Background and objecties Angelica sinensis (Dang gui) has been widely used in traditional Chinese medicine (TCM) clinics and diet therapy for thousands of years. According to TCM theory, A. sinensis can be used for the treatment of breast cancer. As A. sinensis has effects on estrogen, it may have an adverse effect on the prognosis of breast cancer. This article systematically reviews the literature to explore whether breast cancer patients need to avoid taking A. sinensis.
Methods Using the search terms “breast cancer AND Dong-quai”, “breast cancer AND Angelica sinensis”, “breast cancer AND Dang gui” and “breast cancer AND Dang qui”, relevant studies were retrieved from the PubMed database up to December 31, 2022. After excluding irrelevant and repeated studies, the papers were critically reviewed by TCM physicians, and the papers were secondly screened by the impact factor and ranking of the published journals. The included papers were classified into three groups, reporting a “positive”, “negative” or “inconclusive” effect in patients with breast cancer.
Results A total of 22 articles were identified, which included 9, 5 and 7 positive negative and inconclusive studies, respectively. The results showed that studies advocating that A. sinensis may be safely consumed by patients with breast cancer had a higher evidence hierarchy than those that did not support consumption.
Conclusions The findings implied that A. sinensis can be prescribed to patients with breast cancer in appropriate doses under TCM treatment theory.
Acknowledgments
The authors would like to thank Dr Chang-Ju Hsieh, Dr Chih-Nan Huang, Dr Wen-Hua Su, Mr Zhi-Xiang Gan, Dr Yuan-Chun Lo, Dr Shang-Lin Jhong, Miss Tai-Wei Kuo and Dr Chien-Yu Liu for their assistance.
Funding
The study received funding from Changhua Christian Hospital (No: 106-CCH-MST-133).
Conflict of interest
Mark C. Hou served as the editorial board member of Future Inte-grative Medicine from 2021 to 2022. All authors confirm that they do not have any conflict of interests regarding to the publication of this manuscript.
Author contributions
Study design and writing (MCH), execution and drafting the man-uscript (YLC), diagrams and proofreading (YFH).
Data sharing statement
The data used in support of the findings of this study are available from the corresponding author upon request.
| [1] |
Jin M, Zhao K, Huang Q, Xu C, Shang P. Isolation, structure and bio-activities of the polysaccharides from Angelica sinensis (Oliv.) Diels: a review. Carbohydr Polym 2012; 89(3):713-722. doi:10.1016/j.carb-pol.2012.04.049,PMID:24750855.
|
| [2] |
Chen L, Qi J, Chang YX, Zhu D, Yu B. Identification and determina-tion of the major constituents in Traditional Chinese Medicinal formula Danggui-Shaoyao-San by HPLC-DAD-ESI-MS/MS. J Pharm Biomed Anal 2009; 50(2):127-137. doi:10.1016/j.jpba.2009.03.039,PMID:19411155.
|
| [3] |
Hook IL. Danggui to Angelica sinensis root: are potential benefits to European women lost in translation? A review. J Ethnopharmacol 2014; 152(1):1-13. doi:10.1016/j.jep.2013.12.018,PMID:24365638.
|
| [4] |
Zhan JY, Zheng KY, Zhu KY, Zhang WL, Bi CW, Chen JP, et al. Impor-tance of wine-treated Angelica Sinensis Radix in Si Wu Tang, a tra-ditional herbal formula for treating women's ailments. Planta Med 2013; 79(7):533-537. doi:10.1055/s-0032-1328261,PMID:23457023.
|
| [5] |
Amato P, Christophe S, Mellon PL. Estrogenic activity of herbs com-monly used as remedies for menopausal symptoms. Menopause 2002; 9(2):145-150. doi:10.1097/00042192-200203000-00010, PMID:11875334.
|
| [6] |
Liu J, Burdette JE, Xu H, Gu C, van Breemen RB, Bhat KP, et al. Evalu-ation of estrogenic activity of plant extracts for the potential treat-ment of menopausal symptoms. J Agric Food Chem 2001; 49(5):2472-2479. doi:10.1021/jf0014157,PMID:11368622.
|
| [7] |
Piersen CE. Phytoestrogens in botanical dietary supplements: impli-cations for cancer. Integr Cancer Ther 2003; 2(2):120-138. doi:10.1177/1534735403002002004,PMID:15035899.
|
| [8] |
Ding J, Guo Y, Jiang X, Li Q, Li K, Liu M, et al. Polysaccharides Derived from Saposhnikovia divaricata May Suppress Breast Cancer Through Activating Macrophages. Onco Targets Ther 2020; 13:10749-10757. doi:10.2147/OTT.S267984,PMID:33132702.
