Breast Cancer Research and Treatment

, Volume 117, Issue 3, pp 653–665 | Cite as

Complementary and alternative therapy use before and after breast cancer diagnosis: the Pathways Study

  • Heather Greenlee
  • Marilyn L. Kwan
  • Isaac Joshua Ergas
  • Karen J. Sherman
  • Sarah E. Krathwohl
  • Christine Bonnell
  • Marion M. Lee
  • Lawrence H. Kushi


Many women use complementary and alternative medicine (CAM) to maintain or improve their health. We describe CAM use among the first 1,000 participants enrolled in the Pathways Study, an ongoing prospective cohort study of women diagnosed with breast cancer (BC). Participants, identified by rapid case ascertainment in Kaiser Permanente Northern California, are women ≥ 21 years diagnosed with first invasive BC. Comprehensive baseline data are collected on CAM use through in-person interviews. Study participants include 70.9% non-Hispanic whites, 10.2% Hispanics, 9.0% Asians, 6.5% African–Americans, and 3.4% others. Most women (82.2%) were diagnosed with AJCC stage I/II BC at average (±SD) age 59.5 (±12.0) years and reported prior use of at least one form of CAM (96.5% of participants). In the 5 years before diagnosis, CAM therapies used at least weekly by >20% of women included green tea, glucosamine, omega-3 fatty acids, prayer and religion. CAM use was high (86.1% of participants) in the period immediately following diagnosis; 47.5% used botanical supplements, 47.2% used other natural products, 28.8% used special diets, 64.2% used mind-body healing, and 26.5% used body/energy/other treatments. In multivariable analyses, frequent use of each CAM modality before and after diagnosis was associated with use of other CAM modalities and other health behaviors (i.e., high fruit/vegetable intake, lower BMI). CAM use before and after BC diagnosis is common in this diverse group of women. Our results emphasize the need for clinicians to discuss CAM use with all BC patients.


Complementary and alternative medicine Breast cancer Cohort study Epidemiology 



We gratefully acknowledge all Pathways Study participants, as well as the office and field staff. This work was supported by the National Institutes of Health (CA094061, CA105274); the American Cancer Society (RSG-06-209-01-LR); and the Department of Defense (BC043120). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.


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Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Heather Greenlee
    • 1
    • 2
  • Marilyn L. Kwan
    • 3
  • Isaac Joshua Ergas
    • 3
  • Karen J. Sherman
    • 4
  • Sarah E. Krathwohl
    • 3
  • Christine Bonnell
    • 3
  • Marion M. Lee
    • 5
  • Lawrence H. Kushi
    • 3
  1. 1.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.Herbert Irving Comprehensive Cancer CenterColumbia UniversityNew YorkUSA
  3. 3.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  4. 4.Center for Health StudiesGroup Health CooperativeSeattleUSA
  5. 5.Department of EpidemiologyUniversity of California San FranciscoSan FranciscoUSA

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