Thermography: mammography's partner.

Women's Health Letter; 4/1/2002; Fuchs, Nan Kathryn

If there was a way to find and remove cancers in the breast that are so tiny they don't even appear on a mammogram, more lives would be saved. If it were possible to detect cells that are just starting to become malignant and remove them before a tumor formed, even more lives would be saved. The good news is this is now possible. The bad news is, although women are relying on mammograms, they are often not enough.

Mammograms have their limitations when breasts are dense, when women are nursing, and when women are on hormone replacement therapy (HRT). If you have breast implants, mammograms may not be accurate.

I'm not saying that mammograms don't save lives. They do. Even though more women than ever before are having mammograms, deaths from breast cancer haven't changed over the past 40 years. Mammograms are finding cancers that breast examinations may miss, but they're not finding minute cancers or pre-cancerous conditions.

We need a better system of early detection without the risks associated with mammograms. Fortunately, there's an excellent diagnostic tool that fits the bill. When it's combined with mammography, I believe it will save thousands of women's lives. It's called infrared imaging, or thermography. But before I talk about thermography, I want to tell you about some of the limitations of mammograms -- even though I recognize their value.

The problems with mammograms

If you're 60 years old or older, your body has at least one type of dormant cancer. These cancer cells are harmless as long as they remain inactive. For the past 25 years, I've said that mammograms are not as safe as they are purported to be. For instance, mammography squeezes the breast so hard that encapsulated cancer cells occasionally rupture, causing the dormant cancer to become active and grow. Now other people are echoing my concern.

Mammograms are limited in what they can find. Mammograms find tumors, not cancer cells, tiny tumors, or pre-cancerous tissues. Physiological changes occur before a tumor is formed that can indicate malignancy is imminent, but mammography doesn't detect them. Preventing a disease is more effective -- and easier -- than curing it or putting it into remission.

Mammograms "read" the breast via radiation. A high lifetime exposure to radiation is a known risk factor for cancer. Although modern mammogram machines emit much lower amounts of radiation than ever before, if you have regular mammograms and dental X-rays, your exposure to radiation increases every year. Add to this any chest X-rays to rule out pneumonia, and your lifelong accumulation of radiation increases. Fortunately, not all breast diagnostic tools use radiation. Thermography uses a camera that detects heat.

How thermography works

Thermography, or infrared imaging, works by identifying and measuring changes in heat in the body and translates it into images. When the breast is cool, the amount of blood that flows into it is reduced. Even before cells become malignant, the tissues surrounding pre-cancerous cells and the area around breast cancers open up existing blood vessels and produce new ones. This is called angio-genesis. These extra blood vessels, and blood vessels with increased capacity, are needed to carry nutrients into hungry cancer cells. The new blood vessels, and the increased blood flow through them, create minute quantities of heat. Thermography can detect these slight variations in temperature, finding breast cancers and pre-cancerous tissues long before they can be detected through mammography. It does this without compressing the breasts, without radiation, and without any other risks. Thermography is 100 percent safe.

Thermography uses very sensitive infrared cameras along with state-of-the-art computers that produce high-resolution pictures of these variations in temperature. If thermography is performed with good quality equipment, using strict protocols, and is read by board-certified doctors with experience in breast imaging, the results are excellent.

If you are monitoring your breast health, as you should, especially if you have a family history of breast cancer, in my opinion, the best test you can get every year is a thermogram. Then, if the results show any abnormality, you can get a mammogram to rule out breast cancer. Studies show thermography can indicate a cancer may be forming up to 12 years before any other test can detect any problem. It gives you early warnings long before a tumor forms. If you get an abnormal reading and no tumor is present, you can monitor that area carefully with breast self exams, doctor's exams, and follow-up thermograms to catch any progressive changes. Follow-up thermograms may also be performed when indicated. During this time you can take positive actions to improve your breast health by making changes in your diet and lifestyle to minimize any future problems.

A thermogram can detect mastitis (an inflammation in the breast), fibrocystic breasts, or benign tumors as well as cancer or precancerous tissues.

The best approach

The combination of thermography and mammography is the very best, most accurate approach in detecting the earliest cancers. Together, they provide the widest possible coverage in cancer detection. Here's why. Mammography examines the anatomy. It looks at shadows on film for cellular change -- like tumors -- and pinpoints exactly where the problem is located. Thermography examines the physiology (cellular and chemical changes), like heat from blood vessels, the recruitment of blood vessels, and metabolic changes that occur before a mass grows and when a mass is present.

Thermography is excellent in finding pre-cancerous conditions, but it isn't as accurate in locating some of the slow-growing tumors or those few tumors that don't have increased blood vessel activity. It also can't tell doctors exactly where the problem is located. Mammography locates some of these slow-growing tumors that thermography misses and can tell doctors just where any masses are located. But it can't identify precancerous conditions. Together, these two diagnostic tools locate 95 percent of troublesome changes in breast tissue.

Finding thermography near you

Now that I've shared my excitement with you about thermography, I have bad news. Thermography is not as widely available as mammography. And not all places that do thermograms use accurate equipment and adhere to the strict protocols necessary to get the excellent results I've talked about. Most good clinics are on the west coast. But hopefully, if you think thermograms are as valuable as I do, you can tell your doctor you want this technology available to you.

If you have access to a computer, you can find clinics that meet the stringent qualifications for accurate breast thermography on the following Web site: www.breastthermography.com. If you do not have a computer (most libraries do and will help you get to a Web site) call William Amalu, DC, Vice President of the International Academy of Clinical Thermology, in California at 650-361-8908.

If you decide to go to a lab that's not identified on any qualified referral list, be sure the following conditions are present:

* The temperature of the room is between 68 and 73 degrees.

* You have been acclimated for at least 15 minutes after disrobing.

* There is no draft of cold air on your body.

* The background color on your thermogram is black. Any other color means the room was too warm.

* Your thermogram is only read -- and signed -- by a board-certified health care provider who is licensed to diagnose, trained in breast imaging, and certified by a legitimate organization, such as the International Academy of Clinical Thermology, International Thermographic Society, American Academy of Medical Infrared Imaging, or the American Academy of Thermology. If your analysis is not signed, do not accept it.

Thermography study in California

Robert Rowen, MD, editor of Second Opinion health newsletter, and I are in the process of setting up a thermography study in Northern California that will show us just what the combination of mammograms and thermograms can find. Dr Rowen's office is in Santa Rosa, California, a little over an hour north of San Francisco. If you are interested in participating in this study, call his office at 707-571-7560 for details.

Breast Cancer and Estrogens

The single greatest risk factor for getting breast cancer appears to be directly correlated with your lifetime exposure to estrogen. Thermography can differentiate between an image caused by increased estrogen activity in your breasts and a tumor or precancerous tissues. If you are taking any form of estrogen, you will want regular thermograms to monitor the amount and effects of estrogen you're taking. If thermography indicates that there's too much estrogen in your breasts, your doctor can decrease the type and amount of estrogen you're taking or increase your progesterone intake.

Cockburn, William, DC. "Breast thermal imaging: the paradigm shift," IRIE, 1999.

Vaidya, Jayant S. "Screening for breast cancer with mammography," The Lancet, December 22/29, 2001, p. 2166.