The most devastating loss of life from breast cancer occurs between the
ages of 30 to 50. Fortunately, women today have more options available
to them to help in the detection of breast cancer than in the past decades.
Unfortunately, education and awareness of these options and their effectiveness
in detecting breast cancer at different stages in life are woefully deficient.
The first part of this in-depth article explores the latest findings on
the effectiveness and shortcomings of various detection methods used by
the mainstream medical community, including mammography, clinical breast
exams, and to a lesser extent, magnetic resonance imaging (MRIs) and PET scans.
The second part of this article goes beyond mammography, exploring a highly
advanced but much maligned detection tool for breast cancer - breast thermography.
Breast thermography, which involves using a heat-sensing scanner to detect
variations in the temperature of breast tissue, has been around since
the 1960s. However, early infrared scanners were not very sensitive and
were insufficiently tested before being put into clinical practice, resulting
in misdiagnosed cases.
Modern-day breast thermography boasts vastly improved technology and more
extensive scientific clinical research. In fact, the article references
data from major peer review journals and research on more than 300,000
women who have been tested using the technology. Combined with the successes
in detecting breast cancer with greater accuracy than other methods, the
technology is slowly gaining ground among more progressive practitioners.
“Beyond Mammography” concludes that breast thermography needs
to be embraced more widely by the medical community and awareness increased
among women. Not only has it demonstrated a higher degree of success in
identifying women with breast cancer under the age of 55 in comparison
to other technologies, but it is also an effective adjunct to clinical
breast exams and mammography for women over 55. Finally, it provides a
non-invasive and safe detection method, and if introduced at age 25, provides
a benchmark that future scans can be compared with for even greater detection accuracy.
The most devastating loss of life from breast cancer impacts women between
the ages of 30 and 50. For women between the ages of 40 and 44, breast
cancer is the leading cause of death, according to the American Cancer
Society. Yet the November 10, 2003 issue of the AMA journal,
American Medical News, reports little evidence documenting that mammography saves lives from
breast cancer for premenopausal women, which are many of the women who
fall into these age ranges. (1)
Good evidence supports mammography as a valuable breast cancer screening
tool for women in their late 50s and 60s, but reveals room for substantial
improvement. For women over the age of 70, accumulated data documents
limited value in doing mammograms since they do not significantly extend
life. (2, 9, 10)
Obviously, as a detection tool, mammography has a valued place in clinical
practice; however, other technologies are proving to be more effective
in breast cancer detection and should become part of mainstream clinical
practice in order to save more lives.
The risk of breast cancer at age 25 is less than one in 19,000 whereas
by age 35 it is one in 217. (4) Yet, the statistic people are most familiar
with is that one in eight women will eventually develop breast cancer.
It is important to appreciate that this number is a cumulative risk that
only applies to women who have reached the age of 90.
The hereditary breast cancer genes, referred to as BRCA 1 and 2 genes,
are known to be associated with both breast and ovarian cancers, but only
account for 5 to 10 percent of all breast cancer. Newer, less well-known
factors are estimated to account for another 10 percent of all breast
cancers. In at least 70 percent of cases, however, the cause of breast
cancer is yet unknown. (5)
Generally Accepted Risk Factors
The risk for breast cancer is increased if you:
• Had your first period before age 12
• Went through menopause after age 50
• Had your first child after age 30 or never were pregnant
• Were on hormone replacement therapy or birth control pills
• Consume one or more alcoholic drinks per day
• Have a family history of breast cancer
• Are found to have inherited the breast cancer genes
• Are postmenopausal and gained weight (not so for premenopausal women)
• Have elevated levels of insulin as seen with syndrome X or type
2 diabetes, which are conditions associated with central obesity and increased
levels of insulin-like growth factor-1 (6)
• Are sedentary
Popular myths regarding what causes breast cancer include antiperspirants,
wearing a wire bra, and having had an abortion.
The gold standard study that assesses breast cancer detection technologies
stems from the “Breast Cancer Detection Demonstration Project: Five
year summary report.” (7) This study reviewed 283,000 women between
the ages of 35 and 74 who had undergone mammography and clinical breast
examinations. Over a five-year period 4,400 women were found to have developed
breast cancer. So, the purpose of the study was to see how well clinical
breast exams and mammography worked in identifying women with breast cancer.
Mammography has been the state-of-the-art screening test for several decades.
However, considerable controversy remains regarding its value, particularly
in women under the age of 50. (1, 8-10) Results from the widely accepted
BCDDP study documented that the overall ability of mammograms to detect
cancer was only 70 percent. This means that 30 percent of mammograms found
to be negative for potentially cancerous lesions are actually positive.
