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Alternative Medicine For Cancer

Alternative therapies are extremely popular among women with breast cancer. But what are some of the reasons and decision-making processes that go into choosing an alternative therapy? In this column, we look at several qualitative studies that have asked this question. We will also explore a few interesting new studies that show how the rising incidence of breast cancer in industrial nations relates to our evolutionary heritage.

Reasons For Using CAM

A recent review by Boon et al. (1999) notes that up to 80% of cancer patients report using CAM (Brigden, 1995; Cassileth, Lusk, Strouse, & Bodenheimer, 1984; Downer et al., 1994; Lerner & Kennedy, 1992; Yates et al., 1993). Studies have indicated that younger patients and those who live for longer periods of time after receiving a cancer diagnosis are more likely to seek some form of CAM (Lerner & Kennedy, 1992; Yates et al., 1993). Boon notes that women with breast cancer are considered to either be pushed or pulled towards alternative therapies. (Furnham & Smith, 1988) Either bad experiences with conventional medicine or ideological compatibility with alternative therapies are seen as the driving forces in the decision to use CAM. Researchers suggest that people use alternative medicine because they are unhappy with conventional medicine. (Alster, 1989; Berliner & Salmon, 1980; British Medical Association, 1986; Dobi, 1996; Downer et al., 1994; Furnham & Smith, 1988; Gray et al., 1997; van Dam, 1986; Vince nt & Furnham, 1996; Wiesner, 1989). One reason for this dissatisfaction is that many people experience conventional treatments as ineffective, dangerous, and poorly explained by physicians. (Moore, Phipps, Marcer, & Lewith, 1985; Vincent & Furnham, 1996) People who use CAM are less confident in conventional medicine than others (Gray et al., 1997; McGregor & Peay, 1996) or hold ideological views that are compatible with alternative medicines (Dobi, 1996; Furnham & Kirkcaldy, 1996; Furnham & Smith, 1988; McGregor & Peay, 1996; Pawluch, Cain, & Gillett, 1994; Sharma, 1992; Vincent & Furaham, 1996). Ideologies that people who use CAM commonly hold include a "holistic" understanding and a general orientation towards the unconventional. (McGregor & Peay, 1996; Pawluch et al., 1994). People who use CAM also want more control and responsibility for their own treatment. (Downer et al., 1994; Kelner & Wellman, 1997a; Montbriand, 1993; Pawluch et al., 1994; Yates et al., 1993)

In contrast to these ideological, philosophical, political, and emotional attributions for seeking alternative therapies, Boon found in her research on women with breast cancer that using alternative therapies was a rational, logical and functional decision. Indeed many women were simply "hedging their bets" by using both CAM and conventional medicine. In fact, few drew a distinct line between the two, perceiving their options as grab bag from which they must choose a unique treatment protocol and most used both systems simultaneously.

Decision Making and Barriers to Use

With a cancer diagnosis Boon et al. (1999) notes that women with breast cancer engage initially in a discovery stage. This involves a quest for information on alternative therapies through word of mouth, media, health care practitioners (CAM and conventional), and personal reading. Then an investigation phase occurs when they try to narrow down the numerous alternative therapies to make an informed decision. Finally, in the decision phase they actually choose to use an alternative therapy. The most important reason for using alternative therapies for breast cancer in Boon's study was the ability to "boost the immune system." However, participants then hit numerous barriers to use of alternative therapies such as high cost, limited access to the therapies, and the large amounts of time required to complete them. But the most important reason many people decide not to use a CAM therapy is lack of meaningful information regarding safety and efficacy, according to Boon. These barriers are similar to those found by other researchers studying CAM use. (Berger, 1993; Cassileth et al., 1984; Eisenberg et al., 1993; Kelner & Wellman, 1997a; Lerner & Kennedy, 1992; Sharma, 1992; Thomas, Carr, Westlake, & Williams, 1991). In general, since there is little Western scientific data on alternative therapies, perceived effectiveness, based on personal experience, was more important than medical effectiveness in choosing an alternative therapy (see also Powell 1997).

Ethnic Variation in Use of CAM for Breast Cancer

Another recent study explores CAM usage among women with breast cancer who come from different ethnic backgrounds: Latino, white, black, and Chinese (Lee et al. 2000). During the period from 1990 through 1992 researchers conducted 30-minute phone interviews with 370 subjects in San Francisco and used logistic regression models to find patterns in usage of alternative therapies. They found that most therapies were used for a duration of less than 6 months. Blacks most often used spiritual healing (36%), Chinese most often used herbal remedies (22%), and Latino women most often used dietary therapies (30%) and spiritual healing (26%). Among whites, 35% used dietary methods and 21% used physical methods, such as massage and acupuncture. Black women were less likely than women of the other three ethnicities to use dietary and physical therapies, while Latino women were more likely to use mental, physical, and herbal therapies. Chinese women were less likely to use dietary and mental therapies, but they were two times more likely to use herbal therapies. In general, women who had a higher educational level or income, were of younger age, had private insurance, and exercised or attended support groups, were more likely to use alternative therapies. About half of the women using alternative therapies reported discussing this use with their physicians. More than 90% of the subjects found the therapies helpful and would recommend them to their friends.

