Black Cohosh Not Estrogenic to Breasts

anondenet · August 2008

(Interesting study)

Nutr Cancer. 2007;59(2):269-77. L

Black cohosh does not exert an estrogenic effect on the breast.

Ruhlen RL, Haubner J, Tracy JK, Zhu W, Ehya H, Lamberson WR, Rottinghaus GE, Sauter ER.

Department of Surgery, University of Missouri-Columbia, Columbia, MO 65212, USA.

Women's Health Initiative findings indicate that hormone replacement therapy may increase breast cancer and cardiovascular disease risk.

Black cohosh extract (BCE) is a popular alternative that reduced menopausal symptoms in several clinical trials. Preclinical studies have addressed the estrogenic properties of BCE, with conflicting results. The estrogenic influence of BCE on the breast has not been investigated. Black cohosh is standardized to triterpenes, but the activity and mechanism of action of these compounds are unknown. The study goals were to determine 1) triterpene content of 2 commercially available BCE preparations and 2) the effect of BCE on circulating and breast-specific estrogenic markers. Two black cohosh preparations were analyzed for triterpene content. Postmenopausal women took BCE for 12 wk followed by a 12-wk washout. One BCE preparation contained trace amounts and another contained 2.5% triterpenes. Women taking BCE with 2.5% triterpenes experienced relief of menopausal symptoms, with reversion toward baseline after washout.

Smile BCE had no effect on estrogenic markers in serum and no effect on pS2 or cellular morphology in nipple aspirate fluid. Triterpene content in commercially available black cohosh preparations varies. BCE standardized to 2.5% triterpenes relieved menopausal symptoms without systemic or breast-specific estrogenic effects.

Jenniferz · August 2008

The estrogenic influence of BCE on the breast has not been investigated. Black cohosh is standardized to triterpenes, but the activity and mechanism of action of these compounds are unknown.

These two sentences right here bother me.

Jennifer

Bliz · August 2008

My surgeon, onc and I have gone round and round about Black Cohosh. They swear it is estrogenic yet it still appears that the studies are mixed.

tami48 · August 2008

My Onco said "No way" to black cohosh. It contains phytoestrogens and there have been conflicting studies on this.

daiseyjean76 · August 2008

HI, there is something called Femal that is totally safe for people that are at risk for BC. the website it www.florahealth.com. it doesn't have phytoestrogens in it and it is safe to use past 6 months as black cohosh isn't studied past 6 months,there are vertigo type effects with some people after 6 months. it is a little more expensive if u buy it from this website so i bought it thru vitahealth.com for a little cheaper.u can email them and ask them to send u a more detailed information packet to your home.

anondenet · August 2008

+

The studies that find black cohosh "estrogenic" are ONLY IN THE TEST TUBE. In the actual human body the action changes.

Some medical doctors do not know how to read studies. They confuse cells in test tubes with studies on actual women. If any doctor is telling you to restrict phytoestrogens, you can be sure he/she is making this mistake. Most oncs are NOT QUALIFIED to read the studies. They need to be trained to understand how to look at cell lines, animal studies, then human studies.

If an onc is honest, they will tell you they don't know how to read studies. They don't teach that in medical school. Saying reports are "mixed" is a total BS cop out. The oncs are treating breast cancer every day. They need to go over the so-called "mixed" studies an sort them out.

Please ask your doctors for SPECIFICS. Don't let them hide behind fear-mongering scuttlebutt and innuendo.

Ask your onc, "Which study are you talking about? I want to look it up."

althea · August 2008

A need for training is abundantly clear here! I'm no medical professional, but I'm no dummy either. In just these few brief paragraphs, I feel my head swimming.

<>The title says "Black cohosh does not exert an estrogenic effect on the breast"

Then the third sentence of the second paragraph says "The estrogenic influence of BCE on the breast has not been investigated." So unless there's a world of difference between 'effect' and 'influence', it looks to me like a contradiction within the span of less than 2 paragraphs. And even if there is a world of difference between effect and influence, the unknown number of women involved in the study were taking the BCE for just 12 weeks. I'm all in favor of natural remedies, but this study doesn't seem to have much ammunition behind it.

anom, you seem very knowledgeable about studies and dechipering them. Is this study likely to make some inroads to the mainstream doctors who seem to perpetually look down their nose at natural remedies?

anondenet · August 2008

Althea writes:<<Then the third sentence of the second paragraph says "The estrogenic influence of BCE on the breast has not been investigated." So unless there's a world of difference between 'effect' and 'influence', it looks to me like a contradiction within the span of less than 2 paragraphs.<<

Althea and others,

If you read hundreds of studies on cancer or other diseases, you will see that the format is to insert a boilerplate which is a disclaimer by the research scientists who did the study. The "has not been investigated" phrase is one of those standard research boilerplates. Others include," the mechanism of action is not understood," "more research is necessary," further investigation is warranted," etc. This is true for mainstream treatments also.

The disclaimer boilerplate is inserted even though the data reported refutes the boilerplate.

We saw this dramatically when Hansen et al. reported that needle biopsies caused more spread to the nodes than stereotactic or excisional biopsies. Their boilerplate was (paraphrasing): "No changes should be made in the practice of doing needle biopsies even tho we have found compelling evidence of nodal spread. More research is needed."

Research abstracts must be read carefully because the DATA FINDINGS OFTEN CONTRADICT THE CONLUSIONS.

Patients and doctors must look at the data reports, not the mealy-mouthed interpretations which is basically butt-coverring, I-don't-want-to-offend-anybody-in-the-research-community disclaimers.

