Mode de vie, habitudes alimentaires et cancer du sein: Étude cas-témoins chez les Canadiennes-françaises non porteuses de mutations des gènes BRCA

Le cancer du sein (CS) est la deuxième cause de décès liés au cancer parmi les femmes dans la plupart des pays industrialisés. Les personnes qui ont le CS peuvent ne pas hériter des mutations causant le cancer de leurs parents. Ainsi, certaines cellules subissent des mutations qui mènent au cancer. Dans le cas de cancer héréditaire, les cellules tumorales contiennent généralement des mutations qui ne sont pas trouvées ailleurs dans l'organisme, mais peuvent maintenir des mutations qui vont répartir dans toutes les cellules. La genèse du CS est le résultat des mutations de gènes qui assurent la régulation de la prolifération cellulaire et la réparation de l’ADN. Deux gènes semblent particulièrement concernés par les mutations. Les gènes ‘Breast Cancer 1’ (BRCA1) et ‘Breast Cancer 2’ (BRCA2), sont impliqués dans la prédisposition génétique de CS. On estime que 5-10% des cas de cancer du sein sont attribuables à une prédisposition génétique. La plupart de ces cancers sont liés à une anomalie du gène BRCA1 ou BRCA2. Plusieurs études ont été menées chez les femmes atteintes de CS sporadique et quelques études se sont concentrées sur celles qui sont porteuses de mutations de BRCA. Alors, notre recherche a été entreprise afin de vérifier l’hypothèse d’une association entre le CS, le mode vie et les habitudes alimentaires chez les Canadiennes-françaises non porteuses des 6 mutations de BRCA les plus fréquentes parmi cette population. Nous avons mené une étude cas-témoins dans cette population. Quelque 280 femmes atteintes du cancer du sein et non-porteuses de mutations de BRCA, ont été recrutées en tant que cas. Les témoins étaient recrutés parmi les membres de la famille des cas (n=15) ou à partir d'autres familles atteintes de CS (n=265). Les participantes étaient de tous âges, recrutées à partir d’une étude de cohorte qui est actuellement en cours, menée par une équipe de chercheurs au Centre Hospitalier Universitaire de Montréal (CHUM) Hôtel-Dieu à Montréal. Les apports alimentaires ont été recueillis par un questionnaire de fréquence semi-quantitatif validé et administré par une nutritionniste, qui portait sur la période avant les deux ans précédant le premier diagnostic de CS pour les cas et la période avant les deux ans précédant l’entrevue téléphonique pour les témoins. Un questionnaire de base était administré par l’infirmière de recherche aux participantes afin de colliger des renseignements sociodémographiques et sur les facteurs de risque du CS. Une association positive et significative a été détectée entre l’âge (plus de 50 ans) auquel les sujets avaient atteint leur Indice de Masse Corporel (IMC) le plus élevé et le CS rapport de cotes (OR) =2,83; intervalle de confiance à 95% (IC95%) (2,34-2,91). De plus, une association positive a été détectée entre un gain de poids de >34 lbs comparativement à un gain de poids de ≤15 lbs, dès l’âge de 20 ans OR=1,68; IC95% (1,10-2,58). Un gain de poids de >24 lbs comparativement à un gain de poids de ≤9 lbs, dès l’âge de 30 ans a aussi montré une augmentation de risque de CS OR=1,96; IC95% (1,46-3,06). Une association positive a aussi été détecté entre, un gain de poids de >12 lbs comparativement à un gain de poids de ≤1 lb, dès l’âge de 40 ans OR=1,91; IC95% (1,53-2,66). Concernant le tabagisme, nous avons observé une association positive et significative reliée à la consommation de plus de 9 paquets-années OR = 1,59; IC95% (1,57-2,87). Il fut suggéré que l’activité physique modéré confère une protection contre le CS: une pratique de > 24,8 (‘metabolic equivalent’) MET-hrs par semaine par rapport à ≤10,7 MET-hrs par semaine, diminue le risque du CS de 52% OR = 0,48 ; IC95% (0,31-0,74). L’activité physique totale (entre 16,2 et 33,2 MET-hrs par semaine), a aussi montré une réduction de risque de CS de 43% OR = 0,57 ; IC95% (0,37-0,87). Toutefois, il n'y avait aucune association entre une activité physique vigoureuse et le risque de CS. L’analyse portant sur les macro- et micro-nutriments et les groupes alimentaires a montré qu’un apport en énergie totale de plus de 2057 Kcal par jour augmentait le risque de CS de 2,5 fois OR = 2,54; IC95% (1,67-3,84). En ce qui concerne la consommation de café, les participantes qui buvaient plus de 8 tasses de café par jour avaient un risque de CS augmenté de 40% OR = 1,40; IC95% (1,09-2,24). Les sujets ayant une consommation dépassant 9 g d’alcool (éthanol) par jour avaient également un risque élevé de 55% OR = 1,55; IC95% (1,02-2,37). De plus, une association positive et significative a été détectée entre le CS et la consommation de plus de deux bouteilles de bière par semaine OR = 1,34; IC95% (1,28-2,11), 10 onces de vin par semaine OR = 1,16; IC95% (1,08-2,58) ou 6 onces de spiritueux par semaine OR = 1,09; IC95% (1,02-2,08), respectivement. En résumé, les résultats de cette recherche supportent l’hypothèse selon laquelle le mode de vie et les habitudes alimentaires jouent un rôle important dans l’étiologie de CS chez les Canadiennes-françaises non porteuses de mutations de BRCA. Les résultats nous permettent de constater que le gain de poids et le tabagisme sont liés à des risques élevés de CS, tandis que l'activité physique modérée aide à réduire ce risque. De plus, nos résultats suggèrent qu’un apport énergétique total relativement élevé et une consommation élevée de café et d'alcool peuvent accroître le risque de ce cancer. Ce travail a permis de mettre l’accent sur une nouvelle direction de recherche, jusqu'à présent non investiguée. Les résultats de ce travail de recherche pourraient contribuer à recueillir de nouvelles informations et des conseils pouvant influencer et aider la population à modifier son mode de vie et ses habitudes alimentaires afin de diminuer le risque de cancer du sein.

