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Recently, the same research group injected another mice group with human there are said to be indications tumor cells. Lignans also contribute to the decrease of breast cancer risk. Vegetarians have a higher level of lignan ingestion, meaning that their breast cancer risk is lower than that of omnivores (53). This study did not show any effects regarding flaxseed on the aromatase inhibitor activity in selected breast tumor characteristics and serum steroid hormone levels (9).

This risk decrease may be related to a reduction in inflammation, since the presence of large amounts of lignans can lead to a decrease in several inflammatory markers (52, 54).

In two meta-analysis studies, it was found that a higher intake of lignans from dietary sources was associated with a significant reduction in postmenopausal breast cancer risk (54, 55). In a case-control study, the highest lignan consumption was associated with significantly lower Loxapine (Loxapine Succinate)- FDA breast cancer mortality but that association there are said to be indications not happen relatively to premenopausal breast cancer mortality (56).

A case-control study using the Ontario cancer registry database consisted of a random sample of women diagnosed with breast cancer, with the aim of analyzing the phytoestrogen intake (isoflavones and lignans) and their association with breast cancer risk. A food-frequency questionnaire was used, which also included foods rich in phytoestrogens. In premenopausal women, the total phytoestrogen intake was associated with a significant reduction in the risk of breast cancer, but only in overweight women.

There was no association 25mg breast cancer risk and the intake of phytoestrogen in postmenopausal women (51).

Another case-control study also using the Ontario cancer registry database conducted a food-frequency questionnaire with the aim of establishing if phytoestrogen intake during adolescence could protect against breast cancer in adulthood.

The results of this study revealed that a higher phytoestrogen intake (isoflavones and lignans) during adolescence can be associated with a reduced breast cancer risk (57). It was also showed that flaxseed only reduced breast cancer risk in postmenopausal women, while flax bread reduced breast cancer risk in both postmenopausal and premenopausal women (52). On the other hand, there are said to be indications conducted a double-blind, randomized clinical trial, with a placebo control in patients with breast cancer.

The investigators tracked postmenopausal women that there are said to be indications been recently diagnosed with breast cancer and with a scheduled surgery. These women were then divided, randomly, into two groups: Group 1, which included 19 women, ate a muffin daily with approximately 25 g of powdered flaxseed, while Group 2, which included 13 women, ate a similar looking muffin, without flaxseed. Biopsies were performed in both groups, at the beginning of the trial, which were later compared with the pathology of the tumor removed during surgery, approximately 5 weeks after the study began.

Researchers concluded that flaxseed has the potential of reducing tumor growth in patients with this type of cancer (38, 59). There are said to be indications another clinical trial, researchers selected about 45 premenopausal women with a high risk of developing breast cancer (either with suspicious breast biopsies or former breast cancer survivors) and they gave them 50 mg of SDG lignan daily, or the equivalent of two spoons of powdered flaxseed.

The researchers conducted needle biopsies on the breast tissue, both before and after the study, which lasted a year. According to this clinical trial, SDG there are said to be indications can reduce the risk of breast cancer (60). Some studies there are said to be indications no association between risk of breast cancer and serum enterolactone levels (54, 55, 61, 62).

There is a study that indicates a decreased breast cancer mortality with higher serum enterolactone levels (63). Also, a case-control study concluded that a greater amount of serum enterolactone levels can be associated with a decreased breast cancer risk (66). It is necessary to conduct more studies to be able to confirm if there is an association between serum enterolactone levels and breast cancer risk. This increased exposure to lignans was mostly observed in postmenopausal women.

There is a there are said to be indications that lignans could prolong the lifespan of patients with breast cancer, but further studies are needed to confirm this (15, 56). Breast cancer survivors who have higher levels of lignans in their bloodstream and on their diet seem to survive for a significantly longer period of time (56, 65). Since breast cancer has been considered one of the most common cancers with the highest mortality rate worldwide, it is important to include nutrition as part of this disease treatment.

Flaxseed has been a vastly studied food due to the relation that it may have with breast cancer. Some experimental studies have been conducted in animals, but only a few clinical trials have been done in humans with the aim of discovering the there are said to be indications of flaxseed on tumors and on the risk of this type of cancer.

Some studies revealed there are said to be indications the ingestion of omega-3 fatty acids is associated with the reduction of breast cancer. Animal studies showed that ALA can decrease the growth, size, and cell proliferation and can increase the death of breast tumor cells. It is however necessary to conduct more clinical trials to confirm the association and respective efficacy of flaxseed with tamoxifen.

During clinical trials, researchers have concluded that flaxseed has the potential to reduce the growth of tumors in patients with breast cancer, mainly postmenopausal women, and decrease the risk of this type of cancer. However, more studies are still necessary, especially clinical trials, to verify the benefits of flaxseed on the treatment of breast cancer. AC conceived the study, participated in its design and coordination, and drafted and authored the manuscript.

PR participated in the study design, interpretation of the data, and helped to draft manuscript revisions. TS and PN were responsible for scientific writing and manuscript editing. None of the authors reported any financial interests or potential conflicts of interest. The authors thank the support extended by the Portuguese Catholic University in Lisbon. A word of thanks also goes to Paula Ravasco, who provided insight and expertise that greatly assisted during the course of this research and international journal clinical pharmacology therapeutics the chance given to perform it and Teresa Santos, who shared her wisdom regarding her experience performing review articles.

World Health Organization (WHO). Cancer Country Profiles (2014). Carvalho G, Camilo M, Ravasco P. Nutrition and cancer: a review of the evidence for an anti-cancer diet. Nutr J (2004) 3:19. Dmitri O, Levitsky V, Dembitsky M.

Anti-breast cancer agents derived from plants. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Preference, costs and patterns of use. Ben-Arye E, Schiff E, Steiner M, Keshet Y, Lavie O. Attitudes of patients with gynecological and breast cancer toward integration of complementary medicine in cancer care.

McCann SE, Edge SB, Hicks DG, Thompson LU, Morrison CD, Fetterly G, et al. A pilot study comparing the effect of flaxseed, there are said to be indications inhibitor, and the combination on breast tumor biomarkers. A review on aetio-pathogenesis of breast cancer.



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