The current 'early detection' approach used for breast cancer through
breast self-examinations, professional assessments and x-ray mammogram is
inadequate at best and potentially dangerous at worst. Despite the emphatic recommendations of
physicians, medical societies, women’s organizations, and the press, this
approach to early detection is the best we have to offer. To be blunt, I not only disagree but there is
compelling evidence that this is not true.
To understand why I came to this conclusion, some background about one
particular technology is presented. When
you understand the role that thermography offers, I believe you too will
consider it part of your health maintenance program.
What is medical thermography? Infrared technology has been used since the 1970's and medical books listed
thermography as one of the tools to detect breast cancer as early as 1975. Maurice Bales, a scientist at the University of California,
Berkeley
developed the basics, and then upgraded the equipment for the Thermal Image
Processor (TIP). It was used to identify
musculoskeletal problems, like stress fractures.
For breast examinations, the same principle
applies. The procedure is based on the principle
that chemical and blood vessel activity in both pre-cancerous tissue and the
area surrounding a developing breast cancer is almost always higher than in the
normal breast tissue. Since
pre-cancerous and cancerous masses are highly metabolic tissues, they need an
abundant supply of nutrients to maintain their growth. In order to do this they
increase circulation to their cells by sending out chemicals to keep existing
blood vessels open, recruit dormant vessels, and create new ones
(neoangiogenesis). This process results in an increase in regional surface
temperatures of the breast.
Today, we use a state-of-the-art ultra-sensitive infrared camera and
sophisticated computer software to detect, analyze, and produce high-resolution
diagnostic images of these temperature and vascular changes. The equipment is so sophisticated that according
to an article in Alternative Medicine Magazine, September 1999, thermography
enables detection at the very beginning of angiogenesis so that it may be two
to three years ahead of other diagnostic devices. It can differentiate between cysts and tumors.
For this reason thermography could be
used in younger women, those for whom mammography would not be effective.
Thermography can also be used to monitor the
results of treatment as it can be seen when the anti-angiogenesis factors reverse
the disease.
What is a thermogram? A thermogram is an infrared thermal image. An infrared camera is used to photograph the
heat coming from your skin. The heat pattern is then measured and analyzed by
one of the world’s leading experts in thermography and the report is sent back
to us within a few days. If there is
something wrong with the breasts, (for example, an infection, fibrocystic
disease or cancer) then abnormal patterns of heat will be detected. The
procedure is non-invasive: nothing enters or touches the body. There is no
compression as there is with mammography.
There is absolutely no risk of injury, radiation, etc.
What to expect from the breast thermogram appointment: The thermogram is
done in our office in carefully monitored environment. Prior to having the thermogram you will be
asked to sit on a stool 
wearing only a loose cotton gown disrobed from the waist up in order to
allow your skin to cool to room temperature.
Your hair needs to be pulled up away from your neck to allow complete
exposure of your upper chest and neck. A
vanity curtain ensures complete privacy. In fact, no one needs to even see you
unclothed during the procedure! During this
period of adjustment, you will be asked to complete a brief questionnaire. After about 15 minutes of letting your body
temperature stabilize to the room temperature, one of the staff will then focus
the infrared camera to obtain images of your breasts in three specific views:
frontal, left side, and right side. As
soon as these initial three images are obtained, you will immerse both hands
into cold water (about 50° F) for 1 minute. Cooling the
hands (particularly the back of the hands) produces a stress in the sympathetic
nervous system which decreases the blood flow to the surface. After about 4
minutes, the three images are taken again. The procedure is then complete. We expect your appointment should take no
more than 20-30” from start to finish.
The procedure is both comfortable and safe
using no radiation or compression. By carefully examining changes in the
temperature and blood vessels of the breasts, signs of possible cancer or
pre-cancerous cell growth may be detected up to 10 years prior to being
discovered using any other procedure. This provides for the earliest detection
of cancer possible. Because of
thermography's extreme sensitivity, these temperature variations and vascular
changes may be among the earliest signs of breast cancer and/or a pre-cancerous
state of the breast.
How can I trust that
thermography is valid? Over 30 years of clinical use and more than 800 peer-reviewed
studies in the medical literature have established thermography as a safe and
effective means to examine the human body.
