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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK66061_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK66061_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK66061_"><span class="title" itemprop="name">Essiac/Flor Essence (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board</span>.</p><p class="small">Published online: August 20, 2015.</p><p class="small">Created: <span itemprop="datePublished">April 23, 2003</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000301806__108">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of Essiac/Flor Essence in the treatment of people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000301806__109">This summary is reviewed regularly and updated as necessary by the PDQ Cancer Complementary and Alternative Medicine Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000301806__1"><h2 id="_CDR0000301806__1_">Overview</h2><p id="CDR0000301806__104"><b>NOTE: The information in this summary is no longer being updated and is provided for reference purposes only.</b></p><p id="CDR0000301806__2">This <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044964/" class="def">complementary and alternative medicine</a> (CAM) information summary provides an overview of the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac</a> and Flor Essence, which are proprietary <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">herbal</a> tea mixtures, as treatments for people with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. The summary includes a brief history of the development of Essiac and Flor Essence; a review of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044512/" class="def">laboratory</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454774/" class="def">animal</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044195/" class="def">human studies</a>; and possible <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> associated with Essiac and Flor Essence use. </p><p id="CDR0000301806__3">This summary contains the following key information:</p><ul id="CDR0000301806__4"><li class="half_rhythm"><div>Essiac and Flor Essence are herbal tea mixtures originally developed in Canada. There may be differences between Essiac and Flor Essence in their mixture content and effects.</div></li><li class="half_rhythm"><div>These products are marketed worldwide as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplements</a>.</div></li><li class="half_rhythm"><div>Proponents have claimed that Essiac and Flor Essence can help <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446105/" class="def">detoxify</a> the body, strengthen the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>, and fight cancer.</div></li><li class="half_rhythm"><div>Proponents of Essiac have further claimed that it can help relieve pain, reduce side effects, improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>, and reduce tumor size.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045065/" class="def">Molecules</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidant</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044187/" class="def">anti-inflammatory</a>, anticancer, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285968/" class="def">immunostimulatory</a> activity have been identified in the individual herbs in the Essiac and Flor Essence formulas.</div></li><li class="half_rhythm"><div>No controlled data are available from human studies to suggest that Essiac or Flor Essence can be effective in the treatment of patients with cancer. </div></li><li class="half_rhythm"><div>Some evidence suggests that Flor Essence may increase tumor formation in an animal model of breast cancer.</div></li></ul><p id="CDR0000301806__5">Many of the medical and scientific terms used in the summary are hypertext linked (at first use in each section) to the <a href="http://www.cancer.gov/publications/dictionaries/cancer-terms/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI Dictionary of Cancer Terms</a>, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window. </p><p id="CDR0000301806__6">Reference citations in some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> CAM information summaries may include links to external websites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the websites, or of any treatment or product, by the PDQ Cancer CAM Editorial Board or the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a>.</p></div><div id="CDR0000301806__7"><h2 id="_CDR0000301806__7_">General Information</h2><p id="CDR0000301806__8"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac</a> and Flor Essence are proprietary <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">herbal</a> tea mixtures produced by different manufacturers. Essiac is reported to contain four herbs: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330164/" class="def">burdock</a> root (<i>Arctium lappa</i> L.), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330194/" class="def">Indian rhubarb</a> root (<i>Rheum palmatum</i> L., sometimes known as Turkish rhubarb), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330179/" class="def">sheep sorrel</a> (<i>Rumex acetosella</i> L.), and the inner bark of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330180/" class="def">slippery elm</a> (<i>Ulmus fulva</i> Michx. [synonym <i>Ulmus rubra</i>]).[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a> -<a class="bk_pop" href="#CDR0000301806_rl_7_9">9</a>]
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Flor Essence is reported to contain the same four herbs as Essiac, plus four <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330176/" class="def">potentiating</a> herbs: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330181/" class="def">watercress</a> (<i>Nasturtium officinale</i> R.Br.), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330162/" class="def">blessed thistle</a> (<i>Cnicus benedictus</i> L.), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330178/" class="def">red clover</a> (<i>Trifolium pratense</i> L.), and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330171/" class="def">kelp</a> (<i>Laminaria digitata</i> [Hudson] Lamx.).[<a class="bk_pop" href="#CDR0000301806_rl_7_2">2</a>-<a class="bk_pop" href="#CDR0000301806_rl_7_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>]</p><p id="CDR0000301806__11">The manufacturers of Essiac and Flor Essence both claim they market the original herbal mixture promoted by the developer.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>] Although only one company manufactures Flor Essence,[<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>] several companies produce and market Essiac-like products.[<a class="bk_pop" href="#CDR0000301806_rl_7_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_3">3</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_9">9</a>] This summary contains information about the trademarked mixtures only and differentiates between the two products wherever possible. Essiac and Flor Essence may vary in their mixture content and effects.