The 61 year old female was being seen two months after surgery for tubular carcinoma of the breast. She complained of an abdominal wall mass which was mildly tender, subcutaneous and nodular, measuring 4x2x2 cm. Her doctors were immediately concerned about either metastatic breast carcinoma or a recurrence of her follicular lymphoma diagnosed in 2001.
She underwent total excision of the mass, and the tissue was analyzed in using various immunohistochemical studies. There was no evidence of malignancy, only lobular panniculitis with paraseptal lymphoid follicles and vasculitis. Her doctors then continued the workup, including consideration of SLE. It was only after talking with her surgeon that it was revealed that she had been giving herself subcutaneous injections of mistletoe extract in her abdomen. She had heard about this treatment from a friend and was referred to a "complementary therapist" through her primary care practitioner.
The details in this real-life case published in the British Medical Journal in December, 2006 illustrate well the findings in a recent survey released in January. In this nationwide study, investigators at the NCCAM measured complementary and alternative medicine (CAM) use among patients. They found that two out of three adults age 50 and older have used some form of CAM, but 77% of them never discussed it with their physician. The two most common reasons why CAM was not discussed were that patients didn’t know they should (30%) and the doctor never asked (42%). According to the respondents, family and friends were their primary source of CAM information, followed by publications, physicians, Internet, and radio (interestingly, though, the second most common response regarding CAM sources was "I don’t know"). The survey also found that nearly three-fourths of respondents were currently taking multiple prescription medications, and 60% were taking one or more over-the-counter medications.
This study is available at the National Institutes of Health website and provides valuable insights into CAM use among patients.