Table 1.
Summary of Studies.
| Studya (Year) | Study design | Sample size | Selected participant characteristics | Data collection methods and CAM assessment | Period of CAM use assessed | Proportion of cancer-free participants using CAM | Breast screening measuresb | Relevant findings | Correlates 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; USA | Mailed questionnaire 83% response rate at 1 year Y/N 8 CAMsc | Ever use | Baseline 42%; 33% used 1-2 CAMs 1 yr followup 58% | Baseline BSE (rarely/often) 1 year followup CBE (# in past year) Mam BSE | Baseline—no associations 1yr followup CBE negatively correlated with # of CAMs used at 1 year (P < 0.004); No association for Mam or BSE | Baseline Perceived cancer risk, sunscreen use, fruit/vegetable consumption 1 yr followup Higher anxiety, lower perceived breast cancer risk |
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| Downey, (2009), [4] | Cross-sectional | 71,083 | 52–64 yrs, F; enrolled in two washington state insurance companies; USA | Insurance claims data 4 kinds of insurance-paid CAM | Past year | Approximately 22–26% used CAM (depending on year); average 8 visits/yr <1% used only CAM therapies | Mam (past 2 years) | Complementary CAM use more likely to have Mam (OR 1.044; P = 0.031); alternative CAM less likely to have Mam (OR 0.006; P = 0.000); naturopathy negatively associated with Mam (OR 0.736; P = 0.000); massage positively associated with Mam (OR 1.196; P = 0.000) | 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 |
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| Druss, (1999), [16] | Cross-sectional | 10,675 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); USA | Interview 77% response rate Y/N 13 CAMs that are practitioner-based | Past year | 8.3% of overall sample; NRf for women answering breast screening items | CBE Mam (past year) | More CBE in CAM users (58.7%–95% CI: 57%–60%) than non-users (69.7%–95% CI; 65%–74%) (P < 0.001)d No association with Mam | Female, caucasian, higher education, and residing in the west (USA) (only reported for overall sample) |
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| Field, (2009), [17] | Cross-sectional | 892 | 62% 40 yrs+, F; enrolled in the high breast cancer risk cohort; Australia and New Zealand | Mailed questionnaire— 73% response rate Y/N 35 CAMs | Ever use | General Use 55%; 80% >1 CAM therapy, 30% >4 CAM therapies; Intention to prevent cancer 6% of participants | Mam (past 3 yrs) | No association | More education and physical activity, clinical anxiety, being a former smoker and lower perceived BC risk |
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| Gollsche-wski, (2005), [18] | Cross-sectional | 886 | 48–67 yrs, F; 61%, <55 yrs; random sample south-east Queensland, Australia | Mailed questionnaire— 59% response rate Y/N questions on herbal, phytoestrogen, nutrition and supplement CAMs | Ever use | 82% 67% used nutritional approaches, 56% used phytoestrogens, 41% used herbal therapies | CBE, BSE (past 2 yrs) | More BSE in herbal therapy users (OR 1.69, 95% CI 1.34–2.52; P = 0.01); and nutritional users (OR 1.68, 95% CI 1.13–2.50; P = 0.01); no association with CBE | Younger, higher education, middle income, lower smoking, previous hormone therapy, good physical/general health |
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| Gray, (2002), [7] | Cross-sectional | 4404 | >40 yrs, M/F; stratified sample (by chronic conditions) from health plan; Minnesota, USA | Mailed questionnaire— 86% response rate Y/N 17 CAMs | Past year | 42% overall; 46% F | Mam (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) |
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| Mueller, (2008), [19] | Cross-sectional | 135 without cancer history, knew BRCA1/2 status | 25–56 years of age, F; Enrolled in high genetic breast cancer risk clinic; USA | Telephone interview Y/N 13 CAMs | Past year | 78% 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; P = 0.017); no association with Mam | Older, higher education, ovarian cancer worry |
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| Myers, (2008), [20] | Cross-sectional | 2,198, varying risk based on family history | Average 63 yrs, F; family members of women enrolled in breast cancer family study; USA | Mailed questionnaire—70% response rate Y/N 8 CAMs | Ever use | Intention: 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; P = 0.0002); In the multivariate analysis, associations did not remain significant. | Higher education, general health behaviors, optimism (multivariate analyses) |
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| Robinson, (2002), [21] | Cross-sectional | 1,593 | >18 yrs, M/F, attendees at health fair USA | Questionnaire Y/N 8 CAMs, 13 herbs | Past 2 years | 68%; 63% used herbs/supplements | CBE Mam (Past 2 years) | No association | Younger, 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.