Actuele ontwikkelingen over therapeutische behandelingen van borstkanker zijn te lezen onder kankersoorten-borstkanker

26 mei 2007: Bron: Nutraingredients

Vrouwen die voor en in de overgang black cohosh = Cimicifugae racemosae rhizome = zilverkruid gebruiken verminderen daarmee de kans op het krijgen van borstkanker met 61%. Dit blijkt uit een gerandomiseerde epidemologisch studie gepubliceerd in the International Journal of Oncology. Zilverkruid wordt veel gebruikt voor vrouwen om opvliegers tegen te gaan. Nu blijkt dit kruid dus ook borstkanker te kunnen voorkomen. Beetje vreemd is dan wel dat de EMEA (European Medical Agency) een jaar geleden een casecontrole studie gebruikte om te waarschuwen tegen het gebruik van zilverkruid. Het zou volgens die ene casecontrole studie leverproblemen kunnen veroorzaken. In Pubmed is de betreffende studie en geen enkele andere studie te vinden die aan zou tonen dat zilverkruid (Black Cohosh) gevaarlijk zou zijn. Wel zijn er verschillende studies die bewijzen dat zilverkruid (black cohosh) opvliegers tegengaat en andere symptomen die gepaard gaan met de overgang vermindert. Zie onder abstract van epidemologische studie de waarschuwing van de EMEA.

4/27/2007 - Women taking supplements of black cohosh may cut their risk of breast cancer by more than 50 per cent, suggests an epidemiological study from the US.

The study, published in the International Journal of Cancer, needs significant support from future studies before it can be recommended as a breast cancer preventative, but the research could offer a new avenue of research for the herb most commonly used by women to reduce menopausal symptoms such as hot flushes.

Black cohosh (referred to by the European Medicines Agency, or EMEA, as Cimicifugae racemosae rhizome) is a member of the buttercup family, and is a perennial plant native to North America.

Historically it has been a popular alternative to hormone replacement therapy (HRT) in many countries including the UK, where it is estimated that 9 million days worth of black cohosh supplements were purchased in 2004.

"Hormone-related supplements (HRS), many of which contain phytoestrogens, are widely used to manage menopausal symptoms, yet their relationship with breast cancer risk has generally not been evaluated," explained lead author Timothy Rebbeck from University of Pennsylvania School of Medicine.

The researchers used a population-based case-control study consisting of 949 breast cancer cases and 1,524 controls. Demographic information and the use of hormone-related supplements were identified using questionnaires.

Rebbeck and co-workers report that herbal use was more prevalent among African American women than European American women (19.2 versus 14.7, respectively), as well as specific preparations including red clover (4.7 versus 0.6 per cent), black cohosh (5.4 versus 2.0 per cent), and ginseng (12.5 versus 7.9per cent, respectively).

After adjusting for potential confounding factors the use of black cohosh was associated with a 61 per cent reduction in the risk of breast cancer, said the researchers. This risk reduction was also observed for Remifemin, a herbal preparation derived from black cohosh, which was calculated to reduce the risk of breast cancer by 53 per cent.

"Substantial additional research must be undertaken before it can be established that black cohosh, or some compound found in black cohosh, is a breast cancer chemopreventive agent," wrote the researchers. "Furthermore, women may wish to seek guidance from their physician before using these compounds," they concluded.

Previously, concerns have been raised about breast cancer patients taking black cohosh supplements in order to alleviate the menopause-like side effects. Researchers from Yale School of Medicine reported that black cohosh might interact detrimentally with chemotherapy by increasing cytotoxicity (cell killing) by two of the drugs, doxorubicin and docetaxel. It decreased the cytotoxicity of cisplatin.

Over one million women worldwide are diagnosed with breast cancer every year, with the highest incidences in the US and the Netherlands. China has the lowest incidence and mortality rate of the disease.

