Despite advances made in conventional oncological treatment for early-stage breast cancer, such treatments have been known to cause severe side effects without offering a curative guarantee. To this date, acupuncture has proven beneficial for palliative purposes and the treatment of chemotherapy-related toxicities only. We present a case of a female patient who refused standardized medical care and decided to pursue acupuncture with a therapeutic objective and experienced encouraging outcomes. This favorable result gives way to the potential of studying this modality in well-designed trials solely for the treatment of early stage breast cancer.
breast cancer, acupuncture, moxibustion, alternative medicine, palliative care
Although the mechanism of action for acupuncture itself remains unclear, it has widely been acknowledged as beneficial for overall wellness and treatment of several diseases. In fact, its increasing popularity has reached an all-time high over the last few years. In regards to cancer specifically, acupuncture has consistently been considered one of the best means for managing the chemotherapy and radiotherapy related side effects caused by the treatments of many cancers. Nevertheless, methodological limitations and inconclusive or contradictory results have prevented it from becoming integrated into to conventional oncological treatment, or as complementary medicine practice in itself. Moreover, little has been investigated regarding its benefits in a palliative population or its use as alternative cancer treatment. We present a case of a 56yo female diagnosed with triple positive invasive left ductal carcinoma and simultaneous right in-situ ductal carcinoma. The patient declined conventional oncological treatment and pursued acupuncture treatment with highly encouraging results.
A 56yo G0P0 female with no significant past medical history presented a bilaterally abnormal mammogram. Her past surgical history was significant for a right excisional biopsy in 1991 showing atypical cells, however she did not follow up with any therapy options. Her family history was positive for early stage breast cancer with her mother being diagnosed in her 70s and her maternal cousin undergoing a mastectomy in her 40s. Gynecological history was relevant for menarche at age 15 and menopause at age 50. She had never used any contraceptive methods. Her mammogram reported “grouped heterogeneous calcifications in the right subareolar breast at 3 o’clock and 1 o’clock in the left breast. There are mass-like areas associated with the calcifications”. Subsequent ultrasound reported “poorly defined mass in the right breast at 3 o’clock with associated calcifications which corresponds to the mammography finding. The area measures 1.6 × 1.2 × 1.3 cm. There is a similar area in the left breast 1 o’clock which measures 1.7 × 1.4 × 1.3 cm”. US guided biopsy demonstrated right ductal carcinoma-in-situ, intermediate nuclear grade, and cribriform pattern with comedal necrosis and associated calcifications, ER + (90%)”. Left breast tissue demonstrated “invasive ductal carcinoma, histologic grade 2, with ductal carcinoma-in-situ, low nuclear grade, cribriform patterns with focal necrosis, ER + (95%), PR + (75%) with usual ductal hyperplasia, columnar cell change, sclerosing adenosis and cysts calcifications associated with invasive tumor, ductal carcinoma in-situ, lobules and stroma". Given her staging (left T1sN0 DCIS, intermediate nuclear grade and a right T1cNo IDC, grade 2, ER +, PR +), she was recommended bilateral wide local excision and bilateral sentinel lymph node biopsy and genetic counseling. Despite several warnings, the patient refused conventional oncological treatment and decided to pursue acupuncture as an alternative treatment modality.
At the time of initial presentation for acupuncture treatment, patient complained of insomnia, night sweats, sinus problems, mouth sores, and nocturia. The initial evaluation showed an exhausted, irritated patient with obvious stress and anxiety. The right breast lump was measured at 3 cm2 and completely adjacent to the nipple, and the left one was soft and measured 4 cm2. Treatment plan was designed to prevent Qi stasis of stomach and liver meridians and eliminating the lumps. The following acupuncture points were utalized: GB21 Jian Jing, ST16 Yingchuang, LI11 Quchi, ST 36 Zusanli, RN4 (CV4) Guan Yuan, GB36 WaiQiu, LR9 (LV9) YinBao, GB37 Guang Ming, GB39 XuanZhong. Treatment also included surface bloodletting on the upper back. A week after initial therapy, the patient reported feeling stronger and better. Her insomnia was improving and the night sweats had completely subsided. The right breast mass was no longer fixed. However, the pulse was soft and slow; and tongue had a light thin cover. Treatment was planned at that time to eliminate the inside coldness, promote Qi flow, and eradicate the lump. Patient was seen again after 19 days but no significant change in lump characteristics was appreciated. Nevertheless, the stomach was now hot and there was stasis of Liver Qi. Seven days after this visit, wet accumulation was noted. During the course of acupuncture treatments, the patient performed self moxibustion on a daily basis and drank Ling Zhi soap (Ganoderma Lucidum Karst). The three month follow up visit revealed complete resolution of symptoms and no perceivable masses upon physical examination. CA27.29 is 16.5 ng/mL (0.0-38.0). A repeat ultrasound performed at this time indicated no perceivable masses. At this point the patient had received treatment twice a week for 6 weeks followed by weekly sessions for another 6 weeks.
