The Norwegian Study of Mammography Points to a New Future

By Martha Grout, MD, MD(H)

Norwegian researchers cast fresh doubts on the benefits of mammography screening. Their results, published September, 2010 in the New England Journal of Medicine found little benefit.[1]

Mette Kalager, M.D., of Oslo University Hospital, and colleagues are the first to assess the benefit of mammography in the context of the modern era of breast cancer treatment.

The Norwegian breast-cancer screening program analyzed data from 40,075 women with breast cancer. They were able to establish a large comparison cohort by leveraging historical data from the country’s Breast Cancer Screening Program which was implemented gradually over a nine-year period from 1996 to 2005. During the time period of the study, Norway also established multidisciplinary medical teams focused on the treatment of breast cancer. The combined impact of introducing mammography screening and improving treatment was a disappointing 10% reduction in breast cancer mortality. Moreover, an 8% reduction in mortality was noted in women who did not undergo screening but whose cancers were treated by the multidisciplinary teams. These observations suggest tha t the relative reduction in mortality that can be attributed solely to screening mammograms is a surprisingly low 2%, indicating that the decline in mortality attributed to screening alone may be as few as 2 deaths prevented per 100,000 women screened.

Dr. H. Gilbert Welch wrote in an accompanying editorial that since mammograms may have only reduced the cancer death rate by 2 percent, it is an amount so small it may as well be zero.[2]

Radiation Is Carcinogenic

That 2 percent advantage is offset by the fact mammograms, an X-ray of the breast, can cause cancer. Breast tissue is known to be highly susceptible to the cancer-causing effects of radiation, especially when exposure occurs before menopause. One theory is that for radiation damage of breast tissue to develop into a cancer, there is the need for estrogen stimulation and tissue proliferation that occurs during monthly menstrual cycles. Once the menopausal ages have been reached, there is a decrease in this tissue proliferation and damaged cells fail to develop into cancers.[3]

A 2010 study led by researchers with the U.S. Department of Energy’s Lawrence Berkeley National Laboratory (Berkeley Lab) shed new light on the issue. Researchers discovered that radiation exposure can alter the environment surrounding the cells so that future cells are more likely to become cancerous.[4]

The research team used cultures of human mammary epithelial cells (HMECs), the cells that line breast ducts, where most breast cancers start. When placed in a culture dish, the vast majority of these cells divide between five and 20 times until they become what is known as senescent, or unable to divide. However, there are also some variants of these cells (vHMECs) which have a phenotype that allows them to continue dividing for many weeks in culture. This type of breast cell is more susceptible to malignancy because it lacks a tumor-suppressing protein called p16.

Researchers exposed breast cells to a single treatment of a low-to-moderate dose of radiation and compared them to cells that had not been exposed. They found that four to six weeks after the radiation exposure, the normal breast cancer cells (HMECs) had stopped dividing far earlier than they would have normally - and this premature cell senescence had accelerated the growth of vHMECS.

“By getting normal cells to prematurely age and stop dividing, the radiation exposure created space for epigenetically altered cells that would otherwise have been filled by normal cells. In other words, the radiation promoted the growth of pre-cancerous cells by making the environment that surrounded the cells more hospitable to their continued growth,” explained Paul Yaswen, a cell biologist and breast cancer research specialist with Berkeley Lab’s Life Sciences Division.[5]

“Our work shows that radiation can change the microenvironment of breast cells, and this in turn can allow the growth of abnormal cells with a long-lived phenotype that has a much greater potential to be cancerous,” Yaswen said.

A cell’s phenotype is its full complement of observable physical or biochemical characteristics. Different cells can have phenotypes that look dramatically different or exhibit radically different behavior even though their genetic makeup (genotype) is identical. Signals from outside the cell can alter a cell’s phenotype by regulating (or de-regulating) the cell’s use of its genes. Studies have shown that if a cell develops a pre-cancerous phenotype, it can pass on these “epigenetic” changes to its daughters, just as it can pass on genetic mutations.