[<a class="bk_pop" href="#CDR0000301806_rl_7_11">11</a>]</p><p id="CDR0000301806__12">Essiac and Flor Essence are said to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446105/" class="def">detoxify</a> the body and strengthen the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_6">6</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_8">8</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>] Proponents of Essiac further claim that it helps relieve pain, reduce side effects, improves overall <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>, may reduce tumor size, and may prolong the survival of patients with various types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. The individual herbs in the Essiac and Flor Essence formulas have been shown to contain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045065/" class="def">molecules</a> that have anticancer, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044187/" class="def">anti-inflammatory</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidant</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285968/" class="def">immunostimulatory</a> activity (refer to the <a href="#CDR0000301806__27">Laboratory/Animal/Preclinical Studies</a> section of this summary for more information).[<a class="bk_pop" href="#CDR0000301806_rl_7_2">2</a>-<a class="bk_pop" href="#CDR0000301806_rl_7_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_8">8</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_12">12</a>-<a class="bk_pop" href="#CDR0000301806_rl_7_15">15</a>] It is said that the benefits of Essiac and Flor Essence are dependent on the presence of the constituent herbs in the correct proportions. In 2004, a mixture of the Essiac herbs showed a decreased proliferation of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">prostate cancer</a> cell line.[<a class="bk_pop" href="#CDR0000301806_rl_7_16">16</a>] (Refer to the <a href="#CDR0000301806__27">Laboratory/Animal/Preclinical Studies</a> section of this summary for more information.)</p><p id="CDR0000301806__13">Although the use of Essiac and Flor Essence is generally associated with cancer treatment, both products have been used to treat other health conditions. Essiac has reportedly been used to control <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044911/" class="def">diabetes</a> and to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044365/" class="def">acquired immunodeficiency syndrome</a>.[<a class="bk_pop" href="#CDR0000301806_rl_7_6">6</a>] Flor Essence has reportedly been studied in Russia as a treatment for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045692/" class="def">gastrointestinal</a> diseases (e.g., <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044947/" class="def">esophagitis</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330169/" class="def">gastritis</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330166/" class="def">duodenitis</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044318/" class="def">colitis</a>) and as a treatment for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045478/" class="def">cirrhosis</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.[<a class="bk_pop" href="#CDR0000301806_rl_7_2">2</a>] However, no controlled data have been published in the peer-reviewed scientific literature to show the safety or the efficacy of Essiac or Flor Essence in patients with cancer or in patients with other health conditions (refer to the <a href="#CDR0000301806__39">Human/Clinical Studies</a> section of this summary for more information).</p><p id="CDR0000301806__14">Essiac and Flor Essence are sold worldwide as health tonics or herbal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplements</a>.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a> ,<a class="bk_pop" href="#CDR0000301806_rl_7_2">2</a>-<a class="bk_pop" href="#CDR0000301806_rl_7_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_9">9</a>] In the United States, health tonics and dietary supplements are regulated as foods, not drugs. Therefore, premarket evaluation and approval by the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454785/" class="def">U.S. Food and Drug Administration</a> (FDA) are not required, and specific disease treatment or prevention claims are not allowed. Because health tonics and dietary supplements are not formally inspected for manufacturing consistency, there may be considerable variation from lot to lot, and there is no guarantee that ingredients identified on product labels are present at all or are present in the specified amounts. The FDA has not approved the use of either Essiac or Flor Essence for the treatment of patients with cancer or any other medical condition.</p><p id="CDR0000301806__15">To conduct <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044195/" class="def">clinical</a> drug research in the United States, researchers must file an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000762975/" class="def">Investigational New Drug</a> (IND) application with the FDA. An IND application must also be made for clinical evaluation of dietary supplements as agents for the treatment or prevention of disease. The FDA’s IND process is confidential, and the existence of an IND application can be disclosed only by the applicants. To date, no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044685/" class="def">investigator</a> has announced filing an IND application to study either Essiac or Flor Essence in the treatment of patients with cancer.</p><p id="CDR0000301806__16">Essiac and Flor Essence are administered <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">orally</a> in the form of herbal teas.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_6">6</a>-<a class="bk_pop" href="#CDR0000301806_rl_7_8">8</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_17">17</a>] Originally, an extract of one of the herbs (not specified) was administered to cancer patients by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044049/" class="def">intramuscular injection</a> at or near tumor sites, and the other herbs were administered orally as a tea.</p><p id="CDR0000301806__17">Only minimal information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> and schedule of administration is freely available from the manufacturer of Essiac.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>] According to the manufacturer, the dose will vary, depending on the reason for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044100/" class="def">ingestion</a>; the manufacturer’s recommended schedules of administration assume a 12-week program of uninterrupted use.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>] Although Essiac is said to be safe for pets, no information is given about its safety in children.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>]</p><p id="CDR0000301806__18">The manufacturer of Flor Essence states that adults may consume from 30 to 360 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044214/" class="def">mL</a> (i.e., 1–12 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fl</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330174/" class="def">oz</a>) of Flor Essence tea per day, depending on individual requirements, and that it may be used continuously.[<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>] The manufacturer also suggests that Flor Essence may be safely consumed by infants and children, but its use by pregnant women and nursing mothers is not recommended.[<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>] However, the promotion of mammary tumors observed in a rat model of breast cancer raises the theoretical concern that Flor Essence may impact normal mammary ductal development during childhood, thereby raising concern about its use.