Evidence-Based Complementary and Alternative Medicine / 2012 / Article / Tab 1

Review Article

The Relationship between Complementary and Alternative Medicine Use and Breast Cancer Early Detection: A Critical Review

Table 1

Summary of Studies.

Studya  (Year)Study designSample sizeSelected participant characteristicsData collection methods and CAM assessmentPeriod of CAM use assessedProportion of cancer-free participants using CAMBreast screening measuresbRelevant findingsCorrelates of more CAM use

DiGianni, (2003 and 2006), [14, 15]Cross-sectional (2003) Prospective cohort (2006)104 without cancer history>18 yrs, F; Enrolled in a breast/ovarian genetic testing clinic; USAMailed questionnaire 83% response rate at 1 year Y/N 8 CAMscEver useBaseline  42%; 33% used 1-2 CAMs 1 yr followup  58%Baseline  BSE (rarely/often) 1 year followup  CBE (# in past year) Mam BSEBaseline—no associations  1yr followup  CBE negatively correlated with # of CAMs used at 1 year ( ); No association for Mam or BSEBaseline   Perceived cancer risk, sunscreen use, fruit/vegetable consumption 1 yr followup  Higher anxiety, lower perceived breast cancer risk

Downey, (2009), [4]Cross-sectional71,08352–64 yrs, F; enrolled in two washington state insurance companies; USAInsurance claims data 4 kinds of insurance-paid CAMPast yearApproximately 22–26% used CAM (depending on year); average 8 visits/yr <1% used only CAM therapiesMam (past 2 years)Complementary CAM use more likely to have Mam (OR 1.044; ); alternative CAM less likely to have Mam (OR 0.006; ); naturopathy negatively associated with Mam (OR 0.736; ); massage positively associated with Mam (OR 1.196; )Younger age, higher disease burden, enrolled in fee-for-service products; over the 3 measurement years; areas with lower education, income, and percentage of minority residents

Druss, (1999), [16]Cross-sectional10,675 overall (# answering breast screening items NRf )>18 yrs, M/F, age and sex-appropriate subset answered breast questions; national probability sample (medical expenditure panel survey); USAInterview 77% response rate Y/N 13 CAMs that are practitioner-basedPast year8.3% of overall sample; NRf for women answering breast screening itemsCBE Mam (past year)More CBE in CAM users (58.7%–95% CI: 57%–60%) than non-users (69.7%–95% CI; 65%–74%) ( )d  No association with MamFemale, caucasian, higher education, and residing in the west (USA) (only reported for overall sample)

Field, (2009), [17]Cross-sectional89262% 40 yrs+, F; enrolled in the high breast cancer risk cohort; Australia and New ZealandMailed questionnaire— 73% response rate Y/N 35 CAMs Ever useGeneral Use  55%; 80% >1 CAM therapy, 30% >4 CAM therapies; Intention to prevent cancer  6% of participantsMam  (past 3 yrs)No associationMore education and physical activity, clinical anxiety, being a former smoker and lower perceived BC risk

Gollsche-wski, (2005), [18]Cross-sectional886 48–67 yrs, F; 61%, <55 yrs; random sample south-east Queensland, AustraliaMailed questionnaire— 59% response rate Y/N questions on herbal, phytoestrogen, nutrition and supplement CAMsEver use82% 67% used nutritional approaches, 56% used phytoestrogens, 41% used herbal therapiesCBE, BSE (past 2 yrs)More BSE in herbal therapy users (OR 1.69, 95% CI 1.34–2.52; ); and nutritional users (OR 1.68, 95% CI 1.13–2.50; ); no association with CBEYounger, higher education, middle income, lower smoking, previous hormone therapy, good physical/general health

Gray, (2002), [7]Cross-sectional 4404>40 yrs, M/F; stratified sample (by chronic conditions) from health plan; Minnesota, USAMailed questionnaire— 86% response rate Y/N 17 CAMsPast year42% overall; 46% FMam (past yr) CAM users significantly more likely to have had Mam (67% versus 62%)Female, younger, higher education, single, employed, health limitations, improved health over past year. More exercise, vegetable intake, fast food consumption; less dietary fat and alcohol (only reported for overall sample)

Mueller, (2008), [19]Cross-sectional 135 without cancer history, knew BRCA1/2 status25–56 years of age, F; Enrolled in high genetic breast cancer risk clinic; USATelephone interview Y/N 13 CAMsPast year78% overall; 69% if spiritual healing/prayer are excludede; average 2.3 CAM therapies; 34% ≥3 CAM therapies (overall sample)Mam (annual) BSE (Monthly)BSE and CAM use inversely related (OR 0.3, 95% CI 0.1–0.8; ); no association with MamOlder, higher education, ovarian cancer worry

Myers, (2008), [20]Cross-sectional2,198, varying risk based on family historyAverage 63 yrs, F; family members of women enrolled in breast cancer family study; USAMailed questionnaire—70% response rate Y/N 8 CAMsEver useIntention: Preventing Cancer  50%; 42% used 1 CAM, 32% used 2 CAMs, 15% used 3, and 12% used >3 CAM therapies.BSE, CBE, Mam (ever)In the univariate analysis, all 3 breast behaviors were associated with CAM use (OR 1.33, 95% CI 1.15–1.54; ); In the multivariate analysis, associations did not remain significant.Higher education, general health behaviors, optimism (multivariate analyses)

Robinson, (2002), [21]Cross-sectional 1,593>18 yrs, M/F, attendees at health fair USAQuestionnaire Y/N 8 CAMs, 13 herbsPast 2 years68%; 63% used herbs/supplementsCBE Mam (Past 2 years)No associationYounger, female, higher education (high school completion), lower levels of health insurance (only reported for overall sample)

aStudies listed by first author.
bCBE: clinical breast examination; Mam: mammography; BSE: breast self-examination.
cY/N refers to dichotomous responses to use of each CAM treatment.
dThese data reflect the authors’ abstract, data section, and conclusions; the table in the paper presents opposite numbers and is assumed to be a typesetting error.
eParticipants with cancer were included in this calculation because the authors state that overall patterns of the CAM therapies used didn’t differ between cancer survivors and women without cancer and data were not presented separately for each group.
fNR: No response.

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