Développement et caractérisation de nouveaux modèles du cancer épithélial de l’ovaire

Le cancer épithélial de l’ovaire (EOC) est le plus mortel des cancers gynécologiques. Cette maladie complexe progresse rapidement de façon difficilement décelable aux stades précoces. De plus, malgré une chirurgie cytoréductive et des traitements de chimiothérapie le taux de survie des patientes diagnostiquées aux stades avancées demeurt faible. Dans le but d’étudier l’EOC dans un contexte ex vivo, l’utilisation de modèles cellulaires est indispensable. Les lignées cellulaires d’EOC sont un outil pratique pour la recherche cependant, la façon dont l'expression des gènes est affectée en culture par comparaison à la tumeur d'origine n'est pas encore bien élucidée. Notre objectif était donc de développer et de caractériser de nouveaux modèles de culture in vitro qui réflèteront plus fidèlement la maladie in vivo. Nous avons tout d’abord utiliser des lignées cellulaires disponibles au laboratoire afin de mettre au point un modèle 3D de culture in vitro d’EOC. Des sphéroïdes ont été générés à l’aide de la méthode des gouttelettes inversées, une méthode pionnière pour la culture des cellules tumorales. Nous avons ensuite procédé à une analyse des profils d’expression afin de comparer le modèle sphéroïde au modèle de culture en monocouche et le modèle xénogreffe in vivo. Ainsi, nous avons identifié des gènes stratifiant les modèles tridimensionnels, tant in vivo qu’in vitro, du modèle 2D monocouche. Parmi les meilleurs candidats, nous avons sélectionné S100A6 pour une caractérisation ultérieure. L’expression de ce gène fût modulée afin d’étudier l’impact de son inhibition sur les paramètres de croissance des sphéroïdes. L’inhibition de ce gène a comme effet de réduire la motilité cellulaire mais seulement au niveau du modèle sphéroïde. Finalement, toujours dans l’optique de développer des modèles d’EOC les plus représentatifs de la maladie in vivo, nous avons réussi à développer des lignées cellulaires uniques dérivées de patientes atteintes d’EOC du type séreux, soit le plus commun des EOC. Jusque là, très peu de lignées cellulaires provenant de ce type de cancer et de patientes n’ayant pas reçu de chimiothérapie ont été produites. De plus, nous avons pour la première fois caractérise des lignées d’EOC de type séreux provenant à la fois de l’ascite et de la tumeur solide de la même patiente.