The false positive rate of mammograms - those patients without cancer but
with a positive finding on testing - turned out to be another problem.
Only one biopsy in six was found to be positive for cancer when done on
the basis of a positive mammogram or breast examination. The combined
false positive rate was determined to be as high as 89 percent. Identifying
and performing biopsies on these clinically insignificant lesions represents
over diagnosis and over treatment. Further, the physical and psychological
stress associated with mammogram findings is not a small concern nor are
the additional costs.
Recent data from the University of Washington and Harvard University reveals
that over a period of a single decade, one out of every two women will
have a false positive result as the result of mammography, and of those,
nearly 20 percent will undergo an unnecessary breast biopsy. (9) Contrary
to what many health-related agencies advise, recent findings seem to demonstrate
that too many rather than too few mammograms are performed every year
in the United States. Further, estimates show that for every $100 spent
on the cost of mammograms, $33 goes to the unproductive and unnecessary
expense of false positive results.
A recent article from Duke University Medical Center reports that women
over 70 are over-screened for both breast and cervical cancers. (10) The
authors estimated the cost in the year 2000 for women over the age of
70 for the unnecessary mammograms they received was approximately $460
million. The article went on to point out that clinical guidelines for
women over the age of 70 are ambiguous and based on almost no clinical research.
For younger women, mammography is more likely to miss breast cancers that
are rapidly growing, especially in women with dense breast tissue who
are at a significantly increased risk for developing breast cancer. (15)
At least 10 percent of breast cancers cannot be identified by mammography,
even when they are palpable. (8)
Advances in technology now allow digitally enhanced mammograms to be taken
alone or after injecting intravenous contrast, but they have not been
proven to be significantly more sensitive than regular mammograms, and
they have the added risk of the invasiveness of an injection that can
cause other problems. Further, they come with a substantial increase in
cost and still expose the patient to radiation. (11)
Similarly, MRIs with and without contrast are a step forward, but they
involve similar risks and are even more costly. While their sensitivity
is near 90 percent, their accuracy (specificity) in identifying cancer
as opposed to some other benign finding is no better than mammograms. (12)
PET scans are useful in identifying metastatic lesions but have an overall
sensitivity similar to mammography. Further, for breast tumors less than
one centimeter, only 25 percent of breast cancers are identifiable using
this technology. (13) The most useful application of PET scans are in
discriminating between viable tumor, fibrotic scar, and necrosis. Radiologists
do not recommend PET scanning as a screening tool in asymptomatic women
for breast cancer. (14)
For women under the age of 40, no accurate or cost effective technology
exists in mainstream medical practice that identifies lesions likely to
be breast cancer with reasonable sensitivity and specificity. Given that
breast cancer is the leading cause of death between the ages of 40 and
44, it is obvious that a pressing need exists for another test to identify
these cancers when they are just starting to develop and still small enough
to be cured.
Most breast cancers do not become palpable until they are greater than
one centimeter in size - by that time 25 percent have already metastasized.
Because most lethal breast cancers take approximately 15 years from their
beginning to the time of death, women need reliable testing that starts
when the cancer is initially forming - in their mid-twenties.
Even though there is reliable technology existing today that is available,
there is limited awareness and insufficient education that has resulted
in its being greatly underused in clinical practice.
Breast thermography has been available in clinical practice since the 1960s.
Initially, physicians were very excited when they learned that breast
cancers emit more infrared heat than normal healthy tissues, and that
they could be detected using infrared scanners. However, this technology
was brought into practice prematurely - before clinical trials were completed,
and before sufficient information about other health conditions that also
emitted large amounts of infrared light were understood.
Unfortunately, this resulted in many women having breast surgeries that
did not have breast cancer. Eventually, the high rate of unneeded surgeries
led to the rejection of infrared breast imaging in the United States,
with the entire technology being sidelined by mainstream medical practice
for several decades.
Since the 1970s, however, clinical research has continued, especially in
Canada and France where this technology is considered more mainstream.
More than 800 research papers have been published on the subject of breast
thermography, and a research databank on more than 300,000 women who have
been tested with infrared breast imaging now exists.
In addition, major advances in infrared imaging technology have been achieved
that improve the sensitivity to 0.05 degrees centigrade, which makes identifying
breast cancer much easier and more reliable. The combination of improved
technology and scientific clinical research is sparking the return of
breast thermography into clinical practice today.
Breast thermography measures differences in infrared heat emission from
normal breast tissue, benign breast abnormalities - such as fibrocystic
disease, cysts, infections and benign tumors - and from breast cancers.