|
| [9] |
Cao W, Li XQ, Liu L, Yang TH, Li C, Fan HT, et al. Structure of an anti-tumor polysaccharide from Angelica sinensis ( Oliv.). Diels 2006; 66(2):149-159. doi:10.1016/j.carbpol.2006.02.034.
|
| [10] |
Lai JN, Wu CT, Wang JD. Prescription pattern of chinese herbal prod-ucts for breast cancer in taiwan: a population-based study. Evid Based Complement Alternat Med 2012; 2012:891893. doi:10.1155/2012/891893,PMID:22685488.
|
| [11] |
Hu YC, Wu CT, Lai JN, Tsai YT. Detection of a negative correlation be-tween prescription of Chinese herbal products containing coume-strol, genistein or daidzein and risk of subsequent endometrial cancer among tamoxifen-treated female breast cancer survivors in Taiwan between 1998 and 2008: A population-based study. J Ethnopharma-col 2015; 169:356-362. doi:10.1016/j.jep.2015.04.028,PMID:25934515.
|
| [12] |
Wu CT, Lai JN, Tsai YT. The prescription pattern of Chinese herbal products that contain dang-qui and risk of endometrial cancer among tamoxifen-treated female breast cancer survivors in Taiwan: a pop-ulation-based study. PLoS One 2014; 9(12):e113887. doi:10.1371/journal.pone.0113887,PMID:25485843.
|
| [13] |
Clark HD, Wells GA, Huët C, McAlister FA, Salmi LR, Fergusson D, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials 1999;20(5):448-452. doi:10.1016/s0197-2456(99)00026-4, PMID:10503804.
|
| [14] |
Sutherland SE. An introduction to systematic reviews. J Evid-based Dent Pr 2004; 1(4):47-51. doi:10.1016/j.jebdp.2004.02.021.
|
| [15] |
Newman MG, Caton JG, Gunsolley JC. The use of the evidence-based approach in a periodontal therapy contemporary science workshop. Ann Periodontol 2003; 8(1):1-11. doi:10.1902/annals.2003.8.1.1,PMID:14971245.
|
| [16] |
Glass GV. Primary, secondary, and meta-analysis of research. Educ Researcher 1976; 5(10):3-8. doi:10.3102/0013189X005010003.
|
| [17] |
Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ. Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev 2006;(2): CD001724. doi:10.1002/14651858.CD001724.pub2,PMID:16625546.
|
| [18] |
Ma H, Li L, Dou G, Wang C, Li J, He H, et al. Z-ligustilide restores tamoxifen sensitivity of ERa negative breast cancer cells by revers-ing MTA1/IFI16/HDACs complex mediated epigenetic repression of ERa. Oncotarget 2017; 8(17):29328-29345. doi:10.18632/onco-target.16440,PMID:28415616.
|
| [19] |
Qi H, Jiang Z, Wang C, Yang Y, Li L, He H, et al. Sensitization of tamoxifen-resistant breast cancer cells by Z-ligustilide through inhibiting autophagy and accumulating DNA damages. Onco-target 2017; 8(17):29300-29317. doi:10.18632/oncotarget.16832,PMID:28431397.
|
| [20] |
Rosenberg Zand RS, Jenkins DJ, Diamandis EP. Effects of natural prod-ucts and nutraceuticals on steroid hormone-regulated gene expres-sion. Clin Chim Acta 2001;312(1-2):213-219. doi:10.1016/s0009-8981(01)00626-x, PMID:11580929.
|
| [21] |
Zhuang SR, Chiu HF, Chen SL, Tsai JH, Lee MY, Lee HS, et al. Effects of a Chinese medical herbs complex on cellular immunity and toxicity-re-lated conditions of breast cancer patients. Br J Nutr 2012; 107(5):712-718. doi:10.1017/S000711451100345X, PMID:21864416.
|
| [22] |
Chang CJ, Chiu JH, Tseng LM, Chang CH, Chien TM, Wu CW, et al. Modulation of HER2 expression by ferulic acid on human breast can-cer MCF7 cells. Eur J Clin Invest 2006; 36(8):588-596. doi:10.1111/j.1365-2362.2006.01676.x, PMID:16893382.
|
| [23] |
Lau CB, Ho TC, Chan TW, Kim SC. Use of dong quai (Angelica sin-ensis) to treat peri- or postmenopausal symptoms in women with breast cancer: is it appropriate? Menopause 2005; 12(6):734-740. doi:10.1097/01.gme.0000184419.65943.01,PMID:16278617.