Acupuncture is becoming an important component of both complementary and alternative treatment techniques for the oncological population . Inserting a small needle in a certain area of the body relieves pain and facilitates the body's natural healing processes. Unfortunately, its precise mechanism of action remains unclear. Based on current evidence and knowledge, one of the proposed possible answers to this conundrum is the biological computer model. This idea proposes that the human body mimics a biological computer where organs serve as the headquarters and body surface serves as the keyboard. Both regions are wired or connected through set meridians. When a body is alive, a keyboard can be used to send instructions through twelve meridians and Jing/Lou (additional channels) to organs. The organs then respond by initiating specific actions. Similar conclusions have lead to another possible theory known as the connective tissue stretch theory. According to this theory, the mysterious acupuncture meridians may be similarly related to connective tissue, as they do appear to be preferentially located along connective-tissue planes (between muscles and/or bones). Proponents affirm that more than 80 percent of acupuncture points in the arm are located along connective-tissue planes. The manipulation of this tissue with acupuncture needles results in sustained stretching and therefore becomes a useful tool to study the biomechanical function of acupuncture. A twisted acupuncture needle creates a localized stretch by gripping the underlying connective tissue. This effect can be observed in the “tenting” of the skin and a visceral response as the needle is removed . Nevertheless, some believe that manipulation of certain points via acupuncture can induce an ATP-production increase. Once ATP production is increased it will act as a transmitter that binds to purinergic receptors including the P2X and P2Y receptors. Since ATP cannot be transported back into the cell, it is rapidly degraded into adenosine by several ectonucleotidases before re-uptake. Thusly, the adenosine acts as an analgesic agent that suppresses pain through Gi-coupled A1-adenosine receptors. This premise has been encompassed into “ATP/ADP transition model” . Finally, the Physics Quark particular-string theory also seeks to explain the ever evasive method of action for acupuncture treatment. This premise utilizes the supersymmetry of particles caused by string correlation. Any force acting on a particular quark induces similar movement in peer quarks in unlimited distances. Because this theory incorporates fundamental interactions such as gravity, many physicists hope that it fully describes our universe and therefore constitutes the theory of everything. Current research in string theory is focused on finding a solution that is quantitatively identical to the standard model and includes, a small cosmological constant, dark matter and a plausible mechanism for cosmic inflation. Particular Quark is found to fit string theory and has been described as peer particularly linked with string in unlimited distances.
Although the exact mechanism of action for acupuncture and its role regarding mortality rates regarding breast cancer specifically is yet to be determined, it is well established that it can contribute to the better management of chemotherapy-induced side effects such as nausea and vomiting . Additionally, fatigue, anxiety, physical distress, emotional distress, poor quality of life, and the odontological pain associated with conventional treatments can be mitigated with such practices . Also, increased appetite and slower weight loss rates were seen in patients with gastrointestinal and thyroid cancers when acupuncture was utilized as a complementary treatment . Controversially, several authors have argued that there is not enough evidence for acupuncture and/or acupressure to be used as regular, complementary, or alternative treatment, despite the fact others have considered it an important modality for palliative care [7,8]. This is further supported by the fact that unwanted side effects related to acupuncture techniques are limited to minimal bleeding and mild pain on the insertion site. Published case reports have also demonstrated successful outcomes utilizing acupuncture treatments to reduce tumors in uterine myoma cases . Regarding breast cancer specifically, acupuncture has been proven to improve aromatase inhibitor-related musculoskeletal symptoms . Nevertheless, little is known about its impact when used solely for therapeutic purposes in complementary or alternative treatment plans.
Moxibustion has been believed to be beneficial for patients with cancer, ulcerative colitis, constipation, hypertension, pain conditions, breech presentation, and as a means for stroke rehabilitation. The Moxibustion practice dates back to the 16th century. The process involves using the herb Artemisia (also known as mugwort) to produce “Moxa” (jiǔ (灸) or jiǔshù (灸術). Moxa is used to warm meridian points in the body with the intention of stimulating circulation and inducing smoother Qi flow. Several authors cite its capacity to treat conditions associated with the "cold" or "yang deficiencies”. Bian Que, the first specialist in moxibustion, discussed the benefits of moxa over acupuncture in Bian Que Neijing and affirmed that moxa could add energy to the body, treat deficiency related conditions and “excesses”. As such, if cancer patient feels weak or “cold”, moxibustion treatment may provide a beneficial effect. Inversely, moxibustion has not proven capable of providing even symptomatic relief to patients with breast cancer. Although some believe moxibustion is capable of treating cancer-related fatigue, immune function, and pain, the high risk of bias and low quality reporting of existing studies does not allow for a statistically significant difference to be drawn [11-14].
Our patient declined conventional oncological treatment and decided to attempt curative acupuncture and moxibustion instead. She followed a course of treatment focused on strengthening Qi flow and eliminating lump in the breast. Treatment consisted of large intestine, gallbladder, and liver meridian acupuncture treatments up to twice a week for 3 months along with self moxibustion with Ling Zhi soap. This course of treatment caused the breast cancer progression to stop, and subsequent ultrasounds revealed that both breast masses had disappeared. Tumor markers were also measured to be within normal limits, further supporting the theory that acupuncture and moxibustion by themselves can be sufficient to treat and control early stage triple positive breast invasive ductal carcinoma and carcinoma in-situ (Figures 1 and 2).
Figure 1. Left breast mammogram post clip placement
Figure 2. Right breast mammogram post clip placement
Acupuncture has proven to be useful as an adjunct treatment for cancer or chemotherapy or radiotherapy-induced symptom management. While high-quality trials are still needed to establish the treatment's efficacy, palliative patients may benefit from these primarily safe, low-cost services. Furthermore, acupuncture has become an important complementary instrument in the treatment of conventional, oncological treatment-induced side effects. Our case report argues that this treatment modality might also be sufficient by itself to treat triple positive breast invasive ductal carcinoma and carcinoma in-situ breast cancer in early stages. Of course, more standardized studies are necessary in order for these practices to become an individual treatment option for patients with early stage breast cancer as conventional oncological treatment remains unsurpassed for proven safety and efficacy.
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