In this data base well over 250,000 women have been included as study participants. The numbers of participants in many studies
are very large ranging from 37,000 to 118,000 women. Some of these studies followed patients up to
12 years. Breast thermography has an average sensitivity and specificity of
90%.
Extensive
research and investigation performed at prestigious medical teaching
institutions such as Johns
Hopkins University
Medical School,
have established normal values for the distribution of heat in each region of
the body. Variation from these normal values are measured and correlated with
suspected injuries or diseases in the same way a blood or urine laboratory
study is interpreted. Since the pattern of surface heat reflects the interior structure, we
can “see” your neurologic response through thermography. You would expect only one of three responses
– a cooling response (healthy breasts), no change in temperature (cancer as a
rule, does not cool), and a paradoxical warming response. The images are saved, transmitted via a
secured internet connection to a thermogram expert who will read the studies
and report back to our office within a few days.
How often should a breast
thermogram be done? How often to have a thermogram has not been determined. Most experts have suggested every 6 months
for comparison. Since thermograms have shown early disease development as much
as 10 years before a mass has been detected on a mammogram, at about age 20-25
a baseline exam should be done. This is
a very conservative estimate based on what other thermographers are suggesting
(annual exams from age 18 onward).
Where else can I have a
thermogram done? There are only a few certified thermography centers in Southern
California and none in Orange
County as far as we know.
You may want to look at http://www.breastthermography.com
How much does breast
thermography cost? Because the
thermograms are read by an outside expert, the cost is not as low as we would
like. Presently, our charge for the
examination and a written report is no less than $280.00, which is much lower
than nearby exam centers ($350.00). To
my existing patients, the examination is $235.00. We are not sure if insurance will cover
thermography, but we will bill on your behalf with the understanding that we
are not obliged to accept whatever they decide it is worth, if anything. For this reason, payment is required at the
time the exam is done.
What else besides breast examinations is
thermography useful for? At the time of this
writing, medical research has shown thermography to be helpful in the diagnosis
of:
· Nervous System Disorders
· Metabolic Disorders
· Repetitive Strain Injuries
· Headaches, Neck and Back Problems
· TMJ Conditions
· Pain Syndromes
such as Fibromyalgia, myositis
· Arthritis
· Vascular Disorders
(Raynoud’s disease, etc.)
· Soft Tissue Injuries
In addition, there are patterns detectable by thermograms that suggest
stroke risk, etc. Any condition for
which there is an alteration of blood flow or circulation. Other physiological occurrences detected through thermal fluctuations
include complex soft tissue injury, diabetes, peripheral vascular disease, osteo-arthritis, neo-natal activity, dental infection,
intra-operative surgical fluctuations, breast implant rupture, and melanoma.
Many other applications are currently undergoing study.
Does a thermogram replace a mammogram? The medical community investigated breast
thermography quite extensively during the late 1970's and early 1980's. The FDA
approved the procedure as an adjunctive tool in breast cancer screening, and
many physicians, concerned about the radiation exposure of mammography, began
to promote thermography as a replacement for mammography. This was an error. Thermography only provides a physiologic
marker that some abnormality is present in the breast. Nothing more and nothing
less. This is however, an extremely valuable and important finding, but it has
historically been the interpretation of these findings that has been the
problem, and is now the subject of the "responsible second look."
For decades scientists
and health care researchers have looked for tools to identify breast cancer early
and reliably. Since it usually takes
years for a tumor to grow, it should be possible to find some indication than a
cancer is developing. Thermography seemed
a good candidate for this because the breast at risk for cancer often shows a
high risk type of pattern with the cold challenge described above.
HOWEVER, thermography
is a test of PHYSIOLOGY. It does not look at anatomy or structure, and it only
reads the infra-red heat radiating from the surface of the body. Mammography, on the other hand, only shows ANATOMY.
It looks at structure. When a tumor has grown to a size that is large
enough and dense enough to block an x-ray beam, it produces an image that should
be detected by a trained radiologist. A
fine needle biopsy is then generally performed to identify the type of tissue
in the density, to determine if atypical or cancerous cells are present.
We now come to an
important point. NEITHER thermography nor mammography alone or in combination diagnose
breast cancer. They are both diagnostic
tests that reveal different aspects of the disease process, which then guide further
exploration.
