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My hope
with this article is to give women information that may
help them make informed decisions regarding the types of
screening for breast cancer they choose to use. The
current common methods of breast tissue screening are
self-examination, mammography, ultrasound and MRIs. As
MRIs are not readily available, they will not be
included in the discussion below.
Mammography
is familiar to most women. It can pick up lesions as
small as 0.5 cm, which you are usually not able to feel,
and detects approximately 85% of cancers. An
experienced doctor can pick up 61-92% of lumps. One of
the shortcomings for mammograms is that they are less
effective in the following cases: dense or fibrocystic
breasts, small or very large breasts, women under age
50, postoperative scarring, exposure to acute/chronic
radiation, and if receiving hormone replacement. They
will miss cancers 9-20% of the time in younger women
with dense breasts and up to 25% of tumors in women
40-49 years old.
Prolific
author Dr. John Lee, MD points out that the “lag
time between cancer inception and diagnosis, even by
mammograms, may well be over eight years… [and]
diagnosis by palpation (self breast exams) can be made
about one year later.” He questions that if cancer is
prone to spreading (metastasis), would this not likely
occur during years prior to the mammogram? He suggests
that the evidence that this one-year difference in time
of diagnosis will make any difference is lacking. He
concludes that the jury on mammograms is still out, but
his hunch is that a good self-exam would be as effective
as a mammography.
Risks
of Radiation.
Radiation from a mammogram is classified as 0.2 or a low
dose; it is equal to radiation received from a
transcontinental flight, only that this amount is all
focused on the breasts. Some authors claim there is no
safe dose, others disagree. Dr. John Gofman, MD, Phd and
author of "How to Estimate a Personal Radiation Risk
from Mammography" calculates the lifetime risk of
15 mammograms for a woman, beginning at the age of 50.
The result is a lifetime risk of 1 in 136 of contracting
radiation-induced breast cancer. His findings are
based on his own research and assumptions.
The
Mortality Paradox.
Dr. Cornelia Baines, MD, in the Journal of the national
Cancer Institute 2003 published an article highlighting
the results of two Canadian trials and five Swedish
trials which together suggest that “up to 11 years after
the initiation of screening in women aged 40-49 years,
screened women face a higher death rate from breast
cancer than unscreened control women.” She also sites a
2001 study showing that surgical removal of primary
breast tumors from premenopausal women with involved
lymph nodes may trigger the growth of temporarily
dormant micrometastases in 20% of patients. In 1996 a
panel of experts for the National Institute of Health
concluded that there was not enough evidence to support
a recommendation that women in their forties should get
routine mammograms. Please see the website
http://jncicancerspectrum.oxfordjournals.org for Dr.
Baines article as well as Dr. Alfred Berg’s article with
counterpoints to her article.
Well
known author Dr. Christiane Northrup, MD admits
that doctors push mammograms because of the
lawsuit-driven medical system. While she does prescribe
regular mammograms she admits she cannot guarantee their
absolute safety and that she respects the informed
decision of her patients who opt out of mammograms. Dr.
Northrup further admits that when it comes to mammograms
“fear and the feeling of helplessness are indeed very
detrimental to health” in the context of both a
diagnosis for cancer as well as the reports often
seeming “punitive and confusing”.
The
DCIS Dilemma.
Mammograms can detect early abnormalities that may never
become invasive, often know as ductal carcinoma-in-situ
(DCIS). Dr. H. Gilbert Welch cites a study showing that
in breasts of women who died from other causes, “40
percent had microscopic precancerous changes in their
breasts.” He adds that it is well documented that most
women diagnosed with DCIS do not develop invasive breast
cancer. The Journal of American Medical Association
reports that the incidence of DCIS has increased
dramatically due to mammography screening, but the value
of its detection is still unknown. The proportion of
these cases treated by mastectomy may be inappropriately
high. What is being suggested here is that early
screening may be leading to unnecessary treatments in
women that would otherwise have survived without
detection? This is a true dilemma.
What
Other Choices do Women Have?
High-resolution breast ultrasound may be a good
alternative for some women. It is very effective at
distinguishing between a benign cyst and a solid mass
and is 98% effective in distinguishing between a benign
lesion and malignant oneThis may be a great option for
women for whom mammograms are less accurate for the
reasons described earlier. There is no radiation from
ultrasound.
What
about Thermography?
This
technique of breast screening is often supported by
alternative practitioners. Unlike current tools
(mammography, ultrasound, MRIs) that detect structural
changes, thermography uses digital infrared cameras and
a computer program to take heat pictures of the breast
tissue. This monitors functional changes of the breast
tissue based on skin temperature changes that reflect
the metabolic character of underlying tissues. It can
detect breast tissue changes 5-8 years prior to the
development of a mass large enough to be seen with
mammography or ultrasound. It is completely safe and
non invasive. Thermography is not diagnostic of breast
cancer and must be followed by conventional methods if
an abnormality is found. Its main advantages are that
it is equally useful for all types of breasts regardless
of age, density or use of hormones. Please see
www.medthermonline.com for more details.
Preventing Breast Cancer.
