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The effects of dietary supplementation with Agaricales mushrooms and other medicinal fungi on breast cancer: Evidence-based medicine
Maria Rita Carvalho Garbi Novaes
Corresponding author
ritanovaes@ig.com.br

Tel.: 55 61 3254-0925
, Fabiana Valadares, Mariana Campos Reis, Daniella Rodrigues Gonçalves, Marilia da Cunha Menezes
Universidade de Brasília, School of Medicine, Institute of Health Science (ESCS), Brasília/DF, Brazil.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Breast cancer is highly prevalent in women&#46; In 2008&#44; the IARC&#47;OMS estimated that breast cancer was the second biggest incidence of cancer in the world &#40;1&#46;29 million cases&#41;&#46; In Brazil&#44; it would be responsible for 49&#44;000 new cases in women from 2010 to 2011 and the mortality rate for this type of cancer remains high&#44; on one side&#44; due to the fact that this disease continues to be diagnosed at advanced stages&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Treatment for breast cancer is complex and varies according to the histological diagnosis of the patient&#44; the patient&#39;s age&#44; the disease stage and the therapeutic approaches taken&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Factors associated with tumor growth and the conventional treatments used to treat cancer often result in malnutrition in breast cancer patients&#46; Side effects caused by conventional treatments&#44; significantly reduced caloric intake and decreased absorption of nutrients can all complicate cancer treatment and reduce the quality of life of cancer patients&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Previous studies have sought to identify ways to improve the quality of life and nutritional status of cancer patients using adjuvant therapy with mushrooms&#46;<a class="elsevierStyleCrossRefs" href="#bib4">4&#8211;10</a></p><p id="para50" class="elsevierStylePara elsevierViewall">The most recent studies have shown that dietary supplementation with <span class="elsevierStyleItalic">Agaricales</span> mushrooms and other medicinal fungi in breast cancer patients can provide benefits&#44; such as antiproliferative and immunomodulatory effects on tumor cells&#46;<a class="elsevierStyleCrossRefs" href="#bib11">11&#8211;15</a></p><p id="para60" class="elsevierStylePara elsevierViewall">The aim of this study is to analyze the effects of mushrooms and other basidiomycetous <span class="elsevierStyleItalic">Agaricales</span> as adjuvant treatments in breast cancer&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">MATERIALS AND METHODS</span><p id="para70" class="elsevierStylePara elsevierViewall">A critical review of articles published in refereed journals between January&#44; 1990 to March&#44; 2011 was performed&#46; Articles were identified in the Medline&#44; Lilacs&#44; Scielo&#44; and Pubmed&#44; Health Science Descriptors &#40;DeCS&#41; and Medical Subject Heading &#40;MeSH&#41; databases by searching for the following terms&#58; in English &#40;<span class="elsevierStyleItalic">Agaricales</span>&#44; <span class="elsevierStyleItalic">Agaricus</span>&#44; medicinal mushroom&#47;fungus&#44; breast cancer&#44; dietary supplementation&#44; edible mushroom effects&#44; lectin&#41;&#44; in Portuguese &#40;c&#226;ncer de mama&#44; cogumelo medicinal&#41;&#44; in Spanish &#40;c&#225;ncer de mama&#44; suplementaci&#243;n nutricional&#47;diet&#233;tica&#44; cogumelos&#44; hongos medicinales&#41;&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">Articles identified in the indexing databases mentioned above&#44; including both original articles and reviews of the bioactive effects of edible mushrooms on cancer&#44; were selected for inclusion in this study&#46; Experimental trials in animals evaluating the efficacy of medicinal fungi treatments in breast cancer and randomized clinical trials with <span class="elsevierStyleItalic">Agaricales</span> mushrooms &#40;and other medicinal fungi&#41; in humans with breast cancer were also included&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">RESULTS AND DISCUSSION</span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">Bioactive substances found in mushrooms and other <span class="elsevierStyleItalic">Agaricales</span> medicinal fungi</span><p id="para90" class="elsevierStylePara