Background: The incidence of breast cancer is high in women and cancer treatment using chemotherapy agents has many side effects which is a major problem in cancer treatment. The purpose of this study was to determine the effect of white pepper fermentation on the quality of white pepper produced, to predict the anticancer activity of white pepper essential oil, and to predict the effect of the combination of essential oils and chemotherapeutic agents on breast cancer patients. Method: Using the literature review method by looking for various reference sources, taking the essence of each source and writing it in an analytical and synthetic form. Results: Based on the literature that has been obtained, fermented white pepper has a very low number of pathogenic microbial contamination, namely 10 per 100 grams of white pepper, and has an essential oil yield of 3.2% higher than traditional processed pepper which is only around 1-2%. Pepper essential oil has anticancer activity against MCF-7 breast cancer cells with an IC value of 4.69 μg / ml. The main compound of β-caryophyllene white pepper essential oil can increase the activity of chemotherapy drugs so that it can be used as a co-chemotherapy agent. Conclusion: The fermented white pepper essential oil has better quality, has anticancer activity against breast cancer cells, so it can be used as a co-chemotherapy agent and can reduce the side effects of using chemotherapy agents.