Biology, Medicine, & Natural Product Chemistry ISSN 2089-6514 (paper)

Volume 12, Number 1, April 2023 | Pages: 407-412 | DOI: 10.14421/biomedich.2023.121.407-412 ISSN 2540-9328 (online)

The Anticancer Properties of Guava Leaves (Psidium guajava L.) and

Turmeric Rhizome (Curcuma longa L.) Against Breast Cancer:
A Literature Study

Angga Puja Asiandu1,2,*, Widya Sari3,4, Septi Widiya Sari5, Alif Syahrul Abdul Majid6
1
Faculty of Biology, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
2
Laboratory of Biology, SMA IT Harapan Mulia, Palembang 30113, Indonesia.
3
Laboratory of Physics, SMA IT Harapan Mulia, Palembang 30113, Indonesia.
4
Department of Physics, Faculty of Math and Natural Science, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
5
Department of Sociology, University of Bengkulu, Bengkulu 38731, Indonesia.
6
Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,Yogyakarta 55281, Indonesia.

Corresponding author*
[email protected]

Manuscript received: 30 November, 2022. Revision accepted: 22 July, 2023. Published: 03 August, 2023.

Abstract

Breast cancer, one of the most deadly diseases occurring in women, is caused by factors. In the healing process, the sufferer needs treatment,
such as radiation techniques, surgery, and chemotherapy. But, these techniques have avoidable weaknesses that damage healthy cells. To date,
natural sources can be utilized in medicine field. Guava (Psidium guajava L.) and turmeric (Curcuma longa L.) are two common plants
obtaining compounds that inhibit the growth of cancer cells based on phytochemical properties. This study was written to review the potential
both of plants as anticancer agents. Through the literature, guava leaf extract consists of flavonoids, tannins, alkaloids, saponins, terpenoids
that inhibit the proliferation of cancer cells. Besides, turmeric also has tannins, alkaloids, terpenoids, flavonoids, glycosides, sterols, and
curcumin. The presence of curcumin reduces histamine production which induce inflammation and decrease toxin. Because of curcumin,
breast cancer cells have dehydration before apoptosis.

Keywords: apoptosis; curcumin; natural sources; phytochemical.

INTRODUCTION as 1.3 million women worldwide were diagnosed with

breast cancer. Every year, approximately 465,000 women
Various deadly diseases always lurk in human welfare at died from breast cancer. Within 25 years, the number of
any time worldwide. One of those diseases suffered in patients had increased by around 30% in developed
many countries is cancer. Cancer is the second highest countries (Wahyuni 2015).
cause of death after cardiovascular disease. Based on The primary cause of breast cancer is not yet fully
WHO data, the worldwide mortality rate due to cancer known, but it is believed to be multifactorial or caused by
reached 13%. Every year, there were 12 million people in many factors. There are several factors of breast cancer,
the world suffering from cancer and as many as 7.6 such as genetic disorders facilitating the emergence of
million of them died. The number of cancer patients will cancer cells, chronic irritation and inflammation,
continue to increase. In 2030, it is estimated that the radiation, exposure to certain chemical compounds,
number will reach 26 million people with death is carcinogenic foods, and others (Suryaningsih and Sukaca
expected about 17 million (Ministry of Health 2015). 2009; Dewi and Hendrati 2015).
Based on Basic Health Research Data in 2007, the Treatments of breast cancer are usually done with
national rate of cancer patients in Indonesia was 4.3 per radiation techniques, surgery, and chemotherapy.
1000 population, with higher cancer rates occurring in However, these techniques have side effects because they
women than men. In women, 5.7 per 1000 people in sometimes enhance cancer cells to spread to other parts
Indonesia suffered from cancer. Meanwhile, 2.9 per 1000 of the body, damage healthy cells, and also trigger cancer
male population experienced cancer (Ministry of Health cells to mutate. Thus, the discovery of new drugs that are
of Indonesia 2013; Dewi and Hendrati 2015). safer with fewer side effects is needed in overcoming this
The common type of cancer attacking women is problem (Muhartono and Subeki 2015).
breast cancer which causes death in women. The It may be overcome by utilizing plants as herbal
American Cancer Society (2008) reported that as many medicines as some plants produce bioactive compounds
408 Biology, Medicine, & Natural Product Chemistry 12 (1), 2023: 407-412