Les inégalités sociales dans le dépistage du cancer du sein, quand le système s'en mêle...

Réalisé en cotutelle avec Dr. Béatrice Godard, Professeure titulaire à l'Université de Montréal.

How Does Age at Onset Influence the Outcome of Autoimmune Diseases?

The age at onset refers to the time period at which an individual experiences the first symptoms of a disease. In autoimmune diseases (ADs), these symptoms can be subtle but are very relevant for diagnosis. They can appear during childhood, adulthood or late in life and may vary depending on the age at onset. Variables like mortality and morbidity and the role of genes will be reviewed with a focus on the major autoimmune disorders, namely, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), type 1 diabetes mellitus (T1D), Sjögren's syndrome, and autoimmune thyroiditis (AITD). Early age at onset is a worst prognostic factor for some ADs (i.e., SLE and T1D), while for others it does not have a significant influence on the course of disease (i.e., SS) or no unanimous consensus exists (i.e., RA and MS).

Prebiotics and bowel cancer

Bowel cancer is a growing malignancy, with more than a million annual cases reported worldwide. It has been suggested that there is microbial involvement in onset of the disease and that an altered composition has previously been observed in those suffering from the malignancy, compared to healthy counterparts. The use of prebiotic functional foods to modify the colonic microflora may provide a method of reducing genotoxic potential within the colon, whilst offering-Protective strategies in the form of metabolites such as butyrate. The following review highlights some of the studies that demonstrate the potentia role for prebiotics as protective factors against bowel cancer.

Bridging the Faraoni and Selli oceanic anoxic events: late Hauterivian to early Aptian dysaerobic to anaerobic phases in the Tethys.

A detailed geochemical analysis was performed on the upper part of the Maiolica Formation in the Breggia (southern Switzerland) and Capriolo sections (northern Italy). The analysed sediments consist of well-bedded, partly siliceous, pelagic carbonate, which lodges numerous thin, dark and organic-rich layers. Stable-isotope, phosphorus, organic-carbon and a suite of redox-sensitive trace-element contents (RSTE: Mo, U, Co, V and As) were measured. The RSTE pattern and Corg:Ptot ratios indicate that most organic-rich layers were deposited under dysaerobic rather than anaerobic conditions and that latter conditions were likely restricted to short intervals in the latest Hauterivian, the early Barremian and the pre-Selli early Aptian. Correlations are both possible with organic-rich intervals in central Italy (the Gorgo a Cerbara section) and the Boreal Lower Saxony Basin, as well as with the facies and drowning pattern in the Helvetic segment of the northern Tethyan carbonate platform. Our data and correlations suggest that the latest Hauterivian witnessed the progressive installation of dysaerobic conditions in the Tethys, which went along with the onset in sediment condensation, phosphogenesis and platform drowning on the northern Tethyan margin, and which culminated in the Faraoni anoxic episode. This episode is followed by further episodes of dysaerobic conditions in the Tethys and the Lower Saxony Basin, which became more frequent and progressively stronger in the late early Barremian. Platform drowning persisted and did not halt before the latest early Barremian. The late Barremian witnessed diminishing frequencies and intensities in dysaerobic conditions, which went along with the progressive installation of the Urgonian carbonate platform. Near the Barremian-Aptian boundary, the increasing density in dysaerobic episodes in the Tethyan and Lower Saxony Basins is paralleled by a change towards heterozoan carbonate production on the northern Tethyan shelf. The following return to more oxygenated conditions is correlated with the second phase of Urgonian platform growth and the period immediately preceding and corresponding to the Selli anoxic episode is characterised by renewed platform drowning and the change to heterozoan carbonate production. Changes towards more humid climate conditions were the likely cause for the repetitive installation of dys- to anaerobic conditions in the Tethyan and Boreal basins and the accompanying changes in the evolution of the carbonate platform towards heterozoan carbonate-producing ecosystems and platform drowning.

