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 ofCalifornia, 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. 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 stoolwearing 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.
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 HopkinsUniversity 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.
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.
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:
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 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 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.