Leanna J. Standish, ND, PhD, L.Ac.

On April 19, 2001 a 48-year-old Caucasian woman presents for naturopathic medical consultation for a recently diagnosed breast cancer of her left breast. She is married with one child and works as a radiology technician. In March 2001 she had a needle biopsy performed in Bozeman, Montana of a mammographically identified left breast lump. Pathology reports indicated high-grade invasive 2.5 cm ductal carcinoma with a Bloom-Richardson score of 9 out of 9 and a 1 cm satellite area of ductal carcinoma in situ also high grade. On June 4, 2001 the patient had an MRI of the chest and axillae which indicated no nodal involvement. For unknown reason, an estrogen/progesterone receptor study nor her 2neu expression study was not performed at the time of biopsy.

Her surgeon recommended chemotherapy to reduce the size of the tumors through a portocath, followed by resection of the tumor areas and axillary dissection. I recommended at our first visit on April 19, 2001 that she proceed with surgery. She first saw me on 4/19/01 for a naturopathic medical consulta- tion. We discussed her options for therapy including mastectomy, tamoxifen if she were ER+, chemotherapy and radiation, as well as adjunctive naturopathic treatments. I urged her to have surgery with immediately with her surgeon at NW Hospital in Seattle. I gave her information about chemosensitivity and chemoresistance testing on fresh biopsy samples that would be obtained by her surgery. She declined pre-surgical chemotherapy but scheduled with her surgeon for tumor resection late April 2001 in keeping with the follicular phase of her cycle. I also asked her to discuss with the Seattle radiation oncologist if she should have a sentinel biopsy during her surgery rather than full axillary dissection. At our first appointment on April 19, 2001 I prescribed Coriolus versicolor 1200 mg bid and modified citrus pectin 1 tsp in juice bid, in addition to the B-carotene she was already taking. On 4/19/01 her CA27.29 was 31.8 (0-34 nl). She was premenopausal and never took HRT.

On April 26, 2001 the patient returned for follow up with me and reported that she had chosen to not have surgery at this time and to try a short course of aggressive natural therapies followed up with a three month MRI. I said three months was too long and that I would agree for only an 8-week trial of naturopathic medical treatment prior to her next imaging evaluation. An April 26, 2001 she began the following 8-week treatment course:
Carcinosin 200C daily x 2 weeks Vitamin A 25,000 IU bid Vit E succinate 800 IU bid Coriolus versicolor 1200 mg bid Modified citrus pectin 1 tsp bid CoQ10 200 mg bid
Direct correspondence to: LJ Standish, ND, PhD, LAc University Health Clinic 5322 Roosevelt Way, NE Seattle, WA 98105

Melatonin 10 mg gradually increasing to 20 mg h.s. Helixor 1 mg escalating to 30 mg s.c. MWF. (Self-injections into abdominal acupuncture points corresponding to the Stomach meridian which travels through the left beast and the tumor area) 10 day juice fast Bikram’s yoga daily.

With the exception of the juice fast and yoga therapy she was adherent to all treatments. On June 4, 2001 she had a follow- up MRI and high resolution ultrasound shows interval enlargement of both breast tumors. The invasive ductal carcinoma tumor as grown by 0.3 cm and is now 2.8 cm. The DCIS area is also shows interval enlargement. The patient was scheduled for a left-sided mastectomy on July 10, 2001. Subsequent pathology report indicated a 2.5 cm infiltrating ductal carcinoma, a Bloom-Richardson score of 9/9, but without angiolymphatic invasion; 1 out of 12 axillary nodes positive for carcinoma, ER+/PR+, and Her2neu positive.

Conclusion

In this patient with high grade infiltrating ductal carcinoma and DCIS an 8-week aggressive naturopathic medical protocol consisting of science-based antioxidant, immunomodulatory, and homeopathic nosodal therapy was ineffective in reducing tumor size and provided no benefit to the patient in breast- sparing. In this case, delay of surgical intervention may have led to the need for more extensive surgery than had she followed the advice of both her surgeon and naturopathic physician to have breast resection immediately. Sometimes when we do what our patients want us to do, perhaps we do them a disservice.

2004 addendum

I contacted this patient by phone in April 2004 to learn that she had underwent a bilateral mastectomy in 2003, declined adjuvant chemo- or radiation therapy, and reported doing well.

Commentary

This case study describes the use of a variety of natural health product (NHPs) interventions and lifestyle and diet counseling in a patient with high-grade invasive ductal carcinoma of the breast. The case-study provides a definitive diagnosis, a clear protocol, and a well documented 8 week follow-up. This protocol appears not have been effective in this patients over the course of 8 weeks. I do not think this is a surprise.
What the author does not describe are findings on initial intake including aspects of the patient’s medical history, current laboratory work (beyond that directly related to the breast carcinoma), and results of the physical exam. Thus we are left guessing as to the existence of co morbidities, concurrent medications/other interventions, lifestyle, diet, etc. One can envision a number of variables that could have confounded the outcome of the employed protocol.

Invariably, health-care practitioners, especially NDs, may encounter patient’s that refuse standard/conventional care in favor of “natural” treatment. The potential risks of such a decision must be made clear to the patient and the severity of the condition does not preclude this informing. That is, any condition for which a patient refuses standard/conventional treatment must be informed of the risks of using alternative interventions for which the data are sparse.

More controlled trials are required to test such alternative interventions as first-line chemotherapeutics for breast carcinoma of various grades and hormone receptor status before such therapies can be considered to have clinical equipoise with standard/conventional therapies. Until this time, we must remain up to date on the data and keep patients informed.

Joel J. Gagnier B.A.(Hons), N.D., M.Sc.(Cand. Clin. Epi.) Deputy Editor, International Journal of Naturopathic Medicine Associate Professor, Associate Director of Research, Canadian College Of Naturopathic Medicine CIHR-ONHP Fellow in the Faculty of Medicine, University of Toronto