Black cohosh and breast cancer: a systematic review | CCNM

Black cohosh and breast cancer: a systematic review

You are here

BACKGROUND: Many women use black cohosh as a natural treatment for menopausal symptoms. However, controversy exists around safety in breast cancer, because of its purported estrogenic activity. We conducted a systematic review of black cohosh use in women with or at risk of breast cancer. METHODS: We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to July 2012 and October 2012 for human interventional or observational data pertaining to the safety and efficacy of black cohosh in patients with or at risk of breast cancer, including an assessment of the effect of black cohosh on estrogen responsive tissues. RESULTS: Of 450 records, we included 26 articles: 14 randomized controlled trials, 7 uncontrolled trials, and 5 observational studies.The evidence on efficacy for hot flashes is divided, with some benefits seen when compared with baseline, but not when compared with placebo. Two observational studies found no association between black cohosh and risk of breast cancer, whereas 2 studies reported significant reductions in risk of primary breast cancer among postmenopausal women (adjusted odds ratio = 0.47, 95% confidence interval = 0.27-0.82), and risk of recurrence (adjusted hazard ratio = 0.75, 95% confidence interval = 0.63-0.89). Seventeen trials showed no significant impact on circulating hormone levels or proliferation in estrogen responsive tissues. CONCLUSIONS: Current evidence does not support an association between black cohosh and increased risk of breast cancer. There is a lack of evidence supporting the efficacy of black cohosh for reduction of hot flashes in breast cancer patients. Given conflicting but promising results, and apparent safety, further research is warranted. PMID: 23439657
Title of abstract: 
Black Cohosh and Breast Cancer: A Systematic Review
Fritz H, Seely D, McGowan J, Skidmore B, Fernandes R, Kennedy DA, Cooley K, Wong R, Sagar S, Balneaves LG, Fergusson D.
The Canadian College of Naturopathic Medicine, Ottawa Hospital Research Institute, Ottawa Integrative Cancer Center, The University of Toronto, Toronto, Juravinski Cancer Center, McMaster University, University of British Columbia
Monday, December 31, 2012
Integr Cancer Ther. 2014 Jan;13(1):12-29.

CCNM logo


Talk to a student services advisor today by emailing

Canadian College of Naturopathic Medicine

Educating naturopathic doctors in North America for over 40 years

1255 Sheppard Avenue East, Toronto, Ontario M2K 1E2

College: (416) 498-1255 I 1 (866) 241-2266 (toll-free)

Clinic: (416) 498-9763

Member of the Association of
Accredited Naturopathic Medical Colleges