Are Breasts Functional, Medical or Sexual? The Narrative Approach

Langellier et al. (1998) looks at breast cancer narratives in 20 open-ended, in-depth interviews with 17 white, middle-class survivors in Maine. Using phenomenological, cluster analysis, she notes that in contrast to stereotypical, Western concepts of breasts as purely sexual objects, women with breast cancer see them in four very different ways: as medicalized, functional, gendered and sexualized. Similarly, other researchers (Meyerowitz 1981, Meyerowitz, Chaiken, and Clark 1988) found that "future health concerns" were far more upsetting to breast cancer patients than physical attractiveness in contrast to our sex role stereotypes. In open-ended interviews, participants were requested to tell their breast cancer stories (Kasper 1994; Langellier and Hall 1988). Interviews ranged from 1 to nearly 3 hours, took place in the participants' home or office and were tape recorded. Usually little prompting was needed as participants spontaneously told their stories.

For many women, their breasts are perceived as biotechnological attachments. Langellier notes that upon diagnosis the voice of medicine increases (Bell, 1988; Mishler, 1984). Many participants used clinical and technical language to describe their experiences. Previous anthropological studies have shown that in Western medicine the woman's breast is considered detachable (Young, 1990) and, as a separable body part, the medicalized breast is not signified with femininity and sexuality. The result is a fragmented body image (Martin, 1987) and often a worse prognosis and poor survival.

Other women perceive their breasts as functional. Women who view their breasts this way emphasized the reproductive function of the breast as well as its function in containing muscles that helped them to use their arias. Women with this perspective are concerned about losing their breasts with conventional' therapies and emphasize the importance of breast-feeding. Many women who underwent conventional treatments suffered from serious mechanical problems such as back pain (due to weight imbalances) and difficulty using their arms (due to pectoral damage.) I would add that it is probably this cluster of breast cancer survivors who are most likely to want to try alternative therapies, and use conservative approaches. In addition, it is these proactive, holistically and functionally minded patients who tend to have the greatest survival rates based on other studies.

Finally, many women viewed their breasts as gendered or sexual. This is the perspective most often used in Western culture where the symbolic significance of the breast as a sign of femininity, beauty, and sexual desirability outweighs its medicalized meanings or its functional values of lactation and motility. Researchers point to the "veritable breast cult" (Cullinan, 1990) that fetishizes the full, firm, high, pointy Barbie breast. As with the medicalized breast, women who maintained a focus on their breasts as sexual objects tended not to do as well.

Breast Feeding, Culture and Cancer

Important new alternative treatments for breast cancer are emerging from research on our evolutionary past. For example, many anthropologists have documented the importance of breast feeding across cultures for immune support and optimum nutrition in infants. Now fascinating new research links breast feeding to protection from cancer for both the infant and mother. Given our evolutionary heritage of extended nursing (for much longer periods than today) and our modern lifestyle of virtually no breast feeding, this discovery offers new perspective on the increase in breast cancer incidence in developed societies. This research was pioneered by Catharina Svanborg at Lund University in Sweden who was looking for new ways to fight pathogens. In previous studies she found that mothers' milk does a good job of blocking infection by pneumococcus bacteria, the cause of pneumonia, and that breast-fed children suffer significantly fewer ear and upper respiratory tract infections than babies who don't nurse. The breast c ancer cell killing compound her team discovered is a protein called alpha-lactalbumin (alpha-lac for short).

Ethnobotanicals for Breast Cancer

Herbal medicines are also effective in helping to prevent or control breast cancer and its side effects. One promising Indian herbal formula called Amrit can reduce the side effects of chemotherapy according to researcher Dr. Han Sharma, a professor emeritus and former director of cancer prevention and natural products research at Ohio State University. He and researchers at the All India Institute of Medical Sciences in New Delhi recently completed a study on Amrit. Patients reported Amrit improved their overall well-being during chemotherapy by reducing instances of nausea, vomiting, diarrhea, insomnia, anorexia, and boosting their energy levels. Amrit is a combination formula that contains 44 herbs and is rich in antioxidant minerals and vitamins, including large amounts of vitamins C, E, and beta-carotene. Research shows it helps support liver detoxification during cancer and chemotherapy.