elsevierViewall">The therapeutic effects of medicinal mushrooms are due to the presence of lectin&#44; &#946;-glucan&#44; ergosterol&#44; arginine&#44; and other bioactive substances in mushrooms&#46;<a class="elsevierStyleCrossRefs" href="#bib5">5&#8211;9</a> The benefits and possible mechanisms of action of these substances are described in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="para100" class="elsevierStylePara elsevierViewall">Lectins have been shown to be therapeutic agents with anticancer properties in animals and in clinical studies&#46; They cause cytotoxicity and apoptosis and inhibition of tumor growth by preferentially binding to cancer cell membranes&#46; Lectins function by sequestering the body&#39;s polyamines&#44; thereby inhibiting cancer cell growth&#46; Lectins also alter the production of many interleukins&#44; activate protein kinases&#44; bind to ribosomes&#44; and inhibit protein synthesis&#46; In addition&#44; lectins modify the cell cycle by inducing cell cycle arrest at the G2&#47;M phase&#44; promoting apoptosis&#44; and stimulating non-apoptotic G1-phase accumulation mechanisms&#46; Finally&#44; lectins can also down-regulate telomerase activity and inhibit angiogenesis&#46;<a class="elsevierStyleCrossRefs" href="#bib16">16&#8211;20</a></p><p id="para110" class="elsevierStylePara elsevierViewall">&#946;-glucan is a glucose polymer present in medicinal mushrooms&#46; It exhibits immunomodulatory effects as well as tumoricidal and antiproliferative activities in cancer patients through the stimulation of natural killer cells&#44; neutrophils&#44; monocytes&#44; macrophages&#44; and T-cells&#46;<a class="elsevierStyleCrossRefs" href="#bib21">21&#8211;28</a></p><p id="para120" class="elsevierStylePara elsevierViewall">Ergosterol &#40;or provitamin D2&#41; is a precursor of ergocalciferol&#44; an important substrate in vitamin D biosynthesis and is found in the lipid fraction of <span class="elsevierStyleItalic">Agaricales</span> extracts&#46; This substance has antitumor&#44; antiproliferation&#44; and antimigratory effects on human cancer cells&#46;<a class="elsevierStyleCrossRefs" href="#bib25">25&#8211;27</a> It has also been shown to inhibit angiogenesis&#46; In a study on sarcoma 180 cells&#44; patients treated with ergosterol demonstrated delayed tumor growth with minimal side effects&#46; For example&#44; the decrease in lymphocyte count that is commonly caused by chemotherapy was not observed in these patients&#46; Ergosterol appears to have no direct <span class="elsevierStyleItalic">in vitro</span> cytotoxic effects on tumor cells&#44; although it inhibits tumor-induced neovascularization&#46;<a class="elsevierStyleCrossRef" href="#bib28">28</a></p><p id="para130" class="elsevierStylePara elsevierViewall">Arginine is a semi-essential amino acid used as a dietary supplement in cancer patients&#46; It has been associated with a reduction of tumor growth and metastasis progression&#44; and it is reported to have beneficial effects on the immune system&#44; weight gain&#44; and the time of survival of cancer patients&#46;<a class="elsevierStyleCrossRefs" href="#bib29">29&#44;30</a></p><p id="para140" class="elsevierStylePara elsevierViewall">A complete understanding of the actions of these fungi and their bioactive molecules in the prevention and treatment of cancer will require further investigation&#46; However&#44; research shows that many of these substances exert anticarcinogenic&#44; antiviral&#44; antithrombotic&#44; antibiotic&#44; and anti-inflammatory effects in addition to many other activities that provide health benefits&#46;<a class="elsevierStyleCrossRefs" href="#bib5">5&#44;6&#44;9&#44;31&#8211;32</a></p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">Experimental studies with mushrooms and other <span class="elsevierStyleItalic">Agaricales</span> medicinal fungi</span><p id="para150" class="elsevierStylePara elsevierViewall">Promising results have been reported in animals and <span class="elsevierStyleItalic">in vitro</span> using medicinal mushrooms in the treatment of breast cancer and several other cancers&#46;<a class="elsevierStyleCrossRefs" href="#bib33">33&#8211;49</a><a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a> provides a summary of the studies mentioned below&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="para160" class="elsevierStylePara