[<a class="bk_pop" href="#CDR0000301806_rl_7_18">18</a>]</p><p id="CDR0000301806__19">The manufacturers of Essiac and Flor Essence both state these products can be used in conjunction with other cancer treatments.[<a class="bk_pop" href="#CDR0000301806_rl_7_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_7_10">10</a>] Nonetheless, some proponents of Essiac have recommended that no additional anticancer therapy (such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>) be undertaken while patients are being treated with the mixture.[<a class="bk_pop" href="#CDR0000301806_rl_7_7">7</a>] The purported rationale for this statement is that <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044950/" class="def">conventional</a> anticancer treatments may alter immune system function and prevent Essiac from working effectively.[<a class="bk_pop" href="#CDR0000301806_rl_7_7">7</a>] As indicated previously, no evidence has been reported in the peer-reviewed scientific literature to show either that Essiac is an effective treatment for patients with cancer or that conventional anticancer treatments interfere with its effects.</p><div id="CDR0000301806_rl_7"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000301806_rl_7_1">Essiac. Kirkland, Canada: Altramed Health Products, 2002. <a href="http://www.essiac-resperin.com/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_2">Tamayo C, Richardson MA, Diamond S, et al.: The chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac. Phytother Res 14 (1): 1-14, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10641040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10641040</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_3">Tamayo C: Essiac for cancer. Alternative Therapies in Women's Health 2 (3): 19-23, 2000.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_4">Kaegi E: Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 158 (7): 897-902, 1998. [<a href="/pmc/articles/PMC1229186/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1229186</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9559016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9559016</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_5">Ernst E, Cassileth BR: How useful are unconventional cancer treatments? Eur J Cancer 35 (11): 1608-13, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10673970" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10673970</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_6">Locock RA: Essiac. Can Pharm J 130: 18-9, 1997.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_7">Herbal treatments. In: US Congress, Office of Technology Assessment: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405, pp 71-5. <a href="http://www.princeton.edu/~ota/disk2/1990/9044_n.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_8">Essiac. Toronto, Canada: Canadian Breast Cancer Research Alliance, 1996.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_9">The History of Essiac & Rene Caisse, Canada's Cancer Nurse. Kirkland, Canada: Altramed Health Products, 2001. <a href="http://www.essiacinfo.org/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_10">Flora Flor•Essence®. Burnaby, Canada: Flora Manufacturing & Distributing Ltd. <a href="http://www.florahealth.com/product_categories_usa.cfm" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri"> Available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_11">Cheung S, Lim KT, Tai J: Antioxidant and anti-inflammatory properties of ESSIAC and Flor-Essence. Oncol Rep 14 (5): 1345-50, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/16211307" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16211307</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_12">Franke AA, Cooney RV, Custer LJ, et al.: Inhibition of neoplastic transformation and bioavailability of dietary flavonoid agents. In: Manthey JA, Buslig BS, eds.: Flavonoids in the Living System. New York, NY: Plenum Press, 1998. Advances in Experimental Medicine and Biology, 439, pp 237-48. [<a href="https://pubmed.ncbi.nlm.nih.gov/9781307" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9781307</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_13">Waladkhani AR, Clemens MR: Effect of dietary phytochemicals on cancer development (review) Int J Mol Med 1 (4): 747-53, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9852292" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9852292</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_14">de Witte P: Metabolism and pharmacokinetics of anthranoids. Pharmacology 47 (Suppl 1): 86-97, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8234447" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8234447</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_15">Campbell MJ, Hamilton B, Shoemaker M, et al.: Antiproliferative activity of Chinese medicinal herbs on breast cancer cells in vitro. Anticancer Res 22 (6C): 3843-52, 2002 Nov-Dec. [<a href="https://pubmed.ncbi.nlm.nih.gov/12553004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12553004</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_16">Ottenweller J, Putt K, Blumenthal EJ, et al.: Inhibition of prostate cancer-cell proliferation by Essiac. J Altern Complement Med 10 (4): 687-91, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15353028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15353028</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_17">LeMoine L: Essiac: an historical perspective. Can Oncol Nurs J 7 (4): 216-21, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9450419" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9450419</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_7_18">Bennett LM, Montgomery JL, Steinberg SM, et al.: Flor-Essence herbal tonic does not inhibit mammary tumor development in Sprague Dawley rats. Breast Cancer Res Treat 88 (1): 87-93, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15538049" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15538049</span></a>]</div></li></ol></div></div><div id="CDR0000301806__9"><h2 id="_CDR0000301806__9_">History</h2><p id="CDR0000301806__10"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac</a> was popularized in Canada during the 1920s, when the developer, a nurse from Ontario, began to advocate its use as a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> treatment. In 1922, the developer obtained an herbal tea formula from a female breast cancer patient who claimed the mixture had cured her disease.[<a class="bk_pop" href="#CDR0000301806_rl_9_1">1</a>-<a class="bk_pop" href="#CDR0000301806_rl_9_5">5</a>] The patient reportedly received the formula from an Ontario Ojibwa Native American medicine man. The developer subsequently modified the formula, producing both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injectable</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a> forms of treatment.[<a class="bk_pop" href="#CDR0000301806_rl_9_2">2</a>-<a class="bk_pop" href="#CDR0000301806_rl_9_8">8</a>]</p><p id="CDR0000301806__20">From 1934 to 1942, the developer operated a cancer clinic in Bracebridge, Ontario, and dispensed Essiac free of charge.[<a class="bk_pop" href="#CDR0000301806_rl_9_9">9</a>] In 1938, members of the Royal Cancer Commission of Canada visited the clinic and heard testimonials from patients who had been treated with the mixture.