Cover Image

The Role of the Bracken Fern in Upper Gastrointestinal Tract Malignancies: A Systematic Review of the Evidence

Vinayak Nagaraja, Guy D. Eslick


Background: The multifactorial origin of upper alimentary tract cancers encompasses environmental factors mainly associated with diet. Pteridium aquilinum—bracken fern—is the only higher plant known to cause cancer in animals. Its carcinogenic toxin, ptaquiloside, has been identified in milk of cows and groundwater. Humans can be directly exposed by consumption of the plant, contaminated water or milk, and spore inhalation.

Methods: In order to determine the association between bracken and upper alimentary tract cancers a systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science.

Results: Original data was abstracted from each study, the pooled odd ratio and confidence intervals were not calculated as there was no comparable data. However, each study showed a substantial increased risk associated with bracken fern.

Conclusion: The current medical literature suggests a serious risk to human health from bracken, and increasing media coverage of the subject is likely to lead to greater education and prevention strategies. Further epidemiological studies are required.


bracken; gastrointestinal cancer; esophageal cancer; gastric cancer; fern


Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010, 60:277-300

Bollschweiler E, Wolfgarten E, Gutschow C, Holscher AH. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer. 2001, 92:549-555

Ries LAG MD, Krapcho M, et al. , . Seer cancer statistics review1975–2004. 2007.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA: A Cancer Journal for Clinicians. 2005, 55:74-108

Eslick GD. Infectious disease clinics of north america. Diseases of the gastrointestinal tract and associated infections. Dedication. Infectious disease clinics of North America. 2010, 24:xv-xvi

Vetter J. A biological hazard of our age: Bracken fern [ pteridium aquilinum (l.) kuhn] — a review. Acta Veterinaria Hungarica. 2009, 57:183-196

Yamada K, Ojika M, Kigoshi H. Ptaquiloside, the major toxin of bracken, and related terpene glycosides: Chemistry, biology and ecology. Natural Product Reports. 2007, 24:798-813

Niwa H, Ojika M, Wakamatsu K, Yamada K, Hirono I, Matsushita K. Ptaquiloside, a novel norsesquiterpene glucoside from bracken, pteridium aquilinum var. Latiusculum. Tetrahedron Letters. 1983, 24:4117-4120

van der Hoeven JCM, Lagerweij WJ, Posthumus MA, van Veldhuizen A, Holterman HAJ. Aquilide a, a new mutagenic compound isolated from bracken fern (pteridium aquilinum (l.) kuhn). Carcinogenesis. 1983, 4:1587-1590

Freitas RN, O'Connor PJ, Prakash AS, Shahin M, Povey AC. Bracken (pteridium aquilinum)-induced DNA adducts in mouse tissues are different from the adduct induced by the activated form of the bracken carcinogen ptaquiloside. Biochemical and biophysical research communications. 2001, 281:589-594

Matoba M, Saito E, Saito K, Koyama K, Natori S, Matsushima T, Takimoto M. Assay of ptaquiloside, the carcinogenic principle of bracken, pteridium aquilinum, by mutagenicity testing in salmonella typhimurium. Mutagenesis. 1987, 2:419-423

Alonso-Amelot ME. The link between bracken fern and stomach cancer: Milk. Nutrition (Burbank, Los Angeles County, Calif.). 1997, 13:694-696

Shahin M, Smith BL, Prakash AS. Bracken carcinogens in the human diet. Mutation research. 1999, 443:69-79

Rasmussen LH, Kroghsbo S, Frisvad JC, Hansen HC. Occurrence of the carcinogenic bracken constituent ptaquiloside in fronds, topsoils and organic soil layers in denmark. Chemosphere. 2003, 51:117-127

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. Journal of clinical epidemiology. 2009, 62:1006-1012

Cuello C, Correa P, Haenszel W, Gordillo G, Brown C, Archer M, Tannenbaum S. Gastric cancer in colombia. I. Cancer risk and suspect environmental agents. Journal of the National Cancer Institute. 1976, 57:1015-1020

Galpin OP, Whitaker CJ, Whitaker R, Kassab JY. Gastric cancer in gwynedd. Possible links with bracken. British journal of cancer. 1990, 61:737-740

Galpin CJW. In bracken toxicity and carcinogenicity as related to animal and human health. J. Taylor (ed.). International Bracken Group Special Publication. University College, Bangor, UK,. 1989, 52

Villalobos-Salazar J. Carcinogenicidad del pteridium aquilinum y alta incidencia de cáncer gástrico en costa rica. Rev Cost Cienc Med 1985, 6: 131–139.

Hirayama T. Diet and cancer. . Nutrit Cancer. 1979, 1: 67–81.

Kamon SH, T. Proc. Jpn. Cancer Assoc. 1975,

Marliere CA, Wathern P, Castro MC, O'Connor P, Galvao MA. Bracken fern (pteridium aquilinum) ingestion and oesophageal and stomach cancer. IARC scientific publications. 2002, 156:379-380

Marlière CAS, R. C.; Galvao, M. A. M.; Soares, J. F.; Evangelista, C. L. M.; Gomes, R. F. Q. . Rev. Bras.Cancerol., 1998, 44(3), 225. 1998:44(43), 225.

Marlière CAW, P.; Freitas, S. N.; Castro, M. C. F. M.; Galvao, M. A. M. In bracken fern, toxicity, biology and control. J. A. Taylor; r. T. Smith (eds.).International bracken group special publication no 4.Manchester, uk. 2000:144

Alonso-Amelot ME, Avendano M. Possible association between gastric cancer and bracken fern in venezuela: An epidemiologic study. International journal of cancer. Journal international du cancer. 2001, 91:252-259

Fenwick GR. Bracken (pteridium aquilinum)—toxic effects and toxic constituents. Journal of the Science of Food and Agriculture. 1989, 46:147-173

Coggon D, Acheson ED. The geography of cancer of the stomach. British medical bulletin. 1984, 40:335-341

Coggon D, Osmond C, Barker DJ. Stomach cancer and migration within england and wales. British journal of cancer. 1990, 61:573-574

Thomson JAW, C.; Shearer, C. M. . In bracken: Ecology, land use and control technology.; 1986.

Miranda MM, J.; Moya de Madrigal. L. Acta Méd Costaric 1977, 203, 207.

Villalobos-Salazar JM, A.; Rojas, J. L.; Mora, J.;Porras, R. E.; Herrero, M. V. In bracken toxicity and carcinogenicity as related to animal and human health. International Bracken Group Special Publication. Univ. College North Wales, UK. 1989:40-51.

Gomes J, Magalhaes A, Michel V, Amado IF, Aranha P, Ovesen RG, Hansen HC, Gartner F, Reis CA, Touati E. Pteridium aquilinum and its ptaquiloside toxin induce DNA damage response in gastric epithelial cells, a link with gastric carcinogenesis. Toxicological sciences : an official journal of the Society of Toxicology. 2012, 126:60-71

Full Text: PDF


  • There are currently no refbacks.

AJCEP (ISSN 2574-3570) Copyright © 2012-2019. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States