beginning the same day as the injection. Tumor diameters were measured on day 7 and every 3 days thereafter for 31 days. On day 19, tumor volume in the Ruta group was 54.8% less than the control. Tumor volume in the Hydrastis group was 53.1% less than control. At study’s end, tumor volume in the Ruta group was 95.6% less than control. Tumor volume in the Hydrastis group was 95.8% less.

In a third experiment, 30 mice were injected with DLA cells in the hind leg. The mice were divided into two groups on day 30 when tumor volume measured 2 cc. One group received Hydrastis 1M for 20 days while the other got potentized water (agitated as if a homeopathic) as the control. Tumor size did not increase in 9 of 15 mice after Hydrastis treatment began. Four of the group died by day 70, and 2 more died by day 95. The remaining 9 in the Hydrastis group “remained tumour free up to 120 and thereafter.“ In comparison, tumor volume increased in the control group, and all 15 control mice were dead by day 55.

A fourth experiment investigated the homeopathic medicines’ effect on metastasis. Fifty mice were injected in the lateral tail vein with melanoma cells and divided into five groups of 10. One group acted as untreated control. The remaining groups received potentized water, Thuja 1M, Hydrastis 1M, or Lycopodium 1M for 10 days, beginning on the day of contamination. After 21 days, the mice were killed and their lungs were examined for tumor nodules. Control animals and those receiving potentized water had “massive tumours in the intra-alveolar regions of the lungs” and over 250 tumor nodules in their lungs. In comparison, mice receiving homeopathic treatment had fewer nodules per lung: 110.5 ±14.3 in the Thuja group, 183.4 ±16.2 in the Hydrastis group, and 146.5 ± 20.2 in the Lycopodium group. The alveolar region of lungs in the Thuja and Lycopodium groups were “almost free” of tumors. “In the animals treated with Thuja 1M,” the authors report, “the lung morphology was similar to that of normal.”

Neither of these 2007 studies say whether or not the researchers were blinded. Blinding the researchers would prevent biased evaluation and treatment of animals. Also, it is possible that researchers’ positive or negative energy/thoughts about a group’s treatment could affect outcome. Blinding those who administrate the treatments would lessen that concern.

The significant responses in these experiments certainly deserve more investigation.

Hari Kumar KB, Sunila ES, Kuttan G, Preethi KC, Venugopal CN, Kuttan R. Inhibition of chemically induced carcinogenesis by drugs used in homeopathic medicine. Asian Pac J Cancer Prev. 2007;8:98–102. Available at www.audesapere.in/researchstudies/fr/fr40.pdf. Accessed May 17, 2013.

Sunila ES, Kuttan G, Preethi KC, Kuttan R. Effect of homeopathic medicines on transplanted tumors in mice. Asian Pac J Cancer Prev. 2007;8(3):390–394. http://www.apocpcontrol.net/paper_file/issue_abs/Volume8_No3/390-394%20c_Kuttan%205.pdf. Accessed May 17, 2013.

Hormone Replacement and Breast Cancer

Women who begin estrogen-progestin hormone therapy near menopause have a higher risk of breast cancer than those who start hormone replacement therapy (HRT) later, according to a 2013 observational study led by T. Rowan Chlebowski. “Women initiating hormone therapy closer to menopause had higher breast cancer risk with linear diminishing influence as time from menopause increased (P<.001),” say the authors. Giving additional estrogen to women who are still producing some estrogen may account for the higher risk. Chlebowski and colleagues used a cohort of 41,449 postmenopausal women from the Women’s Health Initiative observational study for their analysis: 25,328 never used HRT, and 16,121 used combined estrogen-progestin.

This study also found that all women, including those who begin estrogen-progestin hormone therapy years after menopause, have a higher risk of breast cancer than nonusers: “After a mean of 11.3 (SD-3.1) years, with 2236 breast cancers, incidence was higher in estrogen plus progestin users than in nonusers (0.60% vs 0.42%, annualized rate, respectively; HR=1.55, 95% CI=1.41 to 1.70, P< .001).” Breast cancer survival rates were nearly the same between hormone users and nonusers.