[<a class="bk_pop" href="#CDR0000301806_rl_9_7">7</a>] The Cancer Commission concluded there was only limited evidence for the effectiveness of Essiac. After years of controversy, the developer closed the clinic in 1942 but continued to provide Essiac to patients until the late 1970s.[<a class="bk_pop" href="#CDR0000301806_rl_9_4">4</a>] (Refer to the <a href="#CDR0000301806__39">Human/Clinical Studies</a> section of this summary for more information.)</p><p id="CDR0000301806__21">From 1959 until the late 1970s, the developer collaborated with an American physician to conduct <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044195/" class="def">clinical</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044512/" class="def">laboratory studies</a> of Essiac and to promote its use.[<a class="bk_pop" href="#CDR0000301806_rl_9_7">7</a>] This collaboration led to the development of the eight-herb formula now marketed as Flor Essence. None of the results of these collaborative studies were reported in peer-reviewed scientific journals.</p><p id="CDR0000301806__22">In 1977, the developer provided a four-herb recipe for Essiac to a Canadian corporation.[<a class="bk_pop" href="#CDR0000301806_rl_9_5">5</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_7">7</a>] In 1978, the corporation filed a preclinical new drug submission with the Canadian Department of National Health and Welfare (Health Protection Branch) and received permission to conduct clinical studies of Essiac’s safety and effectiveness in cancer patients.[<a class="bk_pop" href="#CDR0000301806_rl_9_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_5">5</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_7">7</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_8">8</a>] In 1982, this permission was withdrawn when it was determined that the corporation had not fulfilled commitments to adequately control the manufacturing consistency of Essiac, to isolate and characterize active substances in the mixture, and to design and execute appropriate <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.[<a class="bk_pop" href="#CDR0000301806_rl_9_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_5">5</a>] During this period, restrictions were imposed on the promotion of Essiac as a cancer treatment, but the corporation was allowed to distribute it to cancer patients through their physicians under Canada’s Emergency Drug Release Program (also called Health Canada’s Special Access Programme).[<a class="bk_pop" href="#CDR0000301806_rl_9_7">7</a>] While the preclinical new drug submission was in effect in Canada, the corporation filed an unsuccessful New Drug Application (NDA) with the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454785/" class="def">U.S. Food and Drug Administration</a>, seeking permission to market Essiac in the United States. Details of the NDA submission, which can be disclosed only by the corporation, have not been made public.[<a class="bk_pop" href="#CDR0000301806_rl_9_4">4</a>] (Refer to the <a href="#CDR0000301806__39">Human/Clinical Studies</a> section of this summary for more information.)</p><p id="CDR0000301806__23">In the early 1980s, the Canadian Department of National Health and Welfare (Bureau of Human Prescription Drugs) conducted a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044120/" class="def">retrospective</a> review of case summaries submitted by physicians whose patients had obtained Essiac under the Emergency Drug Release Program.[<a class="bk_pop" href="#CDR0000301806_rl_9_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_4">4</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_7">7</a>] The Department found little evidence to suggest that Essiac was effective as a cancer treatment. (Refer to the <a href="#CDR0000301806__39">Human/Clinical Studies</a> section of this summary for more information.)</p><p id="CDR0000301806__24">Also in the 1980s, the manufacturers of Essiac-like products began to market their formulations as health tonics and to avoid making claims of effectiveness in treating disease. Consequently, the mixtures were no longer subject to regulation as drugs. Essiac is not currently available under Canada’s Emergency Drug Release Program.</p><p id="CDR0000301806__25">In 1995, the corporation that acquired the four-herb recipe for Essiac from the developer dissolved voluntarily.[<a class="bk_pop" href="#CDR0000301806_rl_9_1">1</a>] Later that year, a new company was formed to manufacture and distribute this proprietary herbal mixture.[<a class="bk_pop" href="#CDR0000301806_rl_9_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_9_5">5</a>]</p><div id="CDR0000301806_rl_9"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000301806_rl_9_1">Essiac. Kirkland, Canada: Altramed Health Products, 2002. <a href="http://www.essiac-resperin.com/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_2">Tamayo C: Essiac for cancer. Alternative Therapies in Women's Health 2 (3): 19-23, 2000.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_3">Locock RA: Essiac. Can Pharm J 130: 18-9, 1997.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_4">Herbal treatments. In: US Congress, Office of Technology Assessment: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405, pp 71-5. <a href="http://www.princeton.edu/~ota/disk2/1990/9044_n.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_5">LeMoine L: Essiac: an historical perspective. Can Oncol Nurs J 7 (4): 216-21, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9450419" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9450419</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_6">Tamayo C, Richardson MA, Diamond S, et al.: The chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac. Phytother Res 14 (1): 1-14, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10641040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10641040</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_7">Kaegi E: Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 158 (7): 897-902, 1998. [<a href="/pmc/articles/PMC1229186/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1229186</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9559016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9559016</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_8">Essiac. Toronto, Canada: Canadian Breast Cancer Research Alliance, 1996.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_9_9">The History of Essiac & Rene Caisse, Canada's Cancer Nurse. Kirkland, Canada: Altramed Health Products, 2001. <a href="http://www.essiacinfo.org/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed May 21, 2015.</div></li></ol></div></div><div id="CDR0000301806__27"><h2 id="_CDR0000301806__27_">Laboratory/Animal/Preclinical Studies</h2><div id="CDR0000301806__28"><h3>Essiac</h3><p id="CDR0000301806__29">In 2004, a mixture of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac </a> herbs showed a decreased proliferation in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">prostate cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000695994/" class="def">cell line</a>.[<a class="bk_pop" href="#CDR0000301806_rl_27_1">1</a>] Results of laboratory (<i>in vitro</i>) studies of Essiac have been reported.[<a class="bk_pop" href="#CDR0000301806_rl_27_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_27_3">3</a>]</p><p id="CDR0000301806__30">In the mid-1970s, the developer submitted both dried and liquid samples of Essiac to the Memorial Sloan Kettering Cancer Center (MSKCC) in New York City for evaluation of its <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapeutic</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044009/" class="def">chemotherapeutic</a> potential.