It does this with a high degree of sensitivity and accuracy. Breast thermography
is a non-invasive measurement of the physiology of breast tissue. This
technology is not meant to replace mammography or other diagnostic tests
presently used in clinical practice that measure anatomical abnormalities
in breast tissue. While breast cancer can only be diagnosed by tissue
biopsy, breast thermography safely eliminates the need for most unnecessary
biopsies as well as their associated high cost and emotional suffering,
and it does so years sooner than any other test in modern medicine.
Modern infrared scanners have a thermal sensitivity of 0.05 degrees Centigrade.
Because tumor tissue does not have an intact sympathetic nervous system,
it cannot regulate heat loss. When the breast is cooled with small fans
in a room kept at 68 degrees Fahrenheit, blood vessels of normal tissue
respond by constricting to conserve heat while tumor tissue remains hot.
Thus, tumors emit more heat than their surrounding tissues and are usually
easily detected by heat-sensing infrared scanners.
Over time, cancerous tissues stay hot or become even hotter - they do not
cool down. In sharp contrast, however, other possible conditions such
as fibrocystic breasts, infections, and other benign disorders cool down
as they resolve.
At least five important studies published between 1980 and 2003 document
that breast thermal imaging is a major advancement in identifying breast
cancers not only with greater sensitivity and specificity, but also years
earlier than with any other scientifically tested medical technology.
These scientific studies include:
Cancer, 1980, Volume 56, 45-51. (17) Fifty eight thousand patients with breast complaints
were examined between 1965 and 1977. Twelve hundred and forty five patients
with abnormal Th3 mammotherms had normal breasts by mammography, ultrasound,
physical exam, and biopsy. Thirty-eight percent of women with normal breasts
and 44 percent of those with mastopathy developed biopsy proven breast
cancer within five years. Ninety percent of patients with Th4 or 5 had
diagnosis of cancer made on their first visit.
Biomedical Thermology, 1982, 279-301, Alan Liss, Inc, NY. Michel Gautherie, MD, followed 10,834 women
over 2 to 10 years by clinical examination, mammography and thermography.
(15) The study followed 387 people with normal breast examinations and
mammograms but Th3 thermographic scores for an average of less than three
years. In those without symptoms, 33 percent developed cancer. In those
with cystic mastitis, cancer developed in 41 percent. These were predominately
women between 30 to 45 years of age where breast cancer is the leading
cause of death.
Thermology, 1986, Volume 1, 170-73. (18) The effectiveness of mammography, clinical palpation,
and thermography were compared in the detection of breast cancer. Thermography
had the best reliability, but the best results were found when all three
were used together.
The Breast Journal, Volume 4, 1998, 245-51. (19) Keyserlingk et al documented 85 percent
sensitivity in diagnosing breast cancer using clinical examination and
mammography together. This increased to 98 percent when breast thermography
American Journal of Radiology, January 2003, 263-69. (16) The journal reported that thermography has
99 percent sensitivity in identifying breast cancer with single examinations
and limited views.
Thus, a negative thermogram (Th1 or Th2) in this setting is powerful evidence
that cancer is not present.
• Advances in infrared technology combined with data on 300,000 women
with mammotherms document that breast thermography is highly sensitive
and accurate. Today, this means that more than 95 percent of breast cancers
can be identified, and that this is done with 90 percent accuracy. In
women under the age of 50, where there is the most devastating loss of
life from breast cancer, mammography, MRIs and PET scans cannot come close
to matching the combined sensitivity and specificity (accuracy) of breast
• Breast thermography involves no radiation exposure or breast compression,
is easy to do, is done in a private setting, and is affordable.
• The FDA approved breast thermography for breast cancer risk assessment in 1982.
• It is important to begin breast cancer screening long before age
40. It should begin at age 25 in order to identify young women who are
already developing breast cancer since it takes approximately 15 years
for a breast cancer to form and lead to death. Further, young women with
dense breast tissue are the most difficult to evaluate using breast palpation,
mammography, and ultrasound examinations, yet their significantly higher
risk of developing breast cancer can be accurately detected with breast
• Mainstream procedures are not approved for breast cancer screening
in women under age 40 - it is widely known and accepted that they miss
too many cancers and lead to too many false positive findings that result
in far too many needless breast biopsies.
There is an abundance of scientific evidence supporting that breast thermography
is the most sensitive and accurate way to identify women with breast cancer,
especially in women under the age of 55, where it causes the most devastating
loss of life. For women over 55, breast thermography is an important adjunct
to clinical breast examination and mammography, as this combination has
been documented to increase identification of breast cancers to 98 percent.