potentially used as anticancer. Guava (Psidium guajava Generally, there are two types of cancer cells, benign,
L.) and turmeric (Curcuma longa L.) are two common and malignant cancer. Benign cancer cells have a low
plants producing secondary metabolites such as tannins, growth rate and do not spread to other parts. Meanwhile,
flavonoids, alkaloids, and saponins (Correa et al. 2016). malignant cells have a rapid growth rate, invade and
Turmeric (Curcuma longa L.) rhizome contains curcumin damage surrounding tissue, and spread to other organs.
which also has anticancer properties which can inhibit Invasion of cancer cells allows these cells to move into
carcinogenesis (Meiyanto 1999; Nurrochmad 2004). the blood vessels to be transported to other organs
Thus, the combination of Guava (Psidium guajava L.) emerging new cancer in other organs (Lumongga 2008).
and Turmeric (Curcuma longa L..) can be used as an The general characteristic of cancer cells is the ability
alternative to prevent breast cancer without or with fewer to grow rapidly and reduce the body's normal control
side effects. mechanisms. Abnormal genes in cancer are called
oncogenes (Guyton and Hall 1997; Putri et al. 2012).
Cancer cells can not maintain when to stop cell division.
METHODS
They divide uncontrollably which will compete with
This review paper was done with a literature study. A normal cells using oxygen and nutrients from the body.
literature study was carried out to support ideas that are These cells will replace normal cells and cause pain that
based on a strong theoretical basis on several sources ends in death (Nurhayati and Lusiyanti 2006).
consisting of several leading journals. The secondary
data were obtained to support the idea (Asiandu and Breast Cancer
Malayudha, 2022) and used in analyzing the usefulness Breast cancer is one of the most common types of cancer
of the idea to conclude the final conclusion through some in women, although this cancer can also occur in men.
stages (Sari et al. 2020). Furthermore, the benefits to be The risk of breast cancer cases increases at the age of 40
achieved from writing this scientific work are to provide years, which attacks more on the left breast and the upper
information about the dangers of breast cancer and to part of the breast, close to the arm (Wijayakusuma 2008;
socialize these two materials as the formation of Rahmatari 2014). According to the Indonesian Ministry
pharmaceutical drugs to reduce the number of breast of Health in 2013, breast cancer contributed 30% and
cancer patients safely. was the most dominant type of cancer in Indonesia (Dewi
and Hendrati 2015).
Breast cancer is a carcinoma originating from the
RESULTS AND DISCUSSION ducts or lobules of the breast which is an international
Cancer Cell women's health issue. Breast cancer is the most common
Cancer cells are normal cells that have undergone a problem in developed countries and is the number two
genetic mutation causing their growth to be uncontrolled problem in developing countries after cervical cancer.
and uncoordinated with other body cells. The process of Overall, breast cancer is the second leading cause of
forming cancer cells is known as carcinogenesis, a death after lung cancer (Suyatno 2010; Sumiatin, 2013).
somatic event, and is caused by an accumulation of A common symptom of breast cancer is a lump in the
genetic and epigenetic changes leading to changes in the breast that can be felt and will get harder, irregular, and
normal regulation of molecular control of cell growth cause pain. Other symptoms are changes in size and
(Figure 1). These genetic changes can be in the form of shape, wrinkling of the breast skin that resembles an
activation of proto-oncogenes and/or inactivation of orange peel, presence of pus, blood, watery fluids, and
tumor suppressor genes which can trigger tumor discharge of milk in a woman who is not pregnant or
formation (Kondo 1993; Nurhayati and Lusiyanti 2006). breastfeeding. Breast cancer is also characterized by
swelling in one breast, itchy and painful nipples, bone
pain, swelling of the arms, and weight loss (Suryaningsih
and Sukaca 2009; Dewi and Hendrati 2015).
Breast cancer can be caused by several factors. These
factors are combined into hormonal factors which
include age at menarche, age at first pregnancy, parity,
history of breastfeeding, infertility, and long-term use of
hormonal contraception. Early menarche or first
menstruation at the age of below 12 years will increase
the likelihood of breast cancer. The risk of breast cancer
increases with the increasing age of women (Priyatin et
al. 2013).
Breastfeeding duration affects the risk of breast
cancer. Women who breastfeed in the 4-6 month range
Figure 1. Cancer cell invasion (Taken from Gupta and Massague, 2006). have a greater risk of breast cancer than 7-24 months. It
 Asiandu et al. – Anticancer of Guava and Turmeric 409

shows that the longer the breastfeeding time, the lower polyphenolic and flavonoid (Chen et al. 2007; Lee and
the risk of breast cancer. Meanwhile, the consumption of Park 2010). Meanwhile, secondary metabolites such as
fatty foods also affects the high risk of breast cancer in tannins, alkaloids, and saponins contained in guava
women. In addition, passive smoking, alcohol leaves also inhibited the growth and spread of cancer
consumption, and low physical activity also affect the cells by inhibiting the proliferation of cancer cells
occurrence of breast cancer (Yulianti et al. 2016). (Correa et al. 2016).