|
| [24] |
Brasky TM, Lampe JW, Potter JD, Patterson RE, White E. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) Cohort. Cancer Epidemiol Biomarkers Prev 2010; 19(7):1696-1708. doi:10.1158/1055-9965.EPI-10-0318,PMID:20615886.
|
| [25] |
Dietz BM, Hajirahimkhan A, Dunlap TL, Bolton JL. Botanicals and Their Bioactive Phytochemicals for Women’s Health. Pharmacol Rev 2016; 68(4):1026-1073. doi:10.1124/pr.115.010843,PMID:27677719.
|
| [26] |
Cheema D, Coomarasamy A, El-Toukhy T. Non-hormonal therapy of post-menopausal vasomotor symptoms: a structured evidence-based review. Arch Gynecol Obstet 2007; 276(5):463-469. doi:10.1007/s00404-007-0390-9,PMID:17593379.
|
| [27] |
Rock E, DeMichele A. Nutritional approaches to late toxici-ties of adjuvant chemotherapy in breast cancer survivors. J Nutr 2003; 133(11 Suppl 1):3785S-3793 S. doi:10.1093/jn/133.11.3785S,PMID:14608115.
|
| [28] |
Su YJ, Huang SY, Ni YH, Liao KF, Chiu SC. Anti-Tumor and Radiosen-sitization Effects of N-Butylidenephthalide on Human Breast Cancer Cells. Molecules 2018; 23(2):240. doi:10.3390/molecules23020240,PMID:29370116.
|
| [29] |
Wu CY, Chen YC. Riboflavin immobilized Fe(3)O(4) magnetic nanopar-ticles carried with n-butylidenephthalide as targeting-based antican-cer agents. Artif Cells Nanomed Biotechnol 2019; 47(1):210-220. doi :10.1080/21691401.2018.1548473,PMID:30663404.
|
| [30] |
Chen JY, Wang YH, Hidajah AC, Li CY. A population-based case-con-trol study on the association of Angelica sinensis exposure with risk of breast cancer. J Tradit Complement Med 2020; 10(5):454-459. doi:10.1016/j.jtcme.2019.10.003,PMID:32953561.
|
| [31] |
Li X, Shi G. Therapeutic effects and mechanism of ferulic acid and icariin in mammary gland hyperplasia model rats via regulation of the ERK pathway. Ann Transl Med 2021; 9(8):666. doi:10.21037/atm-21-656,PMID:33987364.
|
| [32] |
Zhu H, You J, Wen Y, Jia L, Gao F, Ganesan K, et al. Tumorigenic risk of Angelica sinensis on ER-positive breast cancer growth through ER-induced stemness in vitro and in vivo. J Ethnopharma-col 2021;280:114415. doi:10.1016/j.jep.2021.114415,PMID:34271113.
|
| [33] |
Yen C, Zhao F, Yu Z, Zhu X, Li CG. Interactions Between Natural Products and Tamoxifen in Breast Cancer: A Comprehensive Lit-erature Review. Front Pharmacol 2022;13:847113. doi:10.3389/fphar.2022.847113,PMID:35721162.
|
| [34] |
Boon H, Brown JB, Gavin A, Kennard MA, Stewart M. Breast can-cer survivors’ perceptions of complementary/alternative medicine (CAM): making the decision to use or not to use. Qual Health Res 1999; 9(5):639-653. doi:10.1177/104973299129122135,PMID:10558372.
|
| [35] |
Wu JX, Zheng H, Yao X, Liu XW, Zhu HJ, Yin CL, et al. Comparative analysis of the compatibility effects of Danggui-Sini Decoction on a blood stasis syndrome rat model using untargeted metabolomics. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1105:164-175. doi:10.1016/j.jchromb.2018.12.017,PMID:30594827.
|
| [36] |
Al-Bannay H. Integrating alternative medicine into conventional bio-medical health: How do we weight the evidence. Glob J Arch & An-thropol 2017; 5(1):125-126. doi:10.19080/GJAA.2017.01.555575.
|
| [37] |
Danner M, Hummel JM, Volz F, van Manen JG, Wiegard B, Dintsios CM, et al. Integrating patients’ views into health technology assess-ment: Analytic hierarchy process (AHP) as a method to elicit patient preferences. Int J Technol Assess Health Care 2011; 27(4):369-375. doi:10.1017/S0266462311000523,PMID:22004779.
|
| [38] |
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinners-ley P, et al. Shared decision making: A model for clinical practice. J Gen Intern Med 2012; 27(10):1361-1367. doi:10.1007/s11606-012-2077-6,PMID:22618581.
|
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