A population-based case-control study on the association of Angelica sinensis exposure with risk of breast cancer

10.1016/j.jtcme.2019.10.003

Jhong-Yuan Chen；Yi-Hsiu Wang；Atik Choirul Hidajah；Chung-Yi Li

Angelica sinensis ； Traditional Chinese medicine ； Phytomedicine ； Herbal medicine ； Breast cancer

Journal of Traditional and Complementary Medicine

10卷5期（2020 / 09 / 01）

454 - 459

英文

Background: Due to a lack of evidence from large-scale epidemiological studies by far on this issue, whether there is a link between Angelica sinensis exposure and breast cancer risk remained inconclusive. Methods: We conducted a population-based case-control study using Taiwan's National Health Insurance claim data, in which all breast cancer patients newly diagnosed between 2005 and 2008 were employed as the case group (n = 34,262) and a random sample of non-breast cancer individuals selected from 1- million beneficiaries registered in 2005 was served as the control group. For fair comparability, we employed the time density sampling method to select controls who were matched to case on date of breast cancer diagnosis and age with a case/control ratio of 1/3 (n = 102,786). Results: We found that the use of Angelica sinensis presents a weakly but significantly protective effect on breast cancer (adjusted odds ratio (aOR) 0.95, 95% confidence interval (CI) 0.93-0.98), with a significant dose-gradient relationship. We also noted a stronger association with breast cancer with initial use of Angelica sinensis at a longer time before breast cancer diagnosis, and found that the seemingly protective effect of Angelica sinensis was more obvious among women who had initial use at 47-55 years (aOR 0.93, 95% CI 0.88-0.98). Conclusion: This population-based case-control study revealed that exposure to Angelica sinensis showed a weakly but significantly protective effect on breast cancer risk, which could ease people's concern over the potential carcinogenic effect from exposure to Angelica sinensis.

1. (1997).Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer.Lancet,350(9084),1047-1059.
2. Amato, P,Christophe, S,Mellon, PL(2002).Estrogenic activity of herbs commonly used as remedies for menopausal symptoms.Menopause,9(2),145-150.
3. Cao, W,Li, XQ,Hou, Y,Fan, HT,Zhang, XN,Mei, QB(2008).Structural analysis and anti-tumor activity in vivo of polysaccharide APS-2a from Angelica sinensis.Zhong Yao Cai.,31(2),261-266.
4. Chen, YL,Jian, MH,Lin, CC(2008).The induction of orphan nuclear receptor Nur77 expression by n-butylenephthalide as pharmaceuticals on hepatocellular carcinoma cell therapy.Mol Pharmacol,74(4),1046-1058.
5. Godecke, T,Yao, P,Napolitano, JG(2012).Integrated standardization concept for Angelica botanicals using quantitative NMR.Fitoterapia,83(1),18-32.
6. Hsieh, SC,Lai, JN,Lee, CF,Hu, FC,Tseng, WL,Wang, JD(2008).The prescribing of Chinese herbal products in Taiwan: a cross-sectional analysis of the national health insurance reimbursement database.Pharmacoepidemiol Drug Saf.,17(6),609-619.
7. Kan, WL,Cho, CH,Rudd, JA,Lin, G(2008).Study of the anti-proliferative effects and synergy of phthalides from Angelica sinensis on colon cancer cells.J Ethnopharmacol,120(1),36-43.
8. Lai, JN,Wu, CT,Wang, JD(2012).Prescription pattern of Chinese herbal products for breast cancer in taiwan: a population-based study.Evid Based Compl Altern Med,20,891893.
9. Lau, CB,Ho, TC,Chan, TW,Kim, SC(2005).Use of dong quai (Angelica sinensis) to treat peri- or postmenopausal symptoms in women with breast cancer: is it appropriate?.Menopause,12(6),734-740.
10. Lee, YW,Chen, TL,Shih, YR(2014).Adjunctive traditional Chinese medicine therapy improves survival in patients with advanced breast cancer: a population-based study.Cancer,120(9),1338-1344.
11. Lin, YH,Chiu, JH(2011).Use of Chinese medicine by women with breast cancer: a nationwide cross-sectional study in Taiwan.Complement Ther Med,19(3),137-143.
12. Ma, H,Li, L,Dou, G(2017).Z-ligustilide restores tamoxifen sensitivity of ERa negative breast cancer cells by reversing MTA1/IFI16/HDACs complex mediated epigenetic repression of ERa.Oncotarget,8(17),29328-29345.
13. National Health Insurance Administration MoHaW. Taiwan, R.O.C.(2014).National Health Insurance Annual Report 2014-2015.
14. Qi, H,Jiang, Z,Wang, C(2017).Sensitization of tamoxifen-resistant breast cancer cells by Z-ligustilide through inhibiting autophagy and accumulating DNA damages.Oncotarget,8(17),29300-29317.
15. Rossouw, JE,Anderson, GL,Prentice, RL(2002).Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.J Am Med Assoc.,288(3),321-333.
16. Tsai, NM,Chen, YL,Lee, CC(2006).The natural compound n-butylidenephthalide derived from Angelica sinensis inhibits malignant brain tumor growth in vitro and in vivo.J Neurochem,99(4),1251-1262.
17. Tsai, YT,Lai, JN,Lo, PC,Chen, CN,Lin, JG(2017).Prescription of Chinese herbal products is associated with a decreased risk of invasive breast cancer.Medicine,96(35),e7918.
18. Wu, CT,Lai, JN,Tsai, YT(2014).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 population-based study.PLoS One,9(12),e113887.
19. Yue, GG,Wong, LS,Leung, HW(2019).Is Danggui safe to be taken by breast cancer patients?-a skepticism finally answered by comprehensive preclinical evidence.Front Pharmacol,10,706.
20. Zhou, WJ,Wang, S,Hu, Z,Zhou, ZY,Song, CJ(2015).Angelica sinensis polysaccharides promotes apoptosis in human breast cancer cells via CREB-regulated caspase-3 activation.Biochem Biophys Res Commun,467(3),562-569.