Side Effects of Breast Cancer Treatment

There are several methods used to treat breast cancer. Table 1. Phytochemical properties of guava leaves (Psidium guajava L.).
Methods of treating breast cancer include radiation, Phytochemicals Result
surgery, and chemotherapy. However, these methods Flavonoids +
have side effects, such as the spread of cancer cells to Tannins +
other organs and the mutation of cancer cells (Muhartono Alkaloids +
and Subeki 2015). Terpenoids +
Side effects caused by chemotherapy can be in the Source: Kariawasam et al. 2017.
form of physical and physiological disorders. Effects that
may appear include nausea, vomiting, alopecia, and so
on. Patients who feel the side effects of chemotherapy Guava leaf extract was reported to have considerable
treatment, try to overcome these effects by resting or anticancer activity. Based on Dwitiyanti (2015), 70%
even using anti-emetic or analgesic drugs (Wahyuni ethanol extract from guava leaves had cytotoxic
2015). properties against T47D breast cancer cells with a
Severe side effects also often occur in post- concentration of 130.62 µg mL-1 capable of killing breast
chemotherapy patients, and often these side effects cancer cells by 88.52% which were incubated for 24h.
cannot be tolerated by patients which can even cause Meanwhile, the concentration of 5 µg mL-1 was able to
death. In addition, the side effect of post-chemotherapy kill 12.49% of T47D breast cancer cells. Identification of
patients may feel is anxiety (Setiawan 2015). the chemical groups contained in the 70% ethanol extract
Meanwhile, radiation therapy for cancer patients also of guava leaves indicated the presence of alkaloids,
causes side effects, especially in children. Those effects flavonoids, saponins, tannins, and triterpenoids.
can appear faster or slower and can occur locally or Also, Kaileh et al (2007), cited in Fathilah et al.
systemically, from small to large depending on age, (2010), stated that guava extract was effective in
location of irradiation, area of irradiation, vital organs inhibiting the growth of MCF7 breast cancer cells within
around the tumor, and also the dose (Yunus 2008). 24h with an IC50 value of 55 µg mL−1 mL-1 capable of
Therefore, the use of natural herbal ingredients is killing cancer cells by 50%. Moreover, the extract also
very important in preventing the growth and spread of had immunomodulatory activity in the form of NFkB
breast cancer cells. These herbal ingredients can be (transcription factor protein) regulated the expression of
derived from guava leaves (Psidium guajava L.) which genes involved in apoptosis.
contain secondary metabolites such as tannins, The mechanism of flavonoids in inhibiting and even
flavonoids, alkaloids, and saponins that have anticancer killing cancer cells can be done in several ways. The first
properties inhibiting the growth and spread of cancer way is to act as an antioxidant which will inactivate free
cells (Correa et al. 2016). Meanwhile, turmeric rhizome radicals. Then, flavonoids will also bind to electrophilic
(Curcuma longa L.) contains curcumin which has compounds, induce the work of protective enzymes
anticancer properties which can inhibit the process of conjugate activity, increase the rate of apoptosis, inhibit
carcinogenesis at the stage of initiation and promotion of cell proliferation, and inhibit lipid peroxidation.
cancer cell progression. Furthermore, flavonoids will also inhibit angiogenesis
and inhibit DNA oxidation (Rahayu and Roosmarinto
Guava Leaves (Psidium guajava L.) as Anticancer 2017).
Guava or Psidium guajava Linn is a tropical plant rich in Additionally, alkaloids have properties as
vitamins A, and C, and secondary metabolites which are antineoplastic agents that can inhibit and even kill cancer
beneficial for health. Guava leaves contain chemical cells by inhibiting DNA synthesis and inhibiting mitosis
compounds such as flavonoids, quercetin, tannins, at the metaphase and anaphase stages of cancer cells
saponins, essential oils, and alkaloids used as medicines (Purwaningsih et al. 2015). Steroids function as
for various diseases such as coughs and diarrhea. topoisomerase II inhibitors which can prevent and inhibit
Flavonoids are secondary metabolites of the phenol the cancer cell cycle (Afandi 2006; Sahid et al. 2013).
groups, efficacious as antioxidants, anti-inflammatories, Saponin compounds also play a role in inhibiting cancer
and anticancer (Aziz and Djamil 2013). cells because they are antiproliferative, antimetastatic,
Water extract from guava leaves had been reported to and also antiangiogenesis. Saponins induce apoptosis and
be able to inhibit the spread of prostate gland cancer cell differentiation (Xu et al. 2016). Angiogenesis by
cells. The compounds found in the extract were tumor cells is shown in Figure 2.
410 Biology, Medicine, & Natural Product Chemistry 12 (1), 2023: 407-412

Table 2. Phytochemicals properties of turmeric water-extract (Curcuma

longa L.).