Because of its low cost and high degree of sensitivity and accuracy, all
women who want to be screened for breast cancer should begin having breast
thermograms beginning at age 25. Clearly, there are situations that warrant
the use of other modalities such as mammography, ultrasound, MRI, PET
scanning, nipple aspirations, or biopsy, and these valuable tools should
continue to be used in clinical practice along with breast thermography.
Many new technologies are on the horizon that may become mainstream in
the near future. With the advent of highly sophisticated genetic technology,
new proteins are constantly being discovered that offer promise as markers
of early breast cancer. (20) Recently published reports also suggest that
MRI technology may be blended with spectrophotometric measurements that
could diagnose breast cancer without even doing a biopsy. (21)
The practice of medicine, just like everything in life, is in constant
evolution - there is no guarantee that what is in the mainstream today
will be here tomorrow. Yet, the advancement of all fields of endeavor
often moves slowly and cautiously, sometimes at the expense of human life.
We must remain open and alert as new, exciting, and safe strategies emerge,
especially in situations where there is such a pressing need for new approaches.
1. Elliott, V S. Mammography debate: Who should get screened and when?
American Medical News, an AMA publication. Volume 10, number 42, pages
35-37, November 10, 2003. www.amednews.com.
2. Kerlikowske, K. Use of mammograms in older women questionable. JAMA.
December 10, 2003.
3. Time Magazine, April 28, 2003. Cover story: The No. 1 Killer of Women.
4. SEER, National Cancer Institute: Chances of developing breast cancer
at a given age.
5. de Sanjose S, et al. Prevalence of BRCA1 and BRCA2 germline mutations
in young breast cancer patients: a population-based study. Int J Cancer
2003; 106 (4): 588-93.
6. Furstenberger et al. Insulin like growth factors mediate breast cancer
growth and proliferation. Onkologie, 2003. Volume 26, number 3, pages 290-94.
7. Baker L. Breast cancer detection demonstration project: Five year summary
report. Cancer, 1982, volume 32, pages 194-225.
8. Sickles EA. Breast masses: mammographic evaluation. Radiology 1989.
9. Fletcher, S W, and Elmore, J G. Mammographic Screening for Breast Cancer.
New England Journal of Medicine. Volume 348, no. 17, pages 1672-80. April 24, 2003.
10. Ostbye, T. Elderly women over-screened for cancers with little measurable
benefit. Annals of Family Practice. November/December issue, 2003.
11. Pisano, E. Digital Mammography Offers Better Breast Cancer Diagnoses.
Presented at the Radiologic Society of North America annual meeting, December
2003. Research conducted at University of North Carolina School of Medicine.
12. Freidrich M. MRI of the breast: State of the art. European Radiology,
1998. Volume 8, pages 707-725.
13. Avril N, Rose CA, Schelling M, et al. Breast imaging with positron
emission tomography and fluorine-18 flourodeoxyglucose: use and limitations.
Journal of Clinical Oncology, 2000. Volume 18, pages 3495-3502.
14. Avril N. Discussions in PET Imaging 2003. CMP Healthcare Media, DPI
no. 621, PET and Breast Cancer.
15. Gautherie, M, Haehnel, P, Walter, J p, Keith, L. Long-Term Assessment
of Breast Cancer Risk by Liquid-Crystal Thermal Imaging. Biomedical Thermology,
pages 279-301. 1982 Alan R. Liss, Incl, 150 Fifth Avenue, New York, NY 10011.
16. Parisky, Y R, et al. Efficacy of Computerized Infrared Imaging Analysis
to Evaluate Mammographically Suspicious Lesions. American Journal of Roentgenology,
January 2003, 263-69.
17. Gautherie, M, and Gros, C M. Breast Thermography and Cancer Risk Prediction.
Cancer, 1980, volume 56, 45-51.
18. Nyirjesy, M D, et al. Clinical Evaluation, Mammography and Thermography
in the Diagnosis of Breast Carcinoma. Thermology, 1986, volume 1, 170-73.
19. Keyserlingk, M D, et al. Infrared Imaging of the Breast: Initial Reappraisal
Using High-Resolution Digital Technology in 100 successive cases of Stage
I and II Breast Cancer. The Breast Journal, volume 4, 1998, 245-51.
20. Zangar, R. Breast Cancer Research and Treatment. July 3, 2003.
21. Bolan, P. In vivo quantification of choline compounds in the breast
with 1H MR spectroscopy. Magnetic Resonance in Medicine. Volume 50, Issue
6, Date: December 2003, Pages: 1134-1143.