[<a class="bk_pop" href="#CDR0000301806_rl_27_3">3</a>] No <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285968/" class="def">immunostimulatory</a> or chemotherapeutic activity was detected in eight animal experiments that utilized the S-180 mouse <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">sarcoma</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044091/" class="def">tumor model</a>.</p><p id="CDR0000301806__55">In the early 1980s, the corporation that acquired the four-herb recipe for Essiac from the developer submitted another sample to the MSKCC for evaluation in additional <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454774/" class="def">animal studies</a>. No anticancer activity was detected in 17 separate experiments that utilized a variety of animal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> and tumor models.[<a class="bk_pop" href="#CDR0000301806_rl_27_3">3</a>]</p><p id="CDR0000301806__56">In 1983, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> tested a liquid sample of Essiac that was provided by the manufacturer after the Canadian Department of National Health and Welfare (Health Protection Branch) requested that it be tested in animals.[<a class="bk_pop" href="#CDR0000301806_rl_27_3">3</a>] These studies revealed no anticancer activity in the mouse P388 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330173/" class="def">lymphocytic leukemia</a> tumor system and found lethal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043986/" class="def">toxicity</a> at the highest concentrations of Essiac administered to test animals. It is not known, however, how the concentrations used in these animal tests compare with the concentrations achieved in humans after the consumption of the manufacturer's recommended <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a>. </p></div><div id="CDR0000301806__32"><h3>Flor Essence</h3><p id="CDR0000301806__33"> There are conflicting results in the peer-reviewed literature. One study suggests that Flor Essence enhances tumor growth <i>in vitro</i>, a finding that contradicts the widely available <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043995/" class="def">anecdotal</a> evidence that this product suppresses or inhibits tumor development.[<a class="bk_pop" href="#CDR0000301806_rl_27_4">4</a>] Another study suggests that the growth of human <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444971/" class="def">breast cancer</a> cells is stimulated through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046409/" class="def">estrogen receptor</a> (ER)–mediated as well as ER-independent mechanisms of action from Flor Essence and Essiac herbal tonics.[<a class="bk_pop" href="#CDR0000301806_rl_27_5">5</a>] A third study demonstrated antiproliferative and differentiation-inducing properties <i>in vitro</i> only in high concentrations of Essiac and Flor Essence herbal teas.[<a class="bk_pop" href="#CDR0000301806_rl_27_6">6</a>]</p><p id="CDR0000301806__79">The 2004 <i>in vivo</i> study of Flor Essence in a rat model looked at <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044560/" class="def">mammary</a> tumor development following administration of the herbal compound. Sprague-Dawley rats (N = 112) were assigned to one of three groups. The control group (n = 35) received water only. The second group (n = 40) received 3% Flor Essence in their drinking water in an attempt to provide a dose equivalent to that recommended in the popular literature. The third group (n = 37) received 6% Flor Essence in their drinking water to investigate the dose-response relationship. Mammary tumors were induced by a 40 mg/kg of body weight dose of 7,12-dimethylbenz(a)anthracene. At 19 weeks, palpable mammary tumor incidence was higher (65% and 59.4%) in both Flor Essence groups, compared with controls (51%). Terminal necropsy was performed at age 23 weeks or when tumor burden became too great. Results showed mammary tumor incidence was 82.5% for controls, compared with 90% and 97.3%, respectively, for rats consuming 3% and 6% Flor Essence.[<a class="bk_pop" href="#CDR0000301806_rl_27_4">4</a>]</p></div><div id="CDR0000301806__34"><h3>The Individual Herbs of Essiac and Flor Essence</h3><p id="CDR0000301806__35">Laboratory and animal experiments have shown that some of the chemicals in the herbs used to make Essiac and Flor Essence have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidant</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044187/" class="def">anti-inflammatory</a>, estrogenic, or anticancer activity.[<a class="bk_pop" href="#CDR0000301806_rl_27_7">7</a>-
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<a class="bk_pop" href="#CDR0000301806_rl_27_15">15</a>]</p><p id="CDR0000301806__36">Among the herbs used in both mixtures, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330164/" class="def">burdock</a> root (<i>Arctium lappa</i> L.) contains several <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330168/" class="def">flavonoids</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256573/" class="def">polyphenols</a> that have shown antioxidant activity; <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330194/" class="def">Indian rhubarb</a> root (<i>Rheum palmatum</i> L.) contains several <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045595/" class="def">anthraquinones</a>, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330167/" class="def">emodin</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330159/" class="def">aloe-emodin</a>, which have demonstrated anti-inflammatory and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044020/" class="def">cytotoxic</a> effects; <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330179/" class="def">sheep sorrel</a> (<i>Rumex acetosella</i> L.) contains several types of anthraquinones, including emodin and aloe-emodin, as well as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330175/" class="def">phytoestrogens</a>, which may possess both procancer and anticancer activity; and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330180/" class="def">slippery elm</a> bark (<i>Ulmus fulva</i> Michx.) has been shown to contain antioxidants.[<a class="bk_pop" href="#CDR0000301806_rl_27_7">7</a>-<a class="bk_pop" href="#CDR0000301806_rl_27_13">13</a>]</p><p id="CDR0000301806__37">Among the herbs found in Flor Essence alone, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330181/" class="def">watercress</a> (<i>Nasturtium officinale</i> R.Br.) contains <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044910/" class="def">phenethyl isothiocyanate</a> (PEITC), which has shown cytotoxic and antitumor activities; <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330162/" class="def">blessed thistle</a> (<i>Cnicus benedictus</i> L.) contains <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330165/" class="def">cnicin</a>, which is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330182/" class="def">sesquiterpene lactone</a> that has demonstrated cytotoxic, antitumor, and anti-inflammatory effects, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330161/" class="def">arctiin</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330160/" class="def">arctigenin</a>, which are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330172/" class="def">lignans</a> that have shown anticancer activity; <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330178/" class="def">red clover</a> (<i>Trifolium pratense</i> L.) contains a complex mixture of phytoestrogens, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046107/" class="def">genistein</a>, which has demonstrated <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044186/" class="def">antiangiogenic</a>, estrogenic, and procancer and anticancer effects (depending on the dose); and extracts of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330171/" class="def">kelp</a> (<i>Laminaria digitata</i> [Hudson] Lamx.) have shown immunostimulatory and antitumor activities.