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.
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.
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
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. In fact, another term
that describes the same procedure is INFRARED MAMMOGRAPHY because an infrared
camera is used to photograph the heat coming from your skin. The heat pattern
is then measured and analyzed and a report is generated within a few days. If there is an infection, fibrocystic disease
or cancer, for example, the abnormal patterns of should be detected as heat.
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/infrared mammogram appointment:
The procedure 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 25-30” from start to finish.
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
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
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.
How often should a breast thermogram / infrared mammogram be done? How often to have a thermogram
has not been determined. Most experts
have suggested every 6 months for comparison but we recommend follow-ups based
on the risk rating seen on your study. Since thermograms have shown early
disease development as much as 10 years before a mass is detectable on a
mammogram, a baseline exam at age 20-25 seems reasonable. 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 / infrared mammogram done? There are only a few certified
thermography centers in Southern California and none in Orange County
as far as we know that does the cold water hand immersion challenge. While
there are some thermographers who question the need for this challenge test,
there are some circumstances when it is crucial to detecting abnormal breast
physiology and there is no extra cost.
In addition, we have access to George Chapman, DC who developed the
classification scale we use has read more thermograms using this approach than
anyone else. We also provide a suggested
strategy for breast health if you do not have trustworthy health guidance.
How much does breast thermography /infrared mammography cost? Our charge for the full body examination with
a physiologic challenge and a written report is $390.00. Insurance does not seem willing to 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.
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
Repetitive Strain Injuries
Headaches, Neck and Back Problems
Pain Syndromes such as Fibromyalgia, myositis
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 / infrared mammogram 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 high risk thermogram but 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
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 my thermogram but not on my mammogram?
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. For some
insights on how we approach the patient with cancer,
see our webpage.