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advocate focus 30 cannabis patient care | vol. 2 no. 3 cannapatientcare.com Breast Cancer Doctors See the Value of Cannabis for Treatment— But Stop Short of Advocating for it B Y D A V I D H O D E S R ESULTS OF A growing number of studies (1) indicate that cannabis is used by breast cancer patients for the treat- ment of the symptoms of their cancer, such as nausea due to chemotherapy. But can it do more than that? The jury is still out about how or even if cannabis can actual- ly help reduce the growth of cancer cells or otherwise impede the advancement of the any kind of cancer. However, there have been intriguing developments. Despite this, mainstream breast cancer doctors, working on treat- ments for one of the more successfully treatable types of cancers, are watching these developments carefully. More and more of them face decisions about recommending cannabis (either tetrahydrocan- nabinol [THC] and cannabidiol [CBD] or CBD only) based solely on an- ecdotal evidence or restricted research (2), as they are seeing their patients successfully manage their own care using cannabis. But patients handling their own care is somewhat antithet- ical to what doctors have been trained to do. Doctors want to be more involved in anything that helps their patients have a better quality of life. The Progress on Cannabis for Breast Cancer So Far There are new applications of cannabis for treating breast cancer in Israel, where the use of the cannabis plant for the palliative treatment of cancer patients has been legalized in multiple jurisdictions (3). Last May, breast cancer advocacy organization, Breastcancer. org, released findings from a survey of breast cancer patients evaluating medical cannabis use to manage symptoms related to breast cancer at the 2020 American Society of Clinical Oncol- ogy's (ASCO) Annual Meeting (4). Actual clinical trial support for the use of medical marijuana to manage symptoms is scarce, according to the Breastcancer.org survey. But many known effects of marijuana are appealing to can- cer patients hoping to alleviate symptoms of treatment. Mean- while, medical science urges caution. Respondents to the survey often reported using medical can- nabis to manage more than one symptom or side effect, the most common of which included pain (78%), insomnia (70%), and anxiety (57%). The survey concluded (4): "It's extremely impor- tant to know that cannabis is not a cure or treatment for breast cancer, despite many claims. It's dangerous to use cannabis in- stead of proven cancer therapies." Only one clinical trial (5) has ever been published on the effects of Delta-9-THC on cancer growth in humans. Doctors administered oral Delta-9-THC to nine patients who experienced tumor progres- sion despite surgical therapy and radiation treatments. The ma- jor finding of the study was that Delta-9-THC was safe and did not cause any obvious psychoactive effects in a clinical setting. Another study in 2009 (6) found that cannabinoids have elicited an- ti-cancer effects in many different in vitro and in vivo models of can- cer. "While the various cannabinoids have been examined in a variety of cancer models, recent studies have focused on the role of cannab- inoid receptor agonists (both CB1 and CB2) in the treatment of estro- gen receptor-negative breast cancer," as reported in the study (6). Why Are Doctors Still Hands-Off? Advocates for using cannabis for breast cancer treatment, such as Breastcancer.org or Americans for Safe Access (ASA), try to assuage the fears that licensed medical practitioners face when their patients ask for their advice on medical use of cannabis. It's still a Schedule I substance, making it as bad as heroin in the eyes of the U.S. Drug Enforcement Administration. Discussing canna- bis with patients suffering from breast cancer is one thing—prescrib- ing it is a clear violation of the law. According to the ASA, medical professionals have a legal right to recommend cannabis as a treatment in any state, as protected by the First Amendment. That was established by a 2004 United States Supreme Court decision to uphold earlier federal court rulings that doctors and their patients have a fundamental constitutional right to freely discuss treatment options. "Under federal law, cannabis may not be prescribed, but its therapeutic use can be recommend- ed without any legal jeopardy," the ASA states (7). The court ruling that protects medical professionals comes from a lawsuit brought by a group of doctors and patients led by AIDS specialist Dr. Marcus Conant. The suit was filed in response to feder- al officials who, within weeks of the legalization of medical cannabis