[<a class="bk_pop" href="#CDR0000301806_rl_27_7">7</a>,<a class="bk_pop" href="#CDR0000301806_rl_27_8">8</a>,<a class="bk_pop" href="#CDR0000301806_rl_27_11">11</a>,<a class="bk_pop" href="#CDR0000301806_rl_27_12">12</a>,<a class="bk_pop" href="#CDR0000301806_rl_27_15">15</a>]</p><p id="CDR0000301806__38">Whether equivalent concentrations of relevant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045065/" class="def">molecules</a> can be achieved in the bloodstream of individuals who consume Essiac or Flor Essence in the amounts recommended by their manufacturers has not been determined. An uncharacterized Flor Essence commercial product was dosed at amounts lower than those recommended by the manufacturers for humans, and there was an increase in tumor incidence in this model.[<a class="bk_pop" href="#CDR0000301806_rl_27_4">4</a>] </p></div><div id="CDR0000301806_rl_27"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000301806_rl_27_1">Ottenweller J, Putt K, Blumenthal EJ, et al.: Inhibition of prostate cancer-cell proliferation by Essiac. J Altern Complement Med 10 (4): 687-91, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15353028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15353028</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_2">Seely D, Kennedy DA, Myers SP, et al.: In vitro analysis of the herbal compound Essiac. Anticancer Res 27 (6B): 3875-82, 2007 Nov-Dec. [<a href="https://pubmed.ncbi.nlm.nih.gov/18225545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18225545</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_3">Herbal treatments. In: US Congress, Office of Technology Assessment: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405, pp 71-5. <a href="http://www.princeton.edu/~ota/disk2/1990/9044_n.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_4">Bennett LM, Montgomery JL, Steinberg SM, et al.: Flor-Essence herbal tonic does not inhibit mammary tumor development in Sprague Dawley rats. Breast Cancer Res Treat 88 (1): 87-93, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15538049" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15538049</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_5">Kulp KS, Montgomery JL, Nelson DO, et al.: Essiac and Flor-Essence herbal tonics stimulate the in vitro growth of human breast cancer cells. Breast Cancer Res Treat 98 (3): 249-59, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16541326" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16541326</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_6">Tai J, Cheung S, Wong S, et al.: In vitro comparison of Essiac and Flor-Essence on human tumor cell lines. Oncol Rep 11 (2): 471-6, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/14719086" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14719086</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_7">Tamayo C, Richardson MA, Diamond S, et al.: The chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac. Phytother Res 14 (1): 1-14, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10641040" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10641040</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_8">Tamayo C: Essiac for cancer. Alternative Therapies in Women's Health 2 (3): 19-23, 2000.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_9">Kaegi E: Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 158 (7): 897-902, 1998. [<a href="/pmc/articles/PMC1229186/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1229186</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9559016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9559016</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_10">Essiac. Toronto, Canada: Canadian Breast Cancer Research Alliance, 1996.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_11">Franke AA, Cooney RV, Custer LJ, et al.: Inhibition of neoplastic transformation and bioavailability of dietary flavonoid agents. In: Manthey JA, Buslig BS, eds.: Flavonoids in the Living System. New York, NY: Plenum Press, 1998. Advances in Experimental Medicine and Biology, 439, pp 237-48. [<a href="https://pubmed.ncbi.nlm.nih.gov/9781307" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9781307</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_12">Waladkhani AR, Clemens MR: Effect of dietary phytochemicals on cancer development (review) Int J Mol Med 1 (4): 747-53, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9852292" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9852292</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_13">de Witte P: Metabolism and pharmacokinetics of anthranoids. Pharmacology 47 (Suppl 1): 86-97, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8234447" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8234447</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_14">Campbell MJ, Hamilton B, Shoemaker M, et al.: Antiproliferative activity of Chinese medicinal herbs on breast cancer cells in vitro. Anticancer Res 22 (6C): 3843-52, 2002 Nov-Dec. [<a href="https://pubmed.ncbi.nlm.nih.gov/12553004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12553004</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_27_15">Boué SM, Wiese TE, Nehls S, et al.: Evaluation of the estrogenic effects of legume extracts containing phytoestrogens. J Agric Food Chem 51 (8): 2193-9, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/12670155" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12670155</span></a>]</div></li></ol></div></div><div id="CDR0000301806__39"><h2 id="_CDR0000301806__39_">Human/Clinical Studies</h2><div id="CDR0000301806__40"><h3>Essiac</h3><p id="CDR0000301806__41">No report of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044195/" class="def">clinical study</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac</a> has been published in the peer-reviewed scientific literature. Brief descriptions of one incomplete clinical study and one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044120/" class="def">retrospective</a> evaluation of Essiac as a treatment for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> have been published.[<a class="bk_pop" href="#CDR0000301806_rl_39_1">1</a>-<a class="bk_pop" href="#CDR0000301806_rl_39_6">6</a>] It is not clear whether the described patient populations consisted entirely of adults or whether they included children.</p><p id="CDR0000301806__42">As noted previously (refer to the <a href="#CDR0000301806__9">History</a> section of this summary for more information), the developer provided a four-herb recipe for Essiac to a Canadian corporation in 1977.[<a class="bk_pop" href="#CDR0000301806_rl_39_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_6">6</a>] In 1978, the corporation filed a preclinical new drug submission with the Canadian Department of National Health and Welfare (Health Protection Branch) and received permission to conduct studies on the safety and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346517/" class="def">efficacy</a> of Essiac in cancer patients.[<a class="bk_pop" href="#CDR0000301806_rl_39_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_4">4</a>-