Phytochemicals Result
Alkaloid +
Glycosides -
Flavonoid +
Tannin +
Sterol -
Terpenoid -
Source: Deb et al., 2013

Turmeric n-hexane extract inhibited the growth of

Figure 2. Angiogenesis by tumor cells (Taken from Hejmadi, 2010). QU-DB and T47D breast cancer cells. Data analysis on
the anticancer activity of turmeric rhizome extract
showed that the IC50 value for QU-DB cells was 74 µg
Turmeric Rhizome (Curcuma longa Linn.) as mL-1 and for T47D cells the IC50 value was 57 µg mL-1
Anticancer in the 48-hour MTT assay. The concentration of 68 µg
Turmeric (Curcuma longa L.) is a plant growing in mL-1 of turmeric extract was able to reduce the RTA
tropical and subtropical regions. The main ingredient in (Relative Telomerase Activity) rate in QU-DB cells by
turmeric is curcumin. It is a substance with antioxidant, 76.4% (Ranjbari et al. 2014).
anti-inflammatory, anti-proliferative, and cytotoxic The Curcumin induced cell cycle arrest and apoptosis
effects that can induce apoptosis in malignant blood through the cell-signaling pathway (Kurniawan et al.
cells, breast, colon, liver, and ovaries (Kurniawan et al. 2016). Curcumin damages cancer cells by referring to the
2016). process of apoptosis. In the event of apoptosis, cells will
Curcumin is a yellow polyphenol-derived pigment experience dehydration. Loss of intracellular fluid causes
found in the rhizome of the turmeric plant (Figure 3). the cytoplasm to condense and change shape with
The curcumin found in turmeric can act as an smaller and flattened cell sizes. Cells undergoing
antioxidant, antiviral, antifungal, and anti-inflammatory apoptosis can be characterized by the presence of
by inhibiting several important molecules triggering pyknosis due to chromatin condensation (Hutomo et al.
inflammation. Curcumin reduces the production of 2016).
histamine (a substance inducing inflammation), increases Further mechanisms of curcumin's anticancer effects
the production of cortisol which has an anti- may include suppression of NF-Kb activity through
inflammatory effect and removes toxins from the body inhibition of Ikkb activity resulting in suppression of
(Hutomo et al. 2016). genes inducing tumorigenesis which include TNF, COX-
2, Cyclin D1, c-myc, MMP-9, and interleukins.
Curcumin also controls the cell cycle and stimulates
apoptosis by regulating p16 and p53. Curcumin also acts
as an autophagy modulator which is a tumor
angiogenesis and metastatic inhibitor through the
suppression of various growth factors including VEGF,
COX-2, MMPs, and ICAMs (Wilken 2011; Kurniawan et
Figure 3. Structure of curcumin (Nurrochmad, 2004). al. 2016).
Apart from curcumin, turmeric (C.longa L.) rhizome
also contains several compounds that play a role in
Turmeric rhizome extract suppressed the growth of inhibiting or even killing cancer cells such as alkaloids,
MCF-7 and MDA-MB-231 breast cancer cells. Curcumin flavonoids, and tannins with certain mechanisms. They
contained in turmeric rhizome extract triggered enhance the anticancer potential of turmeric.
apoptosis. The rate of apoptosis of MCF-7 and MDA-
MB-231 breast cancer cells correlated with the curcumin
concentration. It induced the Bax protein used in cell CONCLUSIONS
apoptosis and inhibited Bcl-2 protein expression as an
antiapoptotic protein (Lv et al. 2014). Guava leaves (Psidium guajava Linn.) contain several
compounds that act as anticancer consisting of alkaloids,
flavonoids, saponins, and steroids. Turmeric (Curcuma
longa Linn.) rhizome contains curcumin and several
other compounds such as alkaloids, flavonoids, and
tannins which have anticancer properties. The
 Asiandu et al. – Anticancer of Guava and Turmeric 411

mechanisms of these compounds as anticancer include Kemenkes. (2015). Guidelines for the National Program for the
inhibiting the proliferation of cancer cells and inducing Prevention and Early Detection of Cervical Cancer and Breast
Cancer (Panduan Program Nasional Gerakan Pencegahan dan
apoptosis of breast cancer cells. Further research is
Deteksi Dini Kanker Leher Rahim dan Kanker Payudara).
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Jurnal Berkala Ilmiah Kedokteran Duta Wacana, 1(3), 165-
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