The coupled δ13C-radiocarbon systematics of three Late Glacial/early Holocene speleothems: insights into soil and caveprocesses at climatic transitions

The coupled δ13C-radiocarbon systematics of threeEuropean stalagmites deposited during the Late Glacial and early Holocene were investigated to understand better how the carbon isotope systematics of speleothems respond to climate transitions. The emphasis is on understanding how speleothems may record climate-driven changes in the proportions of biogenic (soil carbon) and limestone bedrock derived carbon. At two of the three sites, the combined δ13C and 14C data argue against greater inputs of limestone carbon as the sole cause of the observed shift to higher δ13C during the cold Younger Dryas. In these stalagmites (GAR-01 from La Garma cave, N. Spain and So-1 from Sofular cave, Turkey), the combined changes in δ13C and initial 14C activities suggest enhanced decomposition of old stored, more recalcitrant, soil carbon at the onset of the warmer early Holocene. Alternative explanations involving gradual temporal changes between open- and closed-system behaviour during the Late Glacial are difficult to reconcile with observed changes in speleothem δ13C and the growth rates. In contrast, a stalagmite from Pindal cave (N. Spain) indicates an abrupt change in carbon inputs linked to local hydrological and disequilibrium isotope fractionation effects, rather than climate change. For the first time, it is shown that while the initial 14C activities of all three stalagmites broadly follow the contemporaneous atmospheric 14C trends (the Younger Dryas atmospheric 14C anomaly can be clearly discerned), subtle changes in speleothem initial 14C activities are linked to climate-driven changes in soil carbon turnover at a climate transition.

Progressive palaeoenvironmental change during the Late Barremian-Early Aptian as prelude to Oceanic Anoxic Event 1a: Evidence from the Gorgo a Cerbara section (Umbria-Marche basin, central Italy)

During Oceanic Anoxic Event 1a (OAE 1a, 120 Ma; Li et al., 2008), organic carbon-rich layers were deposited in marine environments under anoxic conditions on a global scale. In this study, palaeoenvironmental conditions leading to this event are characterised by studying the Upper Barremian to the Lower Aptian succession of the Gorgo a Cerbara section (central Italy). For this, an integrated multi-proxy approach (δ13Ccarb; δ13Corg; δ18O; phosphorus; Total Organic Carbon, TOC; bulk-rock mineralogy, as well as redox-sensitive trace elements — RSTEs) has been applied. During the LateBarremian, thin organic-rich layers occur episodically, and associated Corg:Ptot ratios indicate the presence of intermittent dysoxic to anoxic conditions. Coarse correlations are observed between TOC, P and biogenic silica contents, indicating links between P availability, productivity, and TOC preservation. However, the corresponding δ13Ccarb and δ18O records remain quite stable, indicating that these brief periods of enhanced TOC preservation did not have sufficient impact on the marine carbon reservoir to deviate δ13C records. Around the Barremian–Aptian boundary, TOC-enriched layers become more frequent. These layers correlate with negative excursions in the δ13Ccarb and δ13Corg records, possibly due to a warming period as indicated by the δ18O record. During the earliest Aptian, this warming trend is reverted into a cooling trend, which is then followed by an important warming step near the onset of Oceanic Anoxic Event 1a (OAE 1a). During this time period, organic-rich intervals occur, which are characterised by the progressive increase in RSTE. The warming step prior the onset of OAE 1a is associated with the well-known negative spike in δ13Ccarb and δ13Corg records, an important peak in P accumulation, RSTE enrichments and Corg:Ptot ratios indicating the prevalence of anoxic conditions. The Selli Level itself may document a cooling phase. RSTE enrichments and Corg:Ptot ratios confirm the importance of anoxic conditions during OAE 1a at this site. The Gorgo a Cerbara section is interpreted to reflect the progressive impact of palaeoenvironmental change related to the formation of the Ontong-Java plate-basalt plateau, which started already around the Barremian–Aptian boundary and culminated into OAE 1a.

