Traditional Chinese medicine in the treatment of breast cancer

The treatment of breast cancer involves multiple disciplines, and current recommendations are based on modern tenets of biology and pharmacology along with a growing body of evidence-based literature. Despite advances in screening, surgery, adjuvant radiation, and systemic therapy, as well as novel biologically targeted therapies, there are limitations to their benefits, especially in advanced disease. Complementary therapies including Oriental medicine have enjoyed a growing popularity as a less intensive and more "natural" approach to achieving health or improving quality of life. However, definitive literature in this area is scant and therefore has not been integrated into the mainstream medical community. Traditional Chinese medicine (TCM) may serve as a useful model for scientific inquiry since there is a standardized system of diagnostics and therapies, and this discipline is practiced worldwide. Still, the holistic and individualized nature of TCM presents challenges to rigorous clinical testing, and as a result, most published work in this field is in the form of anecdotal reports or uncontrolled series. Among the components of TCM, herbal or botanical agents possess complex biological activities that could affect many aspects of carcinogenesis such as cell growth and proliferation, apoptosis, host-tumor interactions, and immune function and differentiation. Despite a fairly extensive series of laboratory studies detailing many biological effects of botanical agents, few clinical trials have been completed to test specific hypotheses regarding the mode of action of TCM. Most TCM therapies have been empirically applied in a series of patients, with descriptive results provided. The summaries of a few studies highlighted in this review can provide some evidence of safety but generally do not possess the design and results to verify clinical effectiveness. Nevertheless, the theory of TCM coupled with laboratory studies and safety information can serve as a basis for the design of more definitive trials of TCM for specific indications in breast cancer. There are increasing interest and growing opportunities for investigative approaches that could ultimately verify or reject TCM and specific botanical agents. Some of these initiatives in the area of breast cancer prvention and treatment are outlined. Copyright 2002, Elsevier Science (USA). All rights reserved.