This analysis of WHI data does not prove causality, but it does support a need for caution. “Women should seriously consider whether their symptoms, such as hot flashes and night sweats, are limiting enough to warrant taking hormones, Chlebowski said,” according to HealthDay News.

For women with severe symptoms, bioidentical hormone replacement therapy (BHRT) may be a safer option. Bioidentical hormone therapy does not have the risks of standardized estrogen-progestin products, according to Kent Holtorf, MD. In his literature review, Holtorf points to a 2007 study, led by A. Fournier, that followed over 80,000 postmenopausal women for more than eight years. “Compared with women who had never used any HRT, women who used estrogen only (various preparations) had a nonsignificant increase of 1.29 times the risk for breast cancer (P=0.73). If a synthetic progestin was used in combination with estrogen, the risk for breast cancer increased significantly to 1.69 times that for control subjects (P=0.01). However, for women who used progesterone in combination with estrogen, the increased risk for breast cancer was eliminated with a significant reduction in breast cancer risk compared with synthetic progestin use (P=0.001),” says Holtorf. In addition to using bioidentical progesterone instead of progestins, BHT employs a combination of estrogens, such as estriol. Estriol binds to estrogen receptor-β, which inhibits proliferation and prevents breast cancer development via G2 cell cycle arrest.

Although basic science and some clinical results indicate that BHRT has fewer negative effective and greater efficacy than estrogen-progestin therapy, clinical trials on BHRT’s safety in long-term use have not yet been performed.

Chlebowski RT, Manson JE, Anderson GL, et al. Estrogen plus progestin and breast cancer incidence and mortality in the Women’s Health Initiative Observational Study [abstract]. J Natl Cancer Inst. March 29, 2013 (online); 105(8):526–535. Available at http://jnci.oxfordjournals.org/content/105/8/526. Accessed May 16, 2013.

Doheny K. More evidence shows hormone therapy may increase breast cancer risk [online article]. HealthDay News. March 29, 2013. http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/more-evidence-shows-hormone-therapy-may-increase-breast-cancer-risk-674839.html. Accessed May 16, 2013.

Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the EsN cohort study. Breast Cancer Res Treatment. January 2008; 107(11):103–111. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383. Accessed June 6, 2013.

Holtorf K. The bio-identical hormone debate: are bioidentical hormones safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? [online article]. October 3, 2009. Available at www.antiagingdoctor.co.za. Accessed May 17, 2013.

Integrative Oncology Programs

Integrative oncology care employs the conventional therapies surgery, chemotherapy, and radiation therapy as well as evidence-based complementary therapies, such as acupuncture, massage therapy, and mind-body techniques. These complementary therapies are used to reduce the adverse effects of conventional therapy and/or increase its effectiveness. Complementary therapies can also relieve cancer symptoms, promote emotional health, and improve well-being. Ideally, an integrative oncology program involves collaboration between oncologists and complementary medicine professionals to provide holistic care to patients. The concept of integrative oncology care is new, and offerings to patients differ.

D. M. Seely, L.C. Weeks, and S. Young recently performed a review of integrative oncology programs, focusing on programs’ development and operation. They searched databases, journals, and conference abstracts as well as contacting experts to identify 29 integrative oncology programs: 12 in the US, 10 in England, 3 in Canada, 2 in Germany, and no reported location for 2. The researchers did not include programs that used alternative therapies in place of conventional ones.

The structure of these 29 programs varies greatly. Some treat any type and stage of cancer; others focus on breast cancer alone. Only 12 provide conventional and complementary care at the same location. Eight other programs consist of collaboration between several conventional clinics and a single complementary treatment center at another location. In 9 of the 29 programs, conventional and complementary care practitioners meet to discuss and coordinate individual patient care. Over half of the programs (n = 16) have a research program or evaluation strategy: “All programs have framed their research program in terms of the use of complementary therapies for cancer- and cancer treatment-related symptoms, but not as a cancer cure.”