The Asian summer monsoon: an intercomparison of CMIP5 vs. CMIP3 simulations of the late 20th century

The boreal summer Asian monsoon has been evaluated in 25 Coupled Model Intercomparison Project-5 (CMIP5) and 22 CMIP3 GCM simulations of the late 20th Century. Diagnostics and skill metrics have been calculated to assess the time-mean, climatological annual cycle, interannual variability, and intraseasonal variability. Progress has been made in modeling these aspects of the monsoon, though there is no single model that best represents all of these aspects of the monsoon. The CMIP5 multi-model mean (MMM) is more skillful than the CMIP3 MMM for all diagnostics in terms of the skill of simulating pattern correlations with respect to observations. Additionally, for rainfall/convection the MMM outperforms the individual models for the time mean, the interannual variability of the East Asian monsoon, and intraseasonal variability. The pattern correlation of the time (pentad) of monsoon peak and withdrawal is better simulated than that of monsoon onset. The onset of the monsoon over India is typically too late in the models. The extension of the monsoon over eastern China, Korea, and Japan is underestimated, while it is overestimated over the subtropical western/central Pacific Ocean. The anti-correlation between anomalies of all-India rainfall and Niño-3.4 sea surface temperature is overly strong in CMIP3 and typically too weak in CMIP5. For both the ENSO-monsoon teleconnection and the East Asian zonal wind-rainfall teleconnection, the MMM interannual rainfall anomalies are weak compared to observations. Though simulation of intraseasonal variability remains problematic, several models show improved skill at representing the northward propagation of convection and the development of the tilted band of convection that extends from India to the equatorial west Pacific. The MMM also well represents the space-time evolution of intraseasonal outgoing longwave radiation anomalies. Caution is necessary when using GPCP and CMAP rainfall to validate (1) the time-mean rainfall, as there are systematic differences over ocean and land between these two data sets, and (2) the timing of monsoon withdrawal over India, where the smooth southward progression seen in India Meteorological Department data is better realized in CMAP data compared to GPCP data.

On the seasonal onset of polar mesospheric clouds and the breakdown of the stratospheric polar vortex in the Southern Hemisphere

Southern Hemisphere (SH) polar mesospheric clouds (PMCs), also known as noctilucent clouds, have been observed to be more variable and, in general, dimmer than their Northern Hemisphere (NH) counterparts. The precise cause of these hemispheric differences is not well understood. This paper focuses on one aspect of the hemispheric differences: the timing of the PMC season onset. Observations from the Aeronomy of Ice in the Mesosphere satellite indicate that in recent years the date on which the PMC season begins varies much more in the SH than in the NH. Using the Canadian Middle Atmosphere Model, we show that the generation of sufficiently low temperatures necessary for cloud formation in the SH summer polar mesosphere is perturbed by year‐to‐year variations in the timing of the late‐spring breakdown of the SH stratospheric polar vortex. These stratospheric variations, which persist until the end of December, influence the propagation of gravity waves up to the mesosphere. This adds a stratospheric control to the temperatures in the polar mesopause region during early summer, which causes the onset of PMCs to vary from one year to another. This effect is much stronger in the SH than in the NH because the breakdown of the polar vortex occurs much later in the SH, closer in time to the PMC season.