elsevierViewall">Takimoto et al&#46;<a class="elsevierStyleCrossRef" href="#bib33">33</a> demonstrated that rats administered <span class="elsevierStyleItalic">Agaricus blazei</span> extract orally exhibited increased cytotoxic T lymphocyte growth&#44; increased levels of interferon-gamma and an increase in NK cells when compared to water-treated controls&#46; This study indicates that mushroom extracts estimulate cytotoxic activity on both&#44; innate and adaptive immunological systems&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">Immunomodulatory&#44; antitumor&#44; and antiproliferative effects of lectin isolated from various types of <span class="elsevierStyleItalic">Agaricaceae</span> mushrooms have been demonstrated by Zhao et al&#46;<a class="elsevierStyleCrossRef" href="#bib34">34</a> The lectin contained in <span class="elsevierStyleItalic">Agaricus bisporus</span> has been shown to exhibit an antiproliferative effect on breast cancer cells&#44; and the lectin contained in <span class="elsevierStyleItalic">Tricholoma mongolicum</span> has been shown to have an inhibitory effect on mastocytoma cells &#40;P815&#41; <span class="elsevierStyleItalic">in vitro</span>&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">In an <span class="elsevierStyleItalic">in vivo</span> study&#44; extracts of <span class="elsevierStyleItalic">Coriolus versicolor</span> promoted significant tumor reductions in mice inoculated with mastocytoma tumor cells and mammary tumors&#46;<a class="elsevierStyleCrossRef" href="#bib35">35</a></p><p id="para190" class="elsevierStylePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a> examined the ability of an <span class="elsevierStyleItalic">Agaricus bisporus</span> extract to inhibit aromatase at the estrogen receptor <span class="elsevierStyleItalic">in vitro</span> in MCF-7 cells and rat ovarian cells and <span class="elsevierStyleItalic">in vivo</span> in rats&#46; The extract inhibited cell proliferation&#46; The linoleic and linolenic acid present in the extract inhibited aromatase activity by altering or mutating the active sites&#46; The <span class="elsevierStyleItalic">in vivo</span> study showed that the extract decreased proliferation and tumor growth without affecting apoptosis in rats&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">In studies of breast cancer cells &#40;MFC-7&#41;&#44; Grube et al&#46;<a class="elsevierStyleCrossRef" href="#bib37">37</a> showed that <span class="elsevierStyleItalic">Agaricus bisporus</span> extract suppresses the activity of aromatase&#44; resulting in a reduction of estrogen production&#44; which is a major contributor to postmenopausal breast cancer in women&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">In experiments with breast cancer cells &#40;MDA-MB-231&#41;&#44; Thyagarajan et al&#46;<a class="elsevierStyleCrossRef" href="#bib38">38</a> showed that <span class="elsevierStyleItalic">Ganoderma lucidum</span> extract inhibits cell proliferation and the formation of new cell colonies through the negative regulation of the expression of c-myc&#44; an oncogene&#46; The combination of <span class="elsevierStyleItalic">G&#46; lucidum</span> extract with green tea extract demonstrated a synergistic effect by suppressing secretion of urokinase plasminogen&#44; which is a breast cancer cell activator&#44; and thereby suppressed the growth and invasion of metastatic breast cancers&#46;</p><p id="para220" class="elsevierStylePara elsevierViewall">In a study of breast cancer cells &#40;MCF7&#41;&#44; Petrova et al&#46;<a class="elsevierStyleCrossRef" href="#bib39">39</a> noted that extracts of fungi significantly inhibited the reporter activity of nuclear factor-kappa &#946; &#40;NF-&#954;&#946;&#41; by interfering negatively in its activation pathway&#46; The study was conducted with 28 fungi extracts&#44; 40&#37; of which were found to inhibit NF-&#954;&#946; activity&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall">Gu &#38; Leonard<a class="elsevierStyleCrossRef" href="#bib40">40</a> reported the activities of 38 species of edible mushrooms in estrogen receptor-positive &#40;MCF-7&#41; and negative &#40;MDA-MB-231&#44; BT-20&#41; human breast cancer cells&#46; In aqueous extracts from <span class="elsevierStyleItalic">Coprinellus sp&#46;&#44; Flammulina