“Many in the cancer research community, especially radiobiologists, have been slow to acknowledge and incorporate in their work the idea that cells in human tissues are not independent entities, but are highly communicative with each other and with their microenvironment,” Yaswen says. “We provide new evidence that potential cancer agents and their effects must be evaluated at a systems level.”

Mammography was accepted in the 1970s as the best approach to screening for breast cancer although no research had been carried out on the effects of radiation on the breast.

The Argument For Mammography

“The only thing that we have good science to show can actually save lives – and this is for women over the age of 40 – is mammography,” said Otis Brawley, Chief Medical Officer of the American Cancer Society (ACS).

In 2009, a federally funded task force released recommendations that called into question decades of advice that women over 40 should be screened for breast cancer every year. The panel said most women should begin getting mammograms a decade later, at age 50, and even then only every other year. The task force noted the high number of false positives, the concern about radiation, and called for less mammography screening to spare women some of the worry and expense of extra tests to distinguish between cancer and harmless lumps.

The panel also said screenings often identify cancers that, if left alone, would never spread or cause harm. Dormant cancers that will never spread in the body are often pinpointed by screenings and treated as though they are harmful. Detection of these innocuous cancers almost certainly contributed to the tremendous increase in diagnoses over the years.

There was an uproar. The ACS and other major cancer organizations decided to ignore the new recommendations and continue to encourage women in their 40s to get routine mammograms.

“We’d save at least 1,200 people per year in their 40s from dying from breast cancer if we could screen them all,” Brawley claimed.

Speaking on National Public Radio in October, 2010, Brawley laid out the case for ignoring the new recommendations:[6]

“I understand what the taskforce was trying to say. I think they communicated it badly. In many respects, they were trying to say that mammography is imperfect. The number of lives that can be saved among the 22 or 23 million women in their 40s is relatively small, 1,200.

“You have to remember the limitations of mammography are something that we also want to stress. It is not a very good test for younger women. It’s very difficult for a mammographer to pick up a cancer in a breast in a woman in her 20s or 30s. It’s difficult for mammographers to pick it up in their 40s, and it gets easier as a woman gets older. We need better tests is what I’m really saying, and we need to support research to develop those better tests.

“Thermography is something that some people have advocated, but it’s not been tested in a prospective randomized trial. There are at least prospective randomized trials of mammography to show that it indeed does save lives. It also, by the way, does have some limitations.

“I think that we need to support some of the research in the many things like thermography, like improving mammography and improving MRI or even three-dimensional ultrasound and flow studies that actually might be a better imaging study that even mammography. But that’s a scientific support question. For women who are there today, we must say that the only thing that we have good science to show can actually save lives - and this is for women over the age of 40 - is mammography.”

For a long time, the ACS said a mammogram is “one of the best things a woman can do to protect her health.” There was no mention of risk and limitations were downplayed. Criticisms of this screening technique were ignored.

Ignoring the Science

For example, serious questions were raised in1995 by the British medical journal The Lancet by C. J. Wright and C. B. Mueller. The authors pointed out that the great majority of positive mammogram screenings are false and that these false positives lead to many unnecessary investigations and useless surgeries. Also a negative screening does not mean the absence of breast cancer. And finally, the early detection supposedly offered by mammography was not that early.[7]

Fast forward to 2009. The Journal of the American Medical Association published an editorial challenging the still unquestioned value of mammography. The authors noted that:

“…for every breast cancer death averted, even in the age group for which screening is least controversial (ages 50 to 70 years), 838 women must undergo screening for six years, generating thousands of screens, hundreds of biopsies, and many cancers treated as if they were life-threatening when they are not.”[8]

No one should have been surprised when the federal taskforce in 2009 called for less screening.