The correlation of ULF waves and auroral intensity before, during and after substorm expansion phase onset

We present case studies of the evolution of magnetic wave amplitudes and auroral intensity through the late growth phase and the expansion phase of the substorm cycle. We present strong evidence that substorm-related auroral enhancements are clearly and demonstrably linked to ULF wave amplitudes observed at the same location. In most cases, we find that the highest correlations are observed when the magnetometer time series is advanced in time, indicating that the ULF wave amplitudes start to grow before measured auroral intensities, though interestingly this is not always the case. Further we discuss the four possible reasons that may be able to explain both the timing and the high correlations between these two phenomena, including: a simple coincidence, an artifact of instrumental effects, the response of the ionosphere to magnetic waves and auroral particle precipitation, and finally that ULF waves and auroral particle precipitation are physically linked. We discount coincidence and instrumental effects since in the studies presented here they are unlikely or in general will contribute negligible effects, and we find that the ionospheric response to waves and precipitation can explain some, but not all of the results contained within this paper. Specifically, ionospheric response to substorm waves and auroral precipitation cannot explain that the result that previous studies have shown, that onset of ULF wave activity and the onset of auroral particle precipitation occur at the same time and in the same location. This leaves the possibility that ULF waves and auroral particles are physically linked.

The anti-proliferative Effects of enterolactone in prostate cancer cells: evidence for the role of DNA licencing genes, mi-R106b cluster expression, and PTEN dosage

The mammalian lignan, enterolactone, has been shown to reduce the proliferation of the earlier stages of prostate cancer at physiological concentrations in vitro. However, efficacy in the later stages of the disease occurs at concentrations difficult to achieve through dietary modification. We have therefore investigated what concentration(s) of enterolactone can restrict proliferation in multiple stages of prostate cancer using an in vitro model system of prostate disease. We determined that enterolactone at 20 μM significantly restricted the proliferation of mid and late stage models of prostate disease. These effects were strongly associated with changes in the expression of the DNA licencing genes (GMNN, CDT1, MCM2 and 7), in reduced expression of the miR-106b cluster (miR-106b, miR-93, and miR-25), and in increased expression of the PTEN tumour suppressor gene. We have shown anti-proliferative effects of enterolactone in earlier stages of prostate disease than previously reported and that these effects are mediated, in part, by microRNA-mediated regulation.

Early, late or very late? Timing acquisition and bilingualism

Research on child bilingualism accounts for differences in the course and the outcomes of monolingual and different types of bilingual language acquisition primarily from two perspectives: age of onset of exposure to the language(s) and the role of the input (Genesee, Paradis, & Crago, 2004; Meisel, 2009; Unsworth et al., 2014). Some findings suggest that early successive bilingual children may pattern similarly to simultaneous bilingual children, passing through different trajectories from child L2 learners due to a later age of onset in the latter group. Studies on bilingual development have also shown that input quantity in bilingual acquisition is considerably reduced, i.e., in each of their two languages, bilingual children are likely exposed to much less input than their monolingual peers (Paradis & Genesee, 1996; Unsworth, 2013b). At the same time, simultaneous bilingual children develop and attain competence in the two languages, sometimes without even an attested age delay compared to monolingual children (Paradis, Genesee & Crago, 2011). The implication is that even half of the input suffices for early language development, at least with respect to ‘core’ aspects of language, in whatever way ‘core’ is defined.My aim in this article is to consider how an additional, linguistic variable interacts with age of onset and input in bilingual development, namely, the timing in L1 development of the phenomena examined in bilingual children’s performance. Specifically, I will consider timing differences attested in the monolingual development of features and structures, distinguishing between early, late or ‘very late’ acquired phenomena. I will then argue that this three-way distinction reflects differences in the role of narrow syntax: early phenomena are core, parametric and narrowly syntactic, in contrast to late and very late phenomena, which involve syntax-external or even language-external resources too. I explore the consequences of these timing differences in monolingual development for bilingual development. I will review some findings from early (V2 in Germanic, grammatical gender in Greek), late (passives) and very late (grammatical gender in Dutch) phenomena in the bilingual literature and argue that early phenomena can differentiate between simultaneous and (early) successive bilingualism with an advantage for the former group, while the other two reveal similarly (high or low) performance across bilingual groups, differentiating them from monolinguals. The paper proposes that questions about the role of age of onset and language input in early bilingual development can only be meaningfully addressed when the properties and timing of the phenomena under investigation are taken into account.

