Complementary and Alternative Medicine Use and All-Cause Mortality among U.S.-Born and Foreign-Born Breast Cancer Cases: Results from the Hereditary Breast and Ovarian Cancer (HBOC) Study.

Abstract

Abstract Background: Complementary and alternative medicine (CAM) therapies are used by people from all racial/ethnic backgrounds, and CAM use among cancer patients has recently been a focus of much research. Breast cancer patients, specifically, have embraced many CAM therapies. Use of these therapies is estimated to be between 48 and 70 percent among women diagnosed with breast cancer in the United States (Nahlez and Tabbara, 2003). Mortality patterns in foreign-born women diagnosed with breast and other cancers who immigrate to the United States are complex (Singh and Hiatt, 2006). However, it is unclear how country of birth relates to CAM use and overall survival among women with breast cancer. Therefore, we investigated the associations between country of birth, CAM use, and overall survival in the Hereditary Breast and Ovarian Cancer (HBOC) study, a population-based sample of breast cancer cases in California, comparing U.S.-born versus foreign-born women.Methods: Five hundred and fifty incident breast cancer cases (average age=54.68; SD=11.12) were sampled from the HBOC Study, which were identified through the Orange County regional registry for the state California Cancer Registry. Cases were contacted via telephone, and information on health behaviors, disease history, and socio-demographic characteristics were collected. A self-administered questionnaire queried use of any of the following CAM therapies: herbal teas, megavitamins, acupuncture, religious services, nonreligious services, aspirin, and/or non-prescription pain medicines. Chi-square test followed by Cox proportional hazards regression were used to compare overall survival between U.S.-born and foreign-born breast cancer cases as well as CAM ever- versus never-users.Results: Univariate analyses revealed that 59.5% of foreign-born breast cancer cases, versus 55.7% of U.S.-born reported having ever used CAM (Chi-square=0.76; p=0.38). In multivariate analyses, foreign-born women with breast cancer had roughly 3 times greater risk for all-cause cause mortality (HR=3.38; 95% CI: 2.14, 5.33) compared with U.S.-born breast cancer cases, adjusting for history of CAM use, education, number of existing co-morbidities, stage of tumor at diagnosis, and age at time of survey. Stratified analyses revealed that CAM use was not significantly associated with all-cause mortality using the above multivariate model among foreign-born (HR=1.35; 95% CI: 0.77, 2.37), or U.S.-born breast cancer cases (HR= 2.36; 95% CI: 0.99, 5.64).Discussion: These findings suggest that although foreign-born breast cancer cases are at greater risk for all-cause mortality, history of CAM use does not significantly protect nor increase the risk of death for this population. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3069.