You only learn to read these studies by experience and discussion but it can save the patient a lot of agony once they learn to read them. It is worth the trouble.

Anom

Traci-----TripNeg · August 2008

I am sorry to say that I hardly consider 12 weeks to be a good study. My onc too, told me to stay away until more is known but, I'm trip neg.

I don't mean to be confrontational at all, just adding my two cents.

AnnNYC · August 2008

Hi all: a little more clarification:

Althea writes:<<Then the third sentence of the second paragraph says "The estrogenic influence of BCE on the breast has not been investigated." So unless there's a world of difference between 'effect' and 'influence', it looks to me like a contradiction within the span of less than 2 paragraphs.<<

Anomdenet writes: <<Althea and others, If you read hundreds of studies on cancer or other diseases, you will see that the format is to insert a boilerplate which is a disclaimer by the research scientists who did the study. The "has not been investigated" phrase is one of those standard research boilerplates. Others include," the mechanism of action is not understood," "more research is necessary," further investigation is warranted," etc. This is true for mainstream treatments also.>>

What Anomdenet quoted is an ABSTRACT -- a tiny, condensed version of the whole paper. Some journals require "structured abstracts", which insert the words: Background, Objectives, Methods, Results, Conclusions. Some don't, to save space -- they assume the readers all know that format.

These words would have been helpful here, because the first three sentences are BACKGROUND, i.e. "what was known BEFORE the study was done."

In this case, it's not a "disclaimer." There are "disclaimers" in scientific papers, usually called "limitations" which are addressed in the DISCUSSION section toward the end of the paper ["the mechanism of action is not understood," "more research is necessary," further investigation is warranted"] , or indicated by using words like "may" or "likely" in the CONCLUSION rather than "definitely" or "absolutely, positively"!

A few journals -- notably, the New England Journal of Medicine -- require the "limitations" to also be stated in the abstract.

The abstract is printed before the main article, and it is the info found in press releases or on PubMed. Journals have strict word limits on abstracts, which makes it really hard to get in all the useful information, like the words "heretofore" or "prior to the reported study" which is what the authors meant when they said "The estrogenic influence of BCE on the breast has not been investigated..." PREVIOUSLY, HERETOFORE, UNTIL NOW, IN OUR STUDY WHICH WE REPORT BELOW!

Anyway, this is what the abstract would have looked like if published in a "structured-abstract" journal:

BACKGROUND: Black cohosh extract (BCE) is a popular alternative that reduced menopausal symptoms in several clinical trials. Preclinical studies have addressed the estrogenic properties of BCE, with conflicting results. The estrogenic influence of BCE on the breast has not been investigated. Black cohosh is standardized to triterpenes, but the activity and mechanism of action of these compounds are unknown.

OJECTIVES: The study goals were to determine 1) triterpene content of 2 commercially available BCE preparations and 2) the effect of BCE on circulating and breast-specific estrogenic markers.

METHODS:Two black cohosh preparations were analyzed for triterpene content. Postmenopausal women took BCE for 12 wk followed by a 12-wk washout. One BCE preparation contained trace amounts and another contained 2.5% triterpenes.

RESULTS: Women taking BCE with 2.5% triterpenes experienced relief of menopausal symptoms, with reversion toward baseline after washout.

CONCLUSIONS: BCE had no effect on estrogenic markers in serum and no effect on pS2 or cellular morphology in nipple aspirate fluid. Triterpene content in commercially available black cohosh preparations varies. BCE standardized to 2.5% triterpenes relieved menopausal symptoms without systemic or breast-specific estrogenic effects.

-----------------------

That said, I agree with Traci that 12 weeks is pretty close to meaningless with regard to BCE effects on breast tissue!!!!!!!!

anondenet · August 2008

The 12 weeks measured estrogenic presence, not effect.

The study made no pretense of looking at effect. They are assuming that if you can't find it, it won't have an effect.

AnnNYC · August 2008

But it says :"BCE standardized to 2.5% triterpenes relieved menopausal symptoms without systemic or breast-specific estrogenic effects."

And "The study goals were to determine 1) triterpene content of 2 commercially available BCE preparations and 2) the effect of BCE on circulating and breast-specific estrogenic markers."

I'm quite sure that the early sentence about "BCE influence... has not been investigated" is BACKGROUND -- meaning "it had not been investigated until we investigated it, in the study we are now reporting."

anondenet · August 2008

Okay, I'm phrasing this less precisely than I should have.

They're defining markers, i.e., no measurable estrogenic presence, as "effects."

They ARE NOT describing what I was characterizing --altered, estrogen-initiated effects which would be true tissue changes. I hope this is clear. I'm trying to be absolutely literal here.

So to rephrase, black cohosh contributes NO measurable, estrogenic presence which they are characterizing with the term "effects."

My earlier post attempted to paraphrase the results, the bottom line conclusion. In doing so, I used "effects" in a different way than the researchers did to communicate NOT finding any estrogenic presence.

The word, "effects" connotes organic or physiologic changes. And I would still hesitate to use the term, "effects," since they found none.

althea · August 2008

anom and ann, thank you for your clarifications. They are very helpful. Yet, my eyes are still glazing over. Knowing about the boilerplate language is very helpful. My eyes might not glaze over until page two in the future.

Anonymous · September 2008

I had never heard anything about this until now. My medical oncologist actually suggested black cohosh to me since I couldn't take any hormone therapies, and I had a full hysterectomy.

Black Cohosh Not Estrogenic to Breasts

Comments

Categories