Natural Light, Evolution and Biorhythms

Finally, we turn to the ever-fascinating field of chronobiology, which has some tantalizing clues for the medical anthropologist. Charles Czeisler of Harvard University medical school and George Brainard at Thomas Jefferson University in Philadelphia show that breast cancer rates are five times higher in nations where artificial light is used than in traditional societies. They note that we have evolved with exposure to natural light and dark for thousands of years and are highly dependent on it for health. Richard Stevens at the University of Connecticut Health Center and colleagues in Finland found that women who are completely blind had 60% fewer breast cancers than women with normal sight. Those women who were only slightly blind had similar breast cancer rates to fully sighted women. The researchers found a proportionate decrease in breast cancer that coincided with the severity of the women's visual impairment. The disruption of natural cycles of light and dark, normal sleep patterns and melatonin produ ction has also been raised as a possible explanation for the 200% higher risk of breast cancer faced by Finnish air stewardesses. At first, it was suggested that cancer could be triggered by exposure to higher than average levels of radiation at high altitude. But leukemia, the prime cancer associated with radiation, was not as common among the women as would be expected. Further studies of mice that have been exposed constantly to light or had their pineal glands removed, and so cannot produce melatonin, have shown that they can suffer higher rates of breast cancer. Rats that had their pineal glands removed but received melatonin supplements developed fewer tumors. The disruption of melatonin production by artificial light may be increasing estrogen levels leading to breast cancer.

Conclusion

Exciting new studies show that use of alternative therapies by women with breast cancer is growing quickly In addition, studies are showing that people are demanding more and better information on these therapies and that using these therapies is a rational, functional decision, not an ideological one. Indeed, narrative research methods reveal that women with breast cancer care more about survival than stereotypical notions of sexuality and attractiveness. Those women who take a functional rather than medicalized or sexualized approach to breast cancer appear more likely to use alternative therapies and enjoy increased survival. In addition, researchers point to the many ways our modern lifestyle is incompatible with our evolutionary heritage, possibly leading to breast cancer, and suggest novel ways to restore this connection. Examples include obtaining adequate exposure to full spectrum light, returning to breast feeding, and using herbal medicines, which can help with breast cancer treatment and side effects.

Selected References

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Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998:279:1548-53.

Boon, Heather; Judith Belle Brown; Alan Gavin; MaryAnn Kennard; Moira Stewart; Breast cancer survivors' perceptions of complementary/alternative medicine (CAM): Making the decision to use or not to use Qualitative Health Research; Thousand Oaks; Sep 1999

Burstein HJ, Gelber S. Guadagnoli F, Weeks JC. Use of alternative medicine by women with early-stage breast cancer. N Eng J Med 1999;340:1733-9.

Bury, M. Chronic illness as biographical disruption. Sociology of Health and Illness, 4, 168-182 1982

Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer. A systematic review. Cancer 1998:83:777-82.

Freund, PE.S. The expressive body: A common ground for the sociology of emotions and health and illness. Sociology of Health and Illness, 12,452-477 1990

Furnham, A., & Smith, C. Choosing alternative medicine: A comparison of the beliefs of patients visiting a general practitioner and a homeopath. Social Science and Medicine, 26(7), 685-689 1988

Garro, L. C. Narrative representations of chronic illness experience: Cultural models of illness, mind, and body in stories concerning the temparomandibular joint. Social Science and Medicine, 38, 775-788. 1994

Kelner, M., & Wellman, B. Health care and consumer choice: Medical and alternative therapies. Social Science and Medicine, 45(2), 203-212. 1997

Kelner, M., & Wellman, B. Who seeks alternative health care? A profile of the users of five modes of treatment. The Journal of Alternative and complementary Medicine, 3(2), 127-140. 1997b

Langellier, Kristin M. Claire F Sullivan; Breast talk in breast cancer narratives; Qualitative Health Research; Thousand Oaks; Jan 1998

Lee, Marion M; Scarlett S Lin; Margaret K Wrensch; Shelley R Adler; David Eisenberg; Alternative therapies used by women with breast cancer in four ethnic populations Journal of the National Cancer Institute; Bethesda; Jan 5,2000

McGregor, K. J., & Peay, E. R. The choice of alternative therapy for health care: Testing some propositions. Social Science and Medicine, 43(9), 1317-1327. 1996

Northcott, H., & Bachynoky, J. Concurrent use of chiropractic, prescription medicines, nonprescription medicines and alternative health care. Social Science and Medicine, 37(3), 451-435. 1993

Riessman, C. K. Strategic use of narrative in the presentation of self and illness: A research note. Social Science and Medicine, 30,1195-1200. 1990

Williams, G. The genesis of chronic illness: Narrative reconstruction. Sociology of Health and illness, 6, 175-200. 1984

Yates, P., Beadle, G., Clavarino, A., Najman, J. M., Thomson, D., Williams, G., Kenny, L., Roberts, S., Mason, B., & Schlect, D. Patients with terminal cancer who use alternative therapies: Their beliefs and practices. Sociology of Health and Illness, 15(2)199.217. 1993

About the Author

Tim Batchelder is a biomedical anthropologist. He maintains a web page at www.anthrocode.com with full biographical and contact information.

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