However, the public who gets medical information from the mainstream press, has heard mostly favorable news about thermography. Note this from a Detroit news site in October, 2010:

“Screening tests due [sic] catch early cancers. Mammography does a wonderful job for women age 50 and older. It is a known fact that between six and twenty-seven percent of breast cancers may be missed in a mammogram due to numerous factors including breast density. However, they do not seem to work that efficiently in younger women whereas diagnostic mammograms detect more accurately.”[9]

Did you make sense of that doublespeak?

The medical community has been very reluctant to move on. Renowned author and health advocate Burton Goldberg asked:

“Could it be that mammography has become an industry in its own right? Is it too financially entrenched to be thwarted by logic and common sense? The radiologists have the monopoly and, in my opinion, do not want to give it up to good science.”[10]

Compared to Other Cancer Screenings

A woman’s gold standard for cancer screening is the Pap smear. It was developed by Dr. George Nicolas Papanicolaou and has been in use since the 1940s to detect uterine and cervical cancer. Cervical cancer is the 10th most common cancer among females in the United States. Most cervical cancers begin as lesions that develop into cancer gradually over time. Regular Pap tests can detect abnormal changes before they become cancerous. If cervical cancer is detected early, the likelihood of survival is almost 100 percent with appropriate treatment and follow-up. According to the CDC, almost all cervical cancer deaths could be avoided if all women complied with screening and follow-up recommendations.[11]

The Pap smear is not a particularly invasive test; cells are gently removed from the lower genital tract and placed on a slide, stained, and examined under a microscope. The appearance of the cells determines whether they are normal, suspicious, or cancerous. The test is 80% to 95% reliable and is credited with reducing deaths by about 90 percent.

Like mammograms and thermograms, Pap smears can miss a cancer. Sometimes the test shows no abnormal cells when there are actually a few - a false negative. This can happen when abnormal cells didn’t happen to be in the sample your doctor takes. False negatives can also happen if you have an infection that covers up abnormal cells. But regular screening reduces the problem of false negatives. If one test misses some abnormal cells, the next test will likely find it before it has grown into cancer. Also, a new liquid based test is being used. This test is collected in the same way but the cells are placed in liquid and the slides are made in the lab. This technique cuts down on false negatives. Most women diagnosed with invasive cervical cancer have not had regular Pap smears.

The Pap smear sets a high standard. It is simple, does not involve the risk of radiation or dyes, and is relatively inexpensive.

Colorectal cancer is the third leading cause of cancer death for women - behind lung and breast cancers. Routine colorectal cancer screening, and there are several different kinds, reduces colon cancer or colorectal cancer deaths by at least 60 percent.[12]

Mammography simply doesn’t measure up to those. A tumor must grow to about the size of a pea before it becomes visible on a mammogram. Sensitive breast tissue is exposed to carcinogenic radiation. There is potential for spreading an existing mass of cancer cells through the physical squeezing of the breast. Twenty-two pounds of pressure is sufficient to rupture the encapsulation around a cancerous tumor. Today’s mammogram equipment uses 42 pounds of pressure.[13]

As the Norwegian study found, mammograms reduce the mortality rate perhaps 2 percent.

The Norwegian study came out almost a year after the federal task force’s recommendations for less mammography. The uproar over a call for less mammography has settled down, and now many women and doctors are left with the realization that the mammogram isn’t as good a test as maybe they thought it was, and that it doesn’t save as many lives saved as people had hoped.

One can argue that unlike thermography, mammography is a “mature” science that has been fully studied. But the other side of that argument is, “So what?” That still does not make it a safe or very effective screening method. Seems the more we study mammography, the more we must face its weakness and flaws.

Early detection leads to much better outcomes - everyone agrees. Since thermography can detect tumor formations before they can be seen or felt, it deserves the upmost consideration.

Time to Find a Better Screening Test

As cancer cells initially take hold, they take their nutrition from surrounding cells, but early in the growth of cancer, such cells begin to obtain their own blood supply. With a blood supply established, cancers can grow. Chemical and blood vessel activity in areas surrounding a developing breast cancer is almost always higher - and produces higher temperatures - than in the normal breast.