velutipes&#44;</span> and <span class="elsevierStyleItalic">Coprinus comatus</span>&#44; anticancer agents were identified that actively inhibited tumor growth&#46;</p><p id="para240" class="elsevierStylePara elsevierViewall">Fang et al&#46;<a class="elsevierStyleCrossRef" href="#bib41">41</a> conducted an <span class="elsevierStyleItalic">in vitro</span> investigation of fractions of ethyl acetate extracts from Shiitake mushrooms <span class="elsevierStyleItalic">&#40;Lentinus edodes&#41;</span> via biological assays of apoptosis and cell cycle analysis in two human breast carcinoma cell lines &#40;MDA-MB-453 and MCF-7&#41;&#46; The authors observed antiproliferative activity in all strains&#46; Apoptosis was induced in 50&#37; of the tumor cell lines via the positive regulation of bax&#44; a pro-apoptotic protein&#46; Cell cycle analysis revealed a decrease in the percentage of cells in S phase&#44; an induction of cdk inhibitors and p21 and a suppression of CDK4 and cyclin D1 activities&#44; thus indicating cell cycle arrest&#46;</p><p id="para250" class="elsevierStylePara elsevierViewall">Studies using MCF-7 and MDA-MB-231 cells evaluated the effectiveness of various types of edible mushroom extracts&#46; Jedinak &#38; Sliva&#44;<a class="elsevierStyleCrossRef" href="#bib42">42</a> using flow cytometry&#44; revealed that <span class="elsevierStyleItalic">Pleorotus ostreatus</span> inhibited the proliferation of these cells in breast and colon cancers via p53-dependent and p53-independent mechanisms&#46; This fungus exerted its effect by inducing the expression of the tumor suppressor p53 and the cyclin-dependent kinase inhibitor p21 &#40;CIP1&#47;WAF1&#41;&#44; but at the same time inhibited the phosphorylation of retinoblastoma protein &#40;Rb&#41; in MCF-7 and HT-29 cells&#44; breast and colon cells respectively&#46;<a class="elsevierStyleCrossRef" href="#bib42">42</a></p><p id="para260" class="elsevierStylePara elsevierViewall">A study by Jiang et al&#46;<a class="elsevierStyleCrossRef" href="#bib43">43</a> revealed that <span class="elsevierStyleItalic">Ganoderma lucidum</span> inhibits proliferation of MDA-MB-231 breast cancer cells&#46; By inhibiting Akt and NF-kappa&#946; activity in MDA-MB-231 cells&#44; <span class="elsevierStyleItalic">Ganoderma lucidum</span> reduced their growth&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">Talorete et al&#46;<a class="elsevierStyleCrossRef" href="#bib44">44</a> isolated breast cancer cells &#40;MCF-7&#41; and exposed them to an aqueous extract of <span class="elsevierStyleItalic">Agaricus blazei</span>&#46; The results indicated that this extract was able to reduce cell proliferation in 26&#37; compared to the control group&#44; by significantly enhancing the expression of an API gene regulatory complex in the human breast cancer cell line MCF7&#46; This&#44; again&#44; highlights the anticarcinogenic potential of mushrooms&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">In a study of rats inoculated with breast cancer cells&#44; Vetvicka et al&#46;<a class="elsevierStyleCrossRef" href="#bib45">45</a> observed a reduction in cell proliferation after oral supplementation of &#946;-Glucan extracted from medicinal mushrooms&#46; Likewise&#44; a decrease in the proliferation of cancer cells has been reported in studies carried out by Israilides et al&#46;<a class="elsevierStyleCrossRef" href="#bib46">46</a> with breast cancer cells &#40;MCF-7&#41; and by Sliva et al&#46;<a class="elsevierStyleCrossRef" href="#bib47">47</a> using the MDA-MB-231 cell line&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">Clinical studies with breast cancer patients using <span class="elsevierStyleItalic">Agaricales</span> mushrooms and other medicinal fungi</span><p id="para290" class="elsevierStylePara elsevierViewall">Although there are some inconsistencies in the results of clinical studies regarding the use of medicinal mushrooms as an adjuvant therapy in breast cancer treatment&#44; the majority of studies suggest a beneficial effect &#40;<a class="elsevierStyleCrossRef" href="#tbl3">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p id="para300" class="elsevierStylePara elsevierViewall">A study in patients with breast cancer who received four daily doses &#40;1&#46;6 g each&#41; of <span class="elsevierStyleItalic">Agaricus sylvaticus</span> revealed