The problem has been that
many studies were done on patients who had biopsy-proven breast cancer. These thermography studies used patients known
to have breast cancer to act as their own controls. In other words, the patient’s cancerous
breast was compared thermographically to the patient’s other “healthy” breast. In nearly every case the breast with cancer
were hotter and had specific patterns of heat mimicking the appearance of blood
vessels that suggested 1) cancerous tumors were hotter than surrounding tissue
and 2) blood vessels in the vicinity of the tumor were engorged with blood and
this produced hotter thermal images than the normal vessels in the opposite
breast.
Since this logic
seemed to make sense, researchers proceeded to look at younger and younger
women. When the thermograms detected
heat patterns suspicious for a developing tumor, a mammogram was
performed. However, often there was no
mass detected on the mammogram. These
thermograms were considered "false positives". The more so-called false positives seen in
younger women, the more doubt was placed on thermography. It was based on these studies that thermography
was viewed as a failure. The problem
with that logic was that early stage tumors have not grown large enough or
dense (thick) enough to be seen by x-ray mammography. The thermograms were seeing suspicious
patterns before the mammogram could detect anything at all.
Eventually lobbying
efforts at the AMA's House of Delegates and at Medicare brought about the
removal of thermographic coverage by insurance companies, and the demise of thermography
in large measure. Now that time has
taught us much more, the value of thermography has been re-established. It has been estimated by a number of experts
that thermography is correct 8-10 years before mammography can detect a mass.
Unfortunately,
thermography is often viewed as a competitor to mammography, a role for which
it was never intended. Board Certified Clinical
Thermographers know that thermography is complimentary to mammography and an
adjunctive tool in detecting breast cancer. The proper role for Thermal Imaging is to use
it as a risk marker for breast pathology. Using this perspective, there are a large number
of studies published demonstrating the clinical utility and reliability of the thermography.
At worst, for the many
women who now refuse mammograms because of the discomfort, risks, and lack of
confidence in the sensitivity, thermography will provide at least some ability
to monitor breast health in addition to self examinations and professional
palpation.
What if the thermogram shows a suspicious lesion? As soon as a suspicious (positive) breast
thermal examination is reported, the appropriate follow-up diagnostic and
clinical testing should be done. This may include DIAGNOSTIC (rather than
screening) mammography and other imaging tests, clinical laboratory procedures,
nutritional and lifestyle evaluation and training in breast self examination.
What does it mean if I have a normal mammogram? It is very difficult to tell a woman that they
have an abnormal thermogram and suggest the possibility of disease, and then
have no other tools available to confirm or deny the test’s correctness. This is not thermography's failure. Indeed this is where the scientific and
research community has failed thermal imaging.
Consider the simple concept that thermography is detecting the fever of
a breast pathology, whether it is cancer, fibrocystic disease, an infection or
a vascular disease, then you can plan accordingly. Thus, the role of breast thermography is very different
than it was originally. This tool is really
a highly accurate, highly sensitive thermometer; much like the one every
physician uses daily to determine the presence of fever.
Numerous studies have
been published in the United States, England and France demonstrating that
patients in the false positive thermographic group I mentioned earlier, those
patients with positive thermograms and negative mammograms who were told the
thermography was wrong, were determined by long term follow-up to have
developed breast cancer in exactly the location thermography had demonstrated
its positive finding 5-10 years earlier.
Thermography's only
error is that it is too right ~ too early. It is our challenge together as
physicians and concerned patients to implement the appropriate approach once a
thermogram is positive. It is both an opportunity
and a responsibility to reduce the incidence of breast cancer, by screening
younger women utilizing high resolution thermal imaging technology and then
placing those women with suspicious findings into the appropriate lifestyle
modification and treatment model which may be able to prevent or minimize not
only cancer, but all breast disease.
What do I do if there is an abnormality on thermography
but not on mammography? This is both
exciting and frustrating for the clinician and the patient. A suspicious or abnormal thermogram gives the
opportunity to intervene long before the cancer expands, invades or
metastasizes. If there is no mass on
mammogram, then the suspicion of cancer must be addressed in an aggressive
pro-active fashion. On the other hand,
it is frustrating to uneducated clinicians and patients, and poses quite a
dilemma for those with a "wait and see" attitude.
Dr. Kaslow has long
been an advocate and educator of managing patients with cancer or at least at
high risk for cancer. Review my web
page, http://drkaslow.com/html/cancer.htm
to give you some insights on how we approach the patient with cancer.