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<a class="bk_pop" href="#CDR0000301806_rl_39_7">7</a>] In 1982, the Department withdrew its permission after determining the research was not being conducted as planned (refer to the <a href="#CDR0000301806__9">History</a> section of this summary for more information). At that time, the available incomplete data were reviewed, and no clear evidence of improved survival could be demonstrated for treated patients.[<a class="bk_pop" href="#CDR0000301806_rl_39_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_5">5</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_6">6</a>] Pain control and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> were not assessed in these studies. The review of the data indicated, however, that Essiac was not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043986/" class="def">toxic</a>. Because no evidence of harm was found, the Canadian government allowed the corporation to distribute Essiac to cancer patients through their physicians under Canada’s Emergency Drug Release Program. Nonetheless, restrictions were imposed on the promotion of Essiac as a treatment for cancer.[<a class="bk_pop" href="#CDR0000301806_rl_39_2">2</a>] Access to Essiac under Canada’s Emergency Drug Release Program has since been discontinued.</p><p id="CDR0000301806__43">In the early 1980s, the Canadian Department of National Health and Welfare (Bureau of Human Prescription Drugs) conducted a retrospective review of data voluntarily submitted by physicians for 86 cancer patients who had obtained Essiac under Canada’s Emergency Drug Release Program between 1978 and 1982.[<a class="bk_pop" href="#CDR0000301806_rl_39_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_2">2</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_4">4</a>] (Note: [<a class="bk_pop" href="#CDR0000301806_rl_39_2">2</a>] states that data from 87 patients were reviewed.) The Bureau’s evaluation was based on written summaries submitted by the physicians and not on a review of the original patient records.[<a class="bk_pop" href="#CDR0000301806_rl_39_4">4</a>] The Bureau found 47 patients who did not benefit from Essiac; 1 had <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330183/" class="def">subjective improvement</a>, 5 required fewer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045590/" class="def">analgesics</a>, 4 had an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044067/" class="def">objective response</a>, and four were in stable condition.[<a class="bk_pop" href="#CDR0000301806_rl_39_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_4">4</a>] Among the remaining 25 patients, 17 had died, and the reports for 8 were considered unevaluable. The Bureau solicited additional information about the four patients who had an objective response and the four patients who were in stable condition. This additional information revealed that, among these eight patients, two had died, three had <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045850/" class="def">progressive disease</a>, and three remained in stable condition.[<a class="bk_pop" href="#CDR0000301806_rl_39_1">1</a>,<a class="bk_pop" href="#CDR0000301806_rl_39_4">4</a>] The three patients in stable condition had received previous <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044198/" class="def">conventional therapy</a>. Therefore, the benefits of treatment for these patients, if any, could not be clearly ascribed to Essiac.[<a class="bk_pop" href="#CDR0000301806_rl_39_4">4</a>]</p></div><div id="CDR0000301806__44"><h3>Flor Essence</h3><p id="CDR0000301806__45">No results of human studies of Flor Essence have been reported <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043995/" class="def">anecdotally</a> or in the peer-reviewed scientific literature.</p></div><div id="CDR0000301806_rl_39"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000301806_rl_39_1">Tamayo C: Essiac for cancer. Alternative Therapies in Women's Health 2 (3): 19-23, 2000.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_39_2">Kaegi E: Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 158 (7): 897-902, 1998. [<a href="/pmc/articles/PMC1229186/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1229186</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9559016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9559016</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_39_3">Locock RA: Essiac. Can Pharm J 130: 18-9, 1997.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_39_4">Herbal treatments. In: US Congress, Office of Technology Assessment: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405, pp 71-5. <a href="http://www.princeton.edu/~ota/disk2/1990/9044_n.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_39_5">Essiac. Toronto, Canada: Canadian Breast Cancer Research Alliance, 1996.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_39_6">LeMoine L: Essiac: an historical perspective. Can Oncol Nurs J 7 (4): 216-21, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9450419" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9450419</span></a>]</div></li><li><div class="bk_ref" id="CDR0000301806_rl_39_7">Campbell MJ, Hamilton B, Shoemaker M, et al.: Antiproliferative activity of Chinese medicinal herbs on breast cancer cells in vitro. Anticancer Res 22 (6C): 3843-52, 2002 Nov-Dec. [<a href="https://pubmed.ncbi.nlm.nih.gov/12553004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12553004</span></a>]</div></li></ol></div></div><div id="CDR0000301806__46"><h2 id="_CDR0000301806__46_">Adverse Effects</h2><p id="CDR0000301806__47"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a> are the only reported <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse effects</a> associated with the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac</a>.[<a class="bk_pop" href="#CDR0000301806_rl_46_1">1</a>] The manufacturer of Flor Essence states that users may experience increased bowel movements, frequent urination, swollen glands, skin blemishes, flu-like symptoms, or slight headaches.[<a class="bk_pop" href="#CDR0000301806_rl_46_2">2</a>] </p><div id="CDR0000301806_rl_46"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000301806_rl_46_1">Herbal treatments. In: US Congress, Office of Technology Assessment: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405, pp 71-5. <a href="http://www.princeton.edu/~ota/disk2/1990/9044_n.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed May 21, 2015.</div></li><li><div class="bk_ref" id="CDR0000301806_rl_46_2">Flora Flor•Essence®. Burnaby, Canada: Flora Manufacturing & Distributing Ltd. <a href="http://www.florahealth.com/product_categories_usa.cfm" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri"> Available online</a>. Last accessed May 21, 2015.