A digital infrared thermal imaging device measures changes in skin surface temperature - the heat signature of the inflammation that underlies a cancerous growth. Blood is the main heat exchanging fluid in the body; therefore pathologies identified by thermography are generally associated with changes in blood perfusion.

Infrared technology is the better early screening technology because it has the ability to see suspicious signs of tumor formation perhaps 10 years before the subsequent lump can be felt or seen.[14]

A thermogram is not invasive, is non-toxic, and is relatively inexpensive. It is especially better for women with dense (fibrous) breasts. It is safer for women with implants and it is safe for pregnant women.

Thermography was the subject of a very poorly done trial some forty years ago which turned the medical establishment against it.

The more the establishment is finally willing to acknowledge the limitations of mammography, the more it is time to set the record straight with thermography.

A Poorly Done Trial

In the 1970s, the National Cancer Institute’s Breast Cancer Detection and Demonstration Project (BCDDP) began with the intent to compare the effectiveness of physical exam, mammography, and the relatively new technology of thermography. Two years later, thermography was taken out of the mix:

“The consensus group concluded that although there is no known harmful effect from thermography, there are no scientific data supporting its value as a routine breast cancer screening technique under present conditions of general use. They strongly suggest that research be carried out to improve thermographic techniques and to determine its role in screening.”[15]

The BCDDP was a large-scale study performed from 1973 through 1979 which collected data from many centers around the United States. In a word, the study was a mess. Expertise in mammography was an absolute requirement to be awarded a contract to establish a screening center. However, no experience was required to open a thermography center. The protocol for infrared imaging was summarized in one paragraph and simply indicated that infrared imaging was conducted by a BCDDP trained technician. Many of the project sites were mobile imaging vans which had poor heating and cooling capabilities and often kept their doors open in the front and rear to permit an easy flow of patients. This, combined with a lack of pre-imaging patient acclimation, lead to unreadable images.[16]

Based largely upon this very flawed study, the conventional medical community still shuns thermography.

There have been no randomized trials of thermography. But there have been some 800 peer-reviewed studies done on thermography,[17] and some people have done impressive studies comparing the technologies.

Perhaps the earliest, large comparative study was done by radiologist Harold J. Isard, MD, chairman emeritus of the radiology department of the Albert Einstein Medical Center in Philadelphia.

In 1972, Dr. Isard published data from 10,000 women who had been referred over a four year period to the Center for a mammogram. Additionally, the women all received a thermogram. More than half the women were actively symptomatic - about 5,600 had symptoms such as a lump in the breast, pain or nipple discharge. Dr. Isard concluded that prescreening with thermography instead of mammography would have decreased the need to expose women to an X-ray of the breast by 77 percent. He also calculated that had mammograms been used only after a suspicious thermogram, thermography would have contributed to a cancer detection rate of 24.1 per 1000 instead of the expected 7 per 1,000 using mammograms alone.[18]

In the early 1970s when Dr. Isard published this study, we didn’t know as much about the connection between cellular inflammation and cancer. But today, we know how to address chronic inflammation proactively. We also know that some cancers will regress on their own so watching the functional progression of a tumor tells us more early on than waiting for the X-ray that eventually can see a lump in the anatomy.

Thermography Matures

In the early 1980’s, reading protocols for infrared imaging were introduced that began to standardize the technology around the country. Also, the top thermography researchers of the 1970s collaborated to come up with criteria for interpreting thermograms. Today’s “Digital Infrared Thermal Imaging” (DITI) should not be confused with the older, less accurate, non-digital thermography of the 70’s and early 80’s. DITI has been recognized as a viable diagnostic tool since 1987 by the AMA Council on Scientific affairs and the ACA Council on Diagnostic Imaging, since 1988 by the Congress of Neuro-Surgeons, and since 1990 by the American Academy of Physical Medicine and Rehabilitation.

DITI, or thermography as it is also called, has emerged as a reliable screening procedure. It is the method of choice in screening for breast disease in most of the developed countries. The U.S. and Canada have lagged behind.