Season of birth and sheep husbandry in late Roman and Medieval coastal Flanders: a pilot study using tooth enamel d18O analysis

From the early Roman period, there is archaeological evidence for the exploitation of the Flemish coastal plain (Belgium) for a range of activities, such as sheep herding on the then developing salt-marshes and salt-meadows for the production of wool. During the early Middle Ages, this culminated in the establishment of dedicated ‘sheep estates’. This phase of exploitation was followed by extensive drainage and land reclamation measures in the high Medieval period, transforming areas into grassland, suited for cattle breeding. As part of a larger project investigating the onset, intensification and final decline of sheep management in coastal Flanders in the historical period, this pilot study presents the results of sequential sampling and oxygen isotope analysis of a number of sheep teeth (M2, n = 8) from four late Roman and Medieval sites (dating from 4th to 15th century AD), in order to assess potential variations in season of birth between the different sites and through time. In comparison with published data from herds of known birth season, incremental enamel data from the Flemish sites are consistent with late winter/spring births, with the possibility of some instances of slightly earlier parturition. These findings suggest that manipulation of season of birth was not a feature of the sheep husbandry-based economies of early historic Flanders, further evidencing that wool production was the main purpose of contemporary sheep rearing in the region. Manipulation of season of birth is not likely to have afforded economic advantage in wool-centred economies, unlike in some milk- or meat-based regimes.

Cancer patients taking herbal medicines: a review of clinical purposes, associated factors, and perceptions of benefit or harm

Ethnopharmacological relevance: Cancer patients in all cultures are high consumers of herbal medicines (HMs) usually as part of a regime consisting of several complementary and alternative medicine (CAM) modalities, but the type of patient, the reasons for choosing such HM-CAM regimes, and the benefits they perceive from taking them are poorly understood. There are also concerns that local information may be ignored due to language issues. This study investigates aspects of HM-CAM use in cancer patients using two different abstracting sources: Medline, which contains only peer-reviewed studies from SCI journals, and in order to explore whether further data may be available regionally, the Thai national databases of HM and CAM were searched as an example. Materials and methods: the international and Thai language databases were searched separately to identify relevant studies, using key words chosen to include HM use in all traditions. Analysis of these was undertaken to identify socio-demographic and clinical factors, as well as sources of information, which may inform the decision to use HMs. Results: Medline yielded 5,638 records, with 49 papers fitting the criteria for review. The Thai databases yielded 155, with none relevant for review. Factors associated with HM-CAM usage were: a younger age, higher education or economic status, multiple chemotherapy treatment, late stage of disease. The most common purposes for using HM-CAM cited by patients were to improve physical symptoms, support emotional health, stimulate the immune system, improve quality of life, and relieve side-effects of conventional treatment. Conclusions: Several indicators were identified for cancer patients who are most likely to take HM-CAM. However, interpreting the clinical reasons why patients decide to use HM-CAM is hampered by a lack of standard terminology and thematic coding, because patients' own descriptions are too variable and overlapping for meaningful comparison. Nevertheless, fears that the results of local studies published regionally are being missed, at least in the case of Thailand, appeared to be unfounded.