</div></li></ol></div></div><div id="CDR0000301806__48"><h2 id="_CDR0000301806__48_">Summary of the Evidence for Essiac and Flor Essence</h2><p id="CDR0000301806__49">To assist readers in evaluating the results of human/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044195/" class="def">clinical studies</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044964/" class="def">complementary and alternative medicine</a> (CAM) treatments for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, a scoring system has been devised that allows studies of individual treatments to be ranked according to the strength of their evidence (i.e., their <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446533/" class="def">level of evidence</a>). Not all studies, however, are given a level of evidence score. To be eligible, a study must:</p><ul id="CDR0000301806__65"><li class="half_rhythm"><div>Evaluate a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043985/" class="def">therapeutic</a> outcome or outcomes, such as tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">response</a>, improvement in survival, or carefully measured improvement in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div>Be reported in a peer-reviewed scientific journal.</div></li><li class="half_rhythm"><div>Have its clinical findings published in sufficient detail for a meaningful evaluation to be made.</div></li></ul><p id="CDR0000301806__66">Evidence from studies that do not meet these requirements is considered extremely weak. In addition to scoring individual studies, an overall level of evidence assessment is usually made.
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</p><p id="CDR0000301806__50">Because no study of the use of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446524/" class="def">Essiac</a> or Flor Essence in humans has been reported in a peer-reviewed scientific journal, no level-of-evidence analysis is possible for these mixtures. The data that are available, however, do not support claims that Essiac and Flor Essence can <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446105/" class="def">detoxify</a> the body, strengthen the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>, or fight cancer. At this time, evidence does not support the use of either Essiac or Flor Essence in the treatment of cancer patients outside the context of well-designed <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.</p><p id="CDR0000301806__51">Separate levels-of-evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044724/" class="def">scientific</a> strength of the treatment outcomes (i.e., <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346519/" class="def">endpoints</a>) measured. The resulting two scores are then combined to produce an overall score. For additional information about levels-of-evidence analysis, refer to <a href="/books/n/pdqcis/CDR0000256874/">Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine</a>.</p></div><div id="CDR0000301806__52"><h2 id="_CDR0000301806__52_">Changes to This Summary (08/20/2015)</h2><p id="CDR0000301806__57">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information summaries are reviewed regularly and updated as
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new information becomes available. This section describes the latest
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changes made to this summary as of the date above.</p><p id="CDR0000301806__107">Editorial changes were made to this summary.</p><p id="CDR0000301806__disclaimerHP_3">This summary is written and maintained by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/cam" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000301806__AboutThis_1">About This PDQ Summary</a> and <a href="http://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
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</p></div><div id="CDR0000301806__AboutThis_1"><h2 id="_CDR0000301806__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000301806__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000301806__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of Essiac/Flor Essence in the treatment of people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000301806__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000301806__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/cam" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000301806__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000301806__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000301806__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewers for Essiac/Flor Essence are:</p><ul><li class="half_rhythm"><div>John A. Beutler, PhD (National Cancer Institute)</div></li><li class="half_rhythm"><div>Wayne Jonas, MD (President and CEO, Samueli Institute)</div></li></ul><p id="CDR0000301806__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000301806__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000301806__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Integrative, Alternative, and Complementary Therapies Editorial Board uses a <a href="/books/n/pdqcis/CDR0000256874/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000301806__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000301806__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000301806__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000301806__AboutThis_15">National Cancer Institute: PDQ® Essiac/Flor Essence. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/about-cancer/treatment/cam/hp/essiac-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/about-cancer/treatment/cam/hp/essiac-pdq</a>. Accessed <MM/DD/YYYY>.</p><p id="CDR0000301806__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000301806__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000301806__AboutThis_19">The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000301806__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000301806__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66061.1/?report=reader">PubReader</a></li><li><a href="/books/NBK66061.1/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK66061" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK66061" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. Essiac/Flor Essence (PDQ®): Health Professional Version. 2015 Aug 20. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK66061.7/">NBK66061.7</a></span> April 5, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK66061.6/">NBK66061.6</a></span> June 7, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK66061.5/">NBK66061.5</a></span> May 24, 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Information</a></li><li><a href="#CDR0000301806__9" ref="log$=inpage&link_id=inpage">History</a></li><li><a href="#CDR0000301806__27" ref="log$=inpage&link_id=inpage">Laboratory/Animal/Preclinical Studies</a></li><li><a href="#CDR0000301806__39" ref="log$=inpage&link_id=inpage">Human/Clinical Studies</a></li><li><a href="#CDR0000301806__46" ref="log$=inpage&link_id=inpage">Adverse Effects</a></li><li><a href="#CDR0000301806__48" ref="log$=inpage&link_id=inpage">Summary of the Evidence for Essiac and Flor Essence</a></li><li><a href="#CDR0000301806__52" ref="log$=inpage&link_id=inpage">Changes to This Summary (08/20/2015)</a></li><li><a href="#CDR0000301806__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" 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class="invert">Review</span> 714-X (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> 714-X (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389425" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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