Source: International Journal of Cancer
1 April 2007, Volume 120, Issue 7, Pages 1523-1528, doi: 10.1002/ijc.22485 "A retrospective case-control study of the use of hormone-related supplements and association with breast cancer"

Authors: T.R. Rebbeck, A.B. Troxel, S. Norman, G.R. Bunin, A. DeMichele, M. Baumgarten, M. Berlin, R. Schinnar, B.L. Strom

Hier de waarschuwing van de EMEA:

European Medicines Agency Press office 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 74 18 85 45 E-mail: London, 18 July 2006 Doc. Ref.: EMEA/269259/2006 EMEA PUBLIC STATEMENT ON HERBAL MEDICINAL PRODUCTS CONTAINING CIMICIFUGAE RACEMOSAE RHIZOMA (BLACK COHOSH, ROOT) - SERIOUS HEPATIC REACTIONS - The European Medicines Agency (EMEA) and the Committee on Herbal Medicinal Products (HMPC) have been made aware of a number of case reports of hepatotoxicity (liver injuries) in patients using Cimicifugae racemosae rhizoma (Black Cohosh, root). Following review of all available data, the HMPC considered that there is a potential connection between herbal medicinal products containing Cimicifugae racemosae rhizoma (Black Cohosh, root) and hepatotoxicity. The EMEA therefore wishes to give the following advice to patients and healthcare professionals: Advice to patients: • Patients should stop taking Cimicifugae racemosae rhizoma (Black Cohosh, root) and consult their doctor immediately if they develop signs and symptoms suggestive of liver injury (tiredness, loss of appetite, yellowing of the skin and eyes or severe upper stomach pain with nausea and vomiting or dark urine). • Patients using herbal medicinal products should tell their doctor about it. Advice to healthcare professionals: • Health care professionals are encouraged to ask patients about use of products containing Cimicifugae racemosae rhizoma (Black Cohosh, root). • Suspected hepatic reactions should be reported to the national adverse reaction reporting schemes. Within the EU, Cimicifugae racemosae rhizoma (Black Cohosh, root) is widely used, sometimes in combination with other plants, in different licensed and unlicensed herbal medicinal products. The licensed products have a wide range of indications but Cimicifugae racemosae rhizoma (Black Cohosh, root) is currently most commonly used to treat minor climacteric (peri- and post-menopausal) symptoms such as hotflushes, sweating, sleep disturbances and nervous tension. In some Member States, Cimicifugae racemosae rhizoma (Black Cohosh, root) is also used in a range of other indications, such as: symptomatic relief of rheumatic pain, cough, stomach cramps, period pains/bloatedness, tenseness/irritability. The number of unlicensed herbal medicinal products containing Cimicifugae racemosae rhizoma (Black Cohosh, root) marketed in the Europe is not known. The HMPC evaluated 42 case reports of hepatotoxicity, collected from European National Competent Authorities (34 cases) as well as literature case reports (8 cases). Of these, only 16 cases were considered sufficiently documented1 to allow the Committee to assess if use of Cimicifugae racemosae rhizoma (Black Cohosh, root) could be linked to the liver injuries. As a result of the assessment, 5 cases were excluded and 7 cases were considered unlikely to be related. In the remaining 4 cases (2 autoimmune hepatitis, 1 hepatocellular liver injury and 1 fulminant hepatic failure), there was a temporal association 1 Case reports evaluated according to RUCAM score (Roussel UCLAF causality assessment method), a well-established method used to assess cases of hepatotoxicity. [Danan G. and Benichou C. (1993) J Clin Epidemiology Vol.46 (11): 1323-1330] . [Benichou C. et al (1993) J Clin Epidemiology Vol.46 (11): 1331-1336] between the start of treatment with Cimicifugae racemosae rhizoma (Black Cohosh, root) and the occurrence of hepatic reaction. The HMPC will continue to review all new safety information relating to this issue and if necessary will release a further updated statement. Further details regarding the case reports are provided in the Annex 1: “Assessment of case reports connected to herbal medicinal product containing Cimicifugae racemosae rhizoma (Black Cohosh, root)”, which can be found here. For further information contact: Mr Martin Harvey Press Office (Tel: +44 20 74 18 86 99, Fax: + 44 20 74 18 84 09) 2/2

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