The programs include diverse complementary therapies, most of which primarily address psychoemotional well-being. Mind-body therapies (e.g., relaxation, meditation) and massage are offered by 20 out of 29 programs. Nutrition counseling (n = 16) and acupuncture (n = 15) are the next most common. Other complementary therapies include counseling, art therapy, yoga, reflexology, music therapy, aromatherapy, Reiki, hypnotherapy, support groups, spiritual therapy, tai chi, qi gong, homeopathy, shiatsu, touch therapy, social work, and exercise counseling. Inclusion of a specific complementary therapy is usually based on research evidence, patient demand, and clinical experience.

Seely and colleagues offer this review as a starting point for the establishment of other integrative oncology programs: “If people working in these environments continue to publish descriptions of their experiences with program development and operation, including evaluations of the process and outcomes of their programs, the field can continue to demonstrate value that can translate across disciplines in oncology and within an evolving health care system.”

Seely DM, Weeks LC, Young S. A systematic review of integrative oncology programs. Curr Oncol. 19;e436461. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503675. Accessed May 17, 2013.

Language and Cancer

“Language has the interesting property of being able to increase and decrease our perceptions of control. Different word choices can direct our thoughts about a single situation in many different ways,” writes psychologist Ellen Langer, PhD, in “Can Words Cure Cancer?” For example, why do we accept that the body can successfully fight and cure the common cold? Why do we say we’re cured even though a cold may recur every year? Why don’t we say that a cold is in remission? “Each time we beat a cold, we become more persuaded that we can beat the next one,” writes Langer. “ … Most of us are oblivious to the idea that there is any choice involved. We were simply led early on to believe that we can master colds, that each one is different from the last.”

In contrast, patients are too often told that the cancer is in remission rather than cured. “If two people go for a checkup to see if they have cancer,” Langer writes, “and one never had the disease while the other person is in ‘remission,’ the test results look the same. Psychologically, however, ‘remission’ may be very different from a ‘cure.’ … Being in ‘remission’ means that we are waiting for ‘it’ to return.” If a practitioner is reluctant to deem a patient ‘cured’, what would be the harm in saying the patient ‘beat that cancer’? Wouldn’t the image of victory over an opponent be more empowering than the image of waiting for a foe to return for another assault? Some may discard this as inconsequential, but decades of mind-body research show that thought and emotions that accompany those thoughts affect physiology.

Langer has studied the effects of mindfulness without meditation for over 40 years. Mindfulness “is the simple process of noticing new things,” she explains in “Is It a Tragedy or an Inconvenience?” “When we notice new things about people or ideas that we think we know, we come to see that we didn’t know them as well as we thought we did. … ” The attitude of exploration and possibility, of noticing new things “engages” us and puts us in the present. When we are in the present, we may discover new options or solutions. To Langer, this engagement in the present is mindfulness.

Mindlessness is when we follow well-worn paths and assumptions without question. Being mindless, being on automatic pilot, allows fears about the future and blame about the past take over, creating stress. “It is the mindless view of events that leads to stress,” she writes in “Is It a Tragedy or an Inconvenience?”

“Health is more than the absence of illness and our mindsets may be the cause of unnecessary limits,” she says. Being mindful, being aware of the language we use around illness and health, can be empowering.

Langer EJ. Can words cure cancer? Psychology Today. July 1, 2000; May 28, 2008 (last review). Available at www.psychologytoday.com/articles/200007/can-words-cure-cancer. Accessed May 20, 2013.

———. “Counterclockwise: Mindful Health and the Power of Possibility” [online video]. Happiness & Its Causes. http://www.happinessanditscauses.com.au/presentation-2012-counterclockwise-mindful-health-and-the-power-of-possibility-113641.stm. Accessed May 20, 2013.

———. Is it a tragedy or an inconvenience? [blog post]. Ellen Langer. http://www.ellenlanger.com/blog/168/is-it-a-tragedy-or-an-inconvience.%20Accessed%20May%2020. Accessed May 20, 2013

Ruark J. The Art of Living Mindfully. Chronicle Review. January 3, 2010. Available at http://chronicle.com/article/The-ARt-of-Living-Mindfully/63292. Accessed May 20, 2013.