While we might wish to say that naturopathic medicine is evidence based, we must admit that some of our thoughts regarding patient treatment rely more on best guesses based on relatively scant evidence. We often find ourselves extrapolating from faint data points hoping to find a useful path forward. Here’s a recent example:
Just before Christmas, in December 2016, a paper by Bouchard et al, a group of researchers from Quebec, Canada, was published in the International Journal of Radiation Biology that caught our attention. These researchers reported that radiation of triple negative breast cancer cells indirectly promotes cancer cell invasion and metastasis by increasing interleukin-1β.1 The later chemical is one of a large family of inteleukins also known as cytokines, produced by white blood cells that regulate inflammation and the immune response. This is clearly not something anyone wants to occur.
Most women diagnosed with triple negative breast cancer are going to be treated with radiation; this is the standard of care. Reading that radiation treatment may backfire and encourage the cancer to spread is not what we hope the treatment will do.
Granted this is only one study. It was done on mice rather than humans. By the current standards of medicine, it is inadequate evidence to prove that this problem really exists. Perhaps over time future studies will suggest that this is only a problem for mice and not human women. It certainly is not the sort of evidence that suggests women with TNBC should avoid radiation treatment. We can’t suggest it is evidence-based practice. Yet at the same time it seems foolhardy to ignore this report.
To those of us who focus on naturopathic oncology, these new data hint to a course of action. We question whether there are ways to limit increases in interleukin 1β so that treatment poses less of a risk to the patient?
Rather quickly we create a short list of nutritional supplements that indeed may limit increases in interleukin-1β, a list that includes curcumin2, berberine3, green tea4, and boswellia.5 We, or at least I, paste that list in my notes as things to consider for patients with this type of cancer undergoing this treatment.
At this point we do not have evidence that this thinking is sound and that these supplements will limit this aggressive cancer’s spread by inhibiting this interleukin. It is just a guess, albeit an educated guess, but still a weak guess. What can we call it, in contrast to evidence-based medicine, maybe it’s evidence informed guesswork? Five years in the future we may have published evidence that answers whether our guess was correct or wrong. Only time will tell. In the meantime though, does it hurt to try?
In the Natural Medicine Journal we avoid mention of studies like this paper by Bouchard. Our preference is to report solely on randomized controlled trials conducted on human subjects. Yet to ignore this study would seem to be misconduct; if this study had associated an increased risk of metastasis to a nutritional supplement rather than radiation treatment, all of us would jump to add that supplement to our lists of contraindications, just to be on the safe side. Though the evidence is weak in regard to radiation, interleukin-1β, and metastasis, we should attempt to stay on the safe side, even if it is still an educated guess.
- Bouchard G, Therriault H, Bujold R, Saucier C, Paquette B. Induction of interleukin-1? by mouse mammary tumor irradiation promotes triple negative breast cancer cells invasion and metastasis development. Int J Radiat Biol. 2016 Dec 9:1-38. [Epub ahead of print]
- Park S, Lee LR, Seo JH, Kang S. Curcumin and tetrahydrocurcumin both prevent osteoarthritis symptoms and decrease the expressions of pro-inflammatory cytokines in estrogen-deficient rats. Genes Nutr. 2016 Mar 17;11:2.
- Jin H, Jin X, Cao B, Wang W. Berberine affects osteosarcoma via downregulating the caspase-1/IL-1? signaling axis. Oncol Rep. 2016 Dec 16.
- Yun M, Seo G, Lee JY, Chae GT, Lee SB. Epigallocatechin-3-gallate attenuates the AIM2-induced secretion of IL-1? in human epidermal keratinocytes. Biochem Biophys Res Commun. 2015 Nov 27;467(4):723-9.
- Stürner KH, Verse N, Yousef S, Martin R, Sospedra M. Boswellic acids reduce Th17 differentiation via blockade of IL-1?-mediated IRAK1 signaling. Eur J Immunol. 2014 Apr;44(4):1200-12.