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Women's health update.

Aspirin and Breast Cancer Risk

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have been hypothesized to lower the risk for breast cancer. It is thought that inhibition of cyclooxygenase-2 and the resulting suppression of the aromatase enzyme necessary in converting androgens to estrogen could be a mechanism for lowering breast cancer risk. Data from the Nurses' Health Study II was used to assess associations between use of aspirin, other NSAIDs, or acetaminophen (serving as the control group) and breast cancer in 112,000 premenopausal women over the course of 14 years. (1) In more than 1300 cases of invasive breast cancer in premenopausal women that occurred, there was no consistent association observed between use (two or more times per week) of aspirin, other NSAIDs, or acetaminophen and breast cancer risk.

[ILLUSTRATION OMITTED]

Commentary: Numerous studies over the last 15 years have suggested that inhibition of prostaglandin synthesis is a logical approach to prevention of cancer. Cyclooxygenase (COX) is involved in the synthesis of prostaglandins, and NSAIDs inhibit COX, resulting in inhibiting prostaglandin production. In animal studies, NSAIDs have had protective effects against numerous cancers. In addition, estrogen synthesis is catalyzed by aromatase cytochrome P450 in the final step, and prostaglandin E2 increases aromatase gene expression and therefore estrogen production. High levels of COX and cytochrome P19 expression have been observed in human breast cancer, and progesterone synthesis can also be stimulated by PGE2. Therefore, it is thought that one method of breast cancer prevention may be to use NSAIDs to inhibit prostaglandin-driven production of estrogen and/or progesterone. Observational studies have demonstrated an association between aspirin/NSAID use and a 20% to 40% reduction in breast-cancer risk. In a major population-based case-control study of women with breast cancer published in 2004, researchers looked at every use of aspirin or other NSAIDs. (2) An inverse association of breast cancer and use was most significant among women who took 7 or more tablets per week and among current and recent users of less than five years. The use of ibuprofen was a weaker association.

The use of acetaminophen, which does not inhibit prostaglandin synthesis, was not associated with a reduction in breast cancer incidence. Risk reduction with aspirin was seen in women with hormone--receptor positive tumors, but not hormone-negative tumors.

While the current 2009 study and the 2004 study demonstrate the discrepancy that exists in the research on this topic, the differences in these and other similar studies may be explained by duration, regularity of use, different participant numbers, mechanisms involved. While the most recent study does not show an association, it may be premature to abandon the idea for the role of aspirin/NSAIDs or natural substances with similar mechanisms and their effects on anti-inflammatory pathways and estrogen/progesterone biochemistry.

Ovarian Cancer Screening?

Ovarian cancer diagnosis is usually made after more advanced disease and is the leading cause of death from gynecological malignancies in the US. The need for screening is obvious, and annual transvaginal ultrasounds and serum CA 125 testing have been a tempting approach. This approach would obviously not prevent ovarian cancer, but could reduce mortality rates by earlier diagnosis and treatment.

Healthy women aged 55 to 74 were randomized to four rounds of annual transvaginal ultrasounds and serum CA 125 testing or regular gynecological exams/care without screening. (3) We currently only have preliminary results, but given the low prevalence of ovarian cancer and thus the low positive predictive value of ultrasound and CA 125, with a high false positives of CA 125, it appears unlikely that the benefits of screening will outweigh the number of surgeries that will be done for women who do not have ovarian cancer.

Commentary: The temptation for practitioners to do annual transvaginal ultrasounds and CA 125 screening in healthy women has been strong, but this study, and previous reports, deter one from this approach. However, for a woman with mounting risk factors (first degree relative with ovarian cancer and obesity, for example), I admit that I succumb to that temptation.

Breast Cancer and Integrative Medicine Resource

A colleague and office associate of mine, Barbara Macdonald, ND, LAc, at A Woman's Time has just self-published an important resource for clinicians on the integrative management of breast cancer. Her interest in and clinical practice treating breast cancer for the past 10 years have evolved to such a skill level that I consider her one of the few true breast cancer experts in the naturopathic profession. Her knowledge spans the depth and breadth of conventional treatment options, comprehensive naturopathic management, Chinese medicine interventions, energy medicine, and an astute and talented exploration of the heart and soul of the process for each patient. Her ability to truly practice and treat with an integrative approach gives full meaning to the term integrative medicine, being guided all the way by what is appropriate for each patient physically, emotionally, and spiritually.

Dr. Macdonald's new book, The Breast Cancer Companion: A Complementary Care Manual, is the most valuable clinician resource I've seen written on an integrative approach to breast cancer. For the practitioner new to natural or integrative medicine or to treating breast cancer, this book is an indispensable guide for breast cancer diagnosis and clinical workups, conventional and alternative treatment options, controversial issues such as antioxidants and chemotherapy, indications and contraindications for herbal and nutritional therapies, Chinese medicine assessment and intervention, and important insights in energy and mind/body medicine. For the practitioner already experienced in treating breast cancer patients, it will serve as a quick reference source for treatments, controversies, and questions not always easily remembered, in addition to new ideas.

I thank Dr. Macdonald for sharing her experience and expertise as well as her deep personal commitment to not only her patients but her colleagues. This book is a true gift to practitioners desiring to better serve women with breast cancer, from the heart and mind of a beloved naturopathic colleague.

The book is available at www.thebreastcancercompanion.com or by calling A Woman's Time, 503-222-2322.

Notes

(1.) Eliassen A et al. Use of aspirin, other nonsteroidal anti-inflammatory drugs, and acetaminophen and risk of breast cancer among premenopasual women in the Nurses' Health Study II. Arch Intern Med. 2009; 169:115.

(2.) Terry M, Gammon M, Zhang F, et al. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. JAMA. 2004;291(20):2433-2440.

(3.) Partridge E et al. Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol. 2009;113:775.

by Tori Hudson, ND womanstime@aol.com
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Author:Hudson, Tori
Publication:Townsend Letter
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Geographic Code:1USA
Date:Aug 1, 2009
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