that <span class="elsevierStyleItalic">Agaricus sylvaticus</span> supplementation resulted in an increased number of natural killer &#40;NK&#41; cells in 75&#46;7&#37; of the patients&#46; More than half of the patients were receiving chemotherapy or radiotherapy&#44; which typically reduces the numbers of NK cells in the body&#46;<a class="elsevierStyleCrossRefs" href="#bib45">45&#44;11</a></p><p id="para310" class="elsevierStylePara elsevierViewall">In a clinical study of various cancers&#44; including breast cancer &#40;stage IV&#41;&#44; Sliva et al&#46;<a class="elsevierStyleCrossRef" href="#bib47">47</a> provided patients with a complex of immunomodulatory components&#44; including <span class="elsevierStyleItalic">Agaricus blazei</span> tea &#40;10 mg&#47;day&#41;&#46; After six months of treatment&#44; some patients had increased NK cell activity&#44; as well as increased levels of TNF-&#945; &#40;tumor necrosis factor&#41;&#44; erythrocytes&#44; hemoglobin&#44; and glutathione&#46; In contrast&#44; the number of TNF-&#945; receptors was reduced&#46; Diarrhea and occasional nausea were reported&#44; but the quality of life had improved&#46; The combination of immune-active components was effective in increasing NK cell function and other immunological parameters in patients with advanced stages of cancer&#44; thus providing an effective nutritional combination for the treatment of the late stages of cancer&#46;<a class="elsevierStyleCrossRef" href="#bib47">47</a></p><p id="para320" class="elsevierStylePara elsevierViewall">Gennari et al&#46;<a class="elsevierStyleCrossRef" href="#bib48">48</a> reported a case study of a patient with breast cancer and showed that dietary supplementation with <span class="elsevierStyleItalic">Agaricus sylvaticus</span> increased the number of CD56&#43; NK cells in the blood and caused a total regression of lung metastasis&#46;</p><p id="para330" class="elsevierStylePara elsevierViewall">Dolby<a class="elsevierStyleCrossRef" href="#bib12">12</a> reported that the D-fraction o&#946;-D-Glucan &#40;extracted from Maitake&#41; and mushroom tablets of <span class="elsevierStyleItalic">Grifola frondosa</span> had a positive effect on the health status of the 15 breast cancer patients included in the study&#46; This study reported an improvement in the clinical parameters and laboratory test results of patients as well as improvements in their hematological parameters&#44; reductions in the amount of vomiting caused by chemotherapy&#44; increased appetite and reduced anorexia&#44; which can be a side effect of conventional treatments&#46;</p><p id="para340" class="elsevierStylePara elsevierViewall">Hong et al&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> conducted a study with 362 breast cancer patients between 30 and 65 years of age&#46; The frequency of ingestion of mushrooms was measured through a specific questionnaire&#46; It was found that both the daily intake and the frequency of consumption were inversely related to the risk of breast cancer&#44; especially in postmenopausal women&#46; Similar results were reported by Shin et al&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a>&#59; however&#44; in the Shin study&#44; the consumption of medicinal mushrooms showed a strong protective effect against breast cancer in premenopausal women as well&#46;</p><p id="para350" class="elsevierStylePara elsevierViewall">Several published experimental clinical studies have reported that medicinal mushrooms exhibit beneficial effects on the health and quality of life in breast cancer patients&#46; The use of supplements as adjunctive therapies for the treatment of breast cancer has shown promising results&#44; such as antiproliferative effects on tumor cells and immunomodulatory activities in the body&#46; However&#44; few articles have examined the effects of supplementation with medicinal mushrooms for the treatment of breast cancer&#46; Therefore&#44; new protocols for the purpose of conducting clinical trials are required to elucidate the possible mechanisms of action and clinical benefits of these fungi with respect to the survival time&#44; clinical progression and quality of life of breast cancer patients&#46;</p></span></span></span>"
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          "titulo" => "INTRODUCTION"