Two recent studies of note:

  • 2003 - California diagnostic radiologist Yuri Parisky, MD, published a study of 769 women who had suspicious mammograms followed by thermograms. The thermograms were 97 percent correct in detecting breast cancer.[19] In other words, of the women identified by thermography as cancer-free, only 3 percent turned out to have cancer. This is much better than the 10 to 30 percent rate for mammograms.
  • In 2008 - New York Presbyterian Hospital did a comparative study of women who had a suspicious mammogram and were recommended to get a biopsy. These women were also given a thermogram. Of the 94 biopsies done for the study, 60 turned out to be malignant and 34 benign. Thermography identified 58 of the 60 malignancies.[20]

Limitations of Thermography

No screening test is perfect. Like mammography, thermography screening can miss cancers. Because thermography measures the inflammation caused by the development of an increasing blood supply, it can pick up on the early signs of tumor growth. But what if the tumor is encapsulated and not growing? This describes 17 percent of advanced stage tumors and thermography misses them, according to Peter Leando of Meditherm, a provider of thermal monitoring systems. On the other hand, the size of this kind of tumor can be felt; it would be picked up in a physical exam.

In the 2003 study on the efficacy of thermography,[21] all false negatives were microcalcifications, suggesting that infrared imaging may not be able to detect these abnormalities as well as mammography does. Breast calcifications - calcium deposits - are widespread in all women and are even more common after menopause. Though breast calcifications are typically not cancerous, particular patterns of calcifications - like tight clusters with irregular shapes - might point to breast cancer, most frequently non-invasive ductal carcinoma in situ (DCIS or stage 0 breast cancer). In this instance, many doctors ask the patient to come back in six months for a comparative mammogram.

Thermography, because it is a thermal picture of heat radiating from the surface of the skin, is unable to pinpoint a tumor since abnormalities found by infrared imaging do not define an area that can be surgically biopsied. This is when mammography is particularly helpful - now that we know we have something to look for, we can identify the precise location with X-rays.

We don’t have a screening tool that provides 100% accuracy in detecting the presence of a cancerous tumor. The only definitive diagnostic tool for breast cancer is to take a biopsy and look at the tissue under the microscope. But we do have mounting evidence that thermography should be the primary screening technology, followed by an X-ray of the breast when thermography sees a suspicious trend over time, or when a lump is felt.

Screening versus Treatment

In response to the Norwegian study, Andrew Kaunitz, Professor and Associate Chairman, Department of OB/GYN, University of Florida College of Medicine in Jacksonville told MedScape:

“Although the mortality benefit of screening alone appears unexpectedly small, the investigators point out that their findings are consistent with those from Britain’s national screening program. Although some will view these Norwegian data with confusion or even hostility, I see the findings of this study as good news. We have improved our treatment of breast cancer so dramatically over the last several decades that the benefits of early diagnosis are not as great as they once were.”[22]

In other words, we can treat your breast cancer really well, so it’s not so important to diagnose it early. This is a typical viewpoint in the allopathic medical community - an emphasis on improving treatment and disease management rather than preventing breast cancers so women don’t have to go through the emotional and financial trials one experiences as a “cancer victim.”

Treatment is resulting in better outcomes. According to the CDC, the overall cancer death rate among women from all causes dropped 11.4% between 1991 and 2005.[23]

U.S. TRENDS IN THE RECORDED NUMBER OF DEATHS FROM BREAST CANCERS, 1990-2006
1990 43,391
1995 43,844
2000 41,872
2005 41,116
Source: US Mortality Data, 1990 to 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009

Generally, when discussing cancer survival rates, “5-year survival” is the term used. It refers to the percentage of people who are alive five years after being diagnosed with breast cancer. These people may or may not show symptoms, and they may or may be receiving treatment 5 years after they have been diagnosed with breast cancer.

STAGE 5-YEAR SURVIVAL RATE
0 93%
I 88%
IIA 81%
IIB 74%
IIIA 67%
IIIB 41%
IIIC 49%
IV 15%
Source: National Cancer Data Base, and are based on people who were diagnosed with breast cancer in 2001 and 2002

Why the better survival rates? Surgical techniques have become more precise - mastectomies are no longer the golden rule. Radiation can sometimes be targeted just to the tumor site. And, doctors have also begun to look a little more holistically, to “see the patient behind the cancer.” You’ll find some cancer doctors now who recommend you join a gym, get emotional support, and use fish oils. There is so much documentation on the ability of fish oils to reduce inflammation - a recent study says they can reduce cancer risk by 32% - that doctors are starting to see that nutrition is medicine.[24,25]

Prevention is the Best Cure

Treatment has gotten better, but let’s go back to square one - have the rates of breast cancer declined? Here the news is not so good.

The only significant drop in the incidence of breast cancer came in 2002 when the Women’s Health Initiative Study indicated that synthetic hormone replacement (HRT) was causing some amount of cancer, heart disease, and strokes. Initial results showed that taking the combination therapy for a long period of time increased the risk of getting breast cancer by 25 percent. Many women switched to natural, bio-identical hormones.

In October, 2010, a long-term follow-up study of the Women’s Health Initiative Study found that taking combined synthetic hormone replacement therapy (HRT) over a long period of time not only increased the risk of developing breast cancer, but also doubled the risk of dying from it because women developed deadlier forms of breast cancer. “This [new] study questioned conventional wisdom,” said Peter Ravdin, M.D., “and found an unexpected result that was very useful. We all should salute all the women who participated in this study and leaders like Dr. [Robert S.] Schenken, who bravely saw that this study, at a time when many people thought all hormonal therapies were safe, was completed.” Doctors Ravdin and Schenken work at The University of Texas Health Science Center and published their findings in the Journal of the American Medical Association.[26]

Curiously, the FDA has not issued a “black box” warning for combination synthetic hormones; they continue to be sold freely.

The current data tell us one in eight women will be diagnosed with cancer in her lifetime - that is a cumulative lifetime risk, however, so if you are 30, your risk is 1 in 250, and if you are 40 your risk is 1 in 67. Most cancers, including most breast cancers, take years to develop. The older you are, the more likely it is that slow growing cancers inside you will have developed to a point they can be seen or felt.

THE NUMBER OF U.S. WOMEN EXPECTED TO BE DIAGNOSED WITH BREAST CANCER IN THEIR LIFETIME
1950 1 in 20
1971 1 in 12
1995 1 in 9
1999 1 in 8
Source: National Cancer Institute

Unfortunately, breast cancer is big business. The medical community is gearing up to handle more diagnosis and treatment. The marketing materials for a seminar for medical professionals put it this way:

“According to the American Cancer Society, nationwide there is a new diagnosis every 3 minutes and a death from breast cancer every 14 minutes. Americans older than 65 years are expected to double from 40 million in 2010 to 80 million in 2040. This will lead to a large increase in breast cancer among American women. Due to the recent advances in technology, shrinking reimbursements, economic pressures of managed care and increasing number of baby boomers, most hospitals, physicians and healthcare facilities are starting to see the benefits of defining themselves by 'Comprehensive Breast Centers of Excellence.’ … It is imperative for hospitals to develop the planning and investment strategy to succeed in this highly competitive field and capture the consumer market.”

Conference held in West Palm Beach, Florida, January 2011; sponsored by Active Communications International (ACI)

They are strategizing how to get your business, rather than how to prevent the disease.

Jeanne Rizzo, R.N., president of the Breast Cancer Fund, says too often the statistics of breast cancer are used to market screening and treatment services under the guise of “awareness.” The annual fall avalanche of pink ribbons has not stopped the progression of the disease. “We have to move beyond awareness to prevention,” Rizzo said.

If you can prevent cancer, then the expense of screening and treatment are greatly reduced, and that is the best outcome of all for patients.

RESOURCES:

Breast Cancer Fund. This group’s mission is to identify and advocate for the elimination of the environmental causes of breast cancer. Download their 2010 report: www.breastcancerfund.org/evidence


[1] Kalager M, Zelen M et al. Effect of screening mammography on breast-cancer mortality in Norway. NEJM. September 23, 2010;363:1203-10. [2] Welch HG. Screening mammography-a long run for a short slide? NEJM. 2010;363:1276-78. [3] Fact sheet #52: Ionizing Radiation and Breast Cancer Risk. Cornell University. January 2005 [4] Yaswen, P; Mukhopadhyay, P; Costes, S. Promotion of variant human mammary epithelial cell outgrowth by ionizing radiation: an agent-based model supported by in vitro studies. Breast Cancer Research. February, 2010; 12: R11 [5] Press release. Study Raises New Concerns About Radiation and Breast Cancer. Lawrence Berkeley National Laboratory (Berkeley Lab), May 13, 2010 [6] Ludden, J. Sorting Through Mammogram Confusion. NPR, Talk of the Nation. October 14, 2010 [7] C. J. Wright, CJ; Mueller, C B. Screening Mammography and Public Health Policy: The Need for Perspective. The Lancet, July 1995 [8] Esserman, L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009;302(15):1685-92. [9] Nicholson, Debbie. Breast Cancer Survival Rates Increase Due to New Developments. Examiner.com. October 3, 2010 [10] Goldberg, Burton. An Alternative to Mammograms. Natural Solutions. March 1, 2004 [11] Schiffman, M.H.; Brinton, L.A. et al. Cancer Epidemiology and Prevention. 2nd ed. New York, NY: Oxford University Press, 1996, 1090-1116. [12] Fact Sheet. Preventing Chronic Diseases: Investing Wisely in Health Screening to Prevent Cancer Deaths. CDC. Revised August 2008 [13] Hoekstra P. “Quantitive Digital Thermology: 21st Century Imaging Systems.” Paper presented at: OAND Conference, 2001; Hamilton Ontario. [14] Wang, Jane; Chang, King-Jen. Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study. Biomed Eng Online. January 2010; 9: 3. [15] Meeting Report. Recommendations of the Consensus Development Panel on Breast Cancer Screening. Cancer Research. 38. 476-477, February 1978 [16] Amalu, William C. A Review of Breast Thermography. 1998 [17] ibid [18] Isard, H J; Becker, W. Breast Thermography after Four year and 10,000 Studies. American Journal of Roentgenology, August 1972 [19] Parikh YR, Sardi A. Efficacy of computerized infrared imaging analysis to evaluate mammographically suspicious lesions. Am J Roentgenol. 2003 Jan;180(1):263-9. [20] Arora N, Martins D. Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. Am J Surg. 2008 Oct;196(4):523-6. [21] Parikh YR, Sardi A. Efficacy of computerized infrared imaging analysis to evaluate mammographically suspicious lesions. Am J Roentgenol. 2003 Jan;180(1):263-9. [22] Kaunitz, Andrew M. Reappraising the Value of Screening Mammography. MedScape/WebMD. September 30, 2010. [23] Jemal, Ahmedin, Siegel, Rebecca. Cancer Statistics, 2009 Table 8. CA Cancer J Clin. May 2009; 59:225-249 © 2009 American Cancer Society, Inc. [24] Rose, David P; Connolly, Jeanne M. Omega-3 fatty acids as cancer chemopreventive agents. Pharmacology & Therapeutics. Volume 83, Issue 3, September 1999, Pages 217-244 [25] White, Emily. Fish Oil May Reduce the Risk of Breast Cancer. American Association for Cancer Research. July 8, 2010 [26] Chlebowski, R. T.; Anderson, G. L. Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in Postmenopausal Women. JAMA. October 20, 2010;304(15):1684-1692. doi:10.1001/jama.2010.1500
The Norwegian Study of Mammography Points to a New Future
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