I would like to emphasize that breast self-exams and
mammograms are not preventative measures. These
practices may give many women a false sense of
security. Key to breast cancer prevention is diet,
exercise, quitting smoking, limiting the amount of
chemicals we expose our bodies to, limiting radiation
exposure, and cultivating a peaceful relationship with
our bodies. This is where naturopathic medicine plays a
very valuable role. While I hope this article was
helpful I suggest that it be used only as a guide to
spark your own further research. My only wish is that
women’s decisions are informed, no matter what those
decisions may be.
One of the most frequent questions I am asked as a
clinical thermographer is: “What exactly is the
difference between mammography, ultrasound and
thermography?” There seems to be some confusion on this
subject by thinking that one replaces the other as
tests, nothing could be further from the truth. Both
mammography and ultrasound are structural (anatomical)
tests, while thermography is a functional
(physiological) test. None of these tests are truly
diagnostic technologies. Thermography images the breast
and surrounding area and provides us with risk
assessment, while mammography and ultrasound detect
structural abnormalities. If a breast abnormality is
found that could possibly be malignant, a biopsy is
performed. A biopsy removes a tissue sample for
examination under a microscope.
Many women after their initial assessment with
thermography may be asked to follow up either with an
ultrasound or mammogram or both to rule out the existing
pathology. Frequently some will be relieved that their
mammogram or ultrasound test results show no abnormal
findings, however this does not necessarily mean that
nothing is going on with their breasts. Several other
factors may be contributing to a high risk (abnormal)
thermogram, such as: hormonal imbalance, early
angiogenesis (proliferation of blood vessels), lymphatic
swellings and poor function and other contributing
factors – all of these are important contributors to
breast disease and malignancy and are not detected by
mammography or ultrasound as these factors do not appear
as structural changes.
One of the most frequent questions I am asked as a
clinical thermographer is: “What exactly is the
difference between mammography, ultrasound and
thermography?” There seems to be some confusion on this
subject by thinking that one replaces the other as
tests, nothing could be further from the truth. Both
mammography and ultrasound are structural (anatomical)
tests, while thermography is a functional
(physiological) test. None of these tests are truly
diagnostic technologies. Thermography images the breast
and surrounding area and provides us with risk
assessment, while mammography and ultrasound detect
structural abnormalities. If a breast abnormality is
found that could possibly be malignant, a biopsy is
performed. A biopsy removes a tissue sample for
examination under a microscope.
Many women after their initial assessment with
thermography may be asked to follow up either with an
ultrasound or mammogram or both to rule out the existing
pathology. Frequently some will be relieved that their
mammogram or ultrasound test results show no abnormal
findings, however this does not necessarily mean that
nothing is going on with their breasts. Several other
factors may be contributing to a high risk (abnormal)
thermogram, such as: hormonal imbalance, early
angiogenesis (proliferation of blood vessels), lymphatic
swellings and poor function and other contributing
factors – all of these are important contributors to
breast disease and malignancy and are not detected by
mammography or ultrasound as these factors do not appear
as structural changes.
The following is a list comparing
all three types of tests with their pros and cons:
(This is taken from an article by Alexander
Mostovoy in his article "Thermography, Mammography or
Ultrasound?" published in Human Spirit Magazine
Spring/Summer 2007)
Mammography
- Structural test: can pinpoint the location of
suspicious area
- Compresses the breast
- X-ray radiation produces an image; the area of
concern must have greater density to stand out
against regular tissue
- Can detect tumors in mainly slow growing stage
or pre-invasive stage
- Cannot detect fast growing tumors in the
pre-invasive stage
- The use of hormones decreases sensitivity
- Large, dense and fibrocystic breasts are
difficult to read
- The upper portions of the breast including the
tail of the breast and the Axillary region cannot be
visualized
- Can detect tumors 1-2 years earlier than
physical examination
- Average Specificity 75% (25% false-positive) 9
out of 10 biopsies initiated by mammography are
negative
- Average Sensitivity 80% with 20% of cancers
missed in women over age 50 in women under age 50
Sensitivity is 60% or 40% of cancers missed
Ultrasound
- Structural test, can pinpoint the location of
suspicious area
- Uses sound waves with moderate contact
- High frequency sound waves are bounced off the
breast tissue and collected as an echo to produce an
image
- Able to detect some tumors missed by mammography
- No data available on detecting pre-invasive
tumors
- May be affected by the hormonal influence due to
the menstrual cycle, (i.e. cystic changes)
- All areas of the breast and Axillary region can
be analyzed
- Good for distinguishing between solid and fluid
masses, helpful in investigating an area of concern
due to mammography, thermography or physical
examination findings
- Average Specificity 66% (34% false positive)
- Average Sensitivity 83% (17% of cancers missed)
Thermography
- Functional testing, able to detect physiological
changes, cannot pinpoint the exact location of
suspicious area
- No radiation, non-invasive, no risk, can be used
as often as necessary to observe the effectiveness
of treatment over time
- Uses infrared detectors to detect heat and
increased vascularity that may be related to
angiogenesis
- Can detect physiological changes many years
prior to any other method of screening
- Very sensitive to fast growing aggressive tumors
- Hormonal activity in the breast will affect
thermographic imaging but not to the point of
abnormality
- All breast shapes, conditions and areas are
within the scope of imaging
- Earliest warning system with breast tissue and
physiological changes that usually precedes tumor
formation years prior to its occurrence
- Average Specificity 90% (10% false positive)
- Average Sensitivity 90% (10% cancers missed)
most of these are slow growing tumors with low
metabolic rate in the area with a high rate of
survival
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