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        2 => array:2 [
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          "titulo" => "MATERIALS AND METHODS"
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          "titulo" => "RESULTS AND DISCUSSION"
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              "identificador" => "cesec40"
              "titulo" => "Bioactive substances found in mushrooms and other Agaricales medicinal fungi"
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              "identificador" => "cesec50"
              "titulo" => "Experimental studies with mushrooms and other Agaricales medicinal fungi"
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              "identificador" => "cesec60"
              "titulo" => "Clinical studies with breast cancer patients using Agaricales mushrooms and other medicinal fungi"
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          "titulo" => "ACKNOWLEDGMENTS"
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    "fechaRecibido" => "2011-05-26"
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            0 => "Nutritional supplement"
            1 => "<span class="elsevierStyleItalic">Agaricus sylvaticus</span>"
            2 => "Medicinal mushroom"
            3 => "Adjuvant treatment"
            4 => "Basidiomycetes"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Breast cancer is the most prevalent cancer in women&#46; The most frequent therapeutic approaches for the treatment of this disease are chemotherapy&#44; radiotherapy&#44; hormone therapy&#44; and surgery&#46; Conventional pharmacological treatments cause many harmful side effects in patients&#46; To improve the quality of life of breast cancer patients&#44; researchers have sought alternative adjuvant treatment strategies&#46; To assess the effects of fungi and other basidiomycetes <span class="elsevierStyleItalic">Agaricales</span> on the co-adjuvant treatment of breast cancer&#44; we conducted a literary review of the available scientific evidence&#46; We selected articles published in refereed journals from 1990 to 2011 in Medline&#44; Lilacs&#44; CAPES&#44; Scielo&#44; and Pubmed&#46; Articles written in English&#44; Spanish&#44; and Portuguese were reviewed&#46; We used the following descriptors&#58; <span class="elsevierStyleItalic">Agaricales</span>&#44; medicinal mushroom&#47;fungus&#44; breast cancer&#44; dietary supplementation&#44; synonyms&#44; and related terms&#46; The pharmacological effects of nutritional and medicinal mushrooms have been reported in several experimental clinical studies and have shown promising results in the adjuvant treatment of breast cancer&#46; Adjuvant treatment with mushrooms is associated with improvements in the immunological and hematologic parameters of breast cancer&#44; as well as in the quality of life of these patients&#46; Randomized clinical studies are needed to elucidate the possible mechanisms of action and clinical benefits of these fungi with respect to survival time&#44; disease progression&#44; and metastasis in breast cancer&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported&#46;</p> <p class="elsevierStyleNotepara" id="cenpara20">Novaes MRCG participated at the heading&#44; analysis and preparation of the manuscript&#44; obtained a scholarship from the Scientific Iniciation Project of the Institute of Health Science - PIC&#47;FEPECS&#46; Valadares F&#44; Reis MC&#44; Gon&#231;alves DR and Menezes MC were responsible for the collection and analysis of data and production of the final scientific work&#46;</p>"
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                      "titulo" => "Natural killer cell activity and quality of life were improved by consumption of a mushroom extract&#44; Agaricus blazei Murill Kyowa&#44; in gynecological cancer patients undergoing chemotherapy"
                      "autores" => array:1 [
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        "identificador" => "xack639320"
        "titulo" => "ACKNOWLEDGMENTS"
        "texto" => "<p id="para360" class="elsevierStylePara elsevierViewall">Financial Support&#58; This review is part of a research project that was supported by the scholarship Scientific Iniciation Project - PIC from the Institute of Health Science - FEPECS&#46;</p>"
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos