As I mentioned in my last column, I have always thought it was ironic and disturbing that according to the Mayo Clinic, and nearly every other breast cancer resource, a major risk factor for breast cancer is radiation exposure. Yet women are continuously counseled by doctors and public health initiatives to have regular and ongoing radiation exposure through mammograms, starting from age 40 (or 45 depending on the source) and have a mammogram annually until 50 or 55, then either annually or biennially thereafter (depending on the source).
According to one local radiologist, the average mammogram is the equivalent to a single chest x-ray. Assuming this is at minimum exposure and the average life expectancy for a woman is 72 years of age, this is the equivalent of approximately 21 chest x-rays in her lifetime. I asked this doctor, why they don’t use less invasive procedures such as Ultrasound or MRI, which are the recommended follow-up procedures when a woman has a positive mammogram. While he assured me that there are things that cannot be seen on ultrasound, that can be seen on a mammogram, like small calcifications, it seems to me that there has to be a better way than exposing the sensitive breast tissue to annual x-rays, especially when radiation is a major risk factor for breast cancer.
Thankfully there seems to be another option, which, though it is not being promoted by public health officials and doctors, seems to be a promising alternative.
According to a 1984 study published in the Journal of Roentology, mammography has a sensitivity rate of less than 65%. A 1994 study in the New England Journal of Medicine found a 30% rate of false negatives using mammography (meaning 30 % of women with breast cancer were missed on screening). So although mammography is the present day gold-standard screening tool, it should be clear that it falls short in its ability to detect breast cancer at rates that one would expect.
Additionally, according to the statistics sited by Michele McDermott, MD in her January 2, 2015 web article “The Confusion about Breast Density,” 40% of women have dense breast tissue, and 10% of women have extremely dense breast tissue. Texas passed a law requiring mammography providers to inform women that mammography is not an adequate screen for women with dense breast tissue. “Dense breasts also make it more difficult for the radiologist to detect cancer on a mammogram. Dense tissue appears white on a mammogram. Lumps also appear white, so they can be very difficult to differentiate. Mammograms can be less accurate in women with dense breasts.”
Since women of a certain age need regular screening it would behoove health professionals to resolve this conflict and find alternative, less risky methods to regularly screen women for breast cancer.
Some women are choosing to turn to a diagnostic tool called digital infrared thermal imaging (DITI), also known as thermography, as an early breast cancer-screening tool. According to the site BreastThermography.com, “Because of thermography’s unique ability to image the thermovascular aspects of the breast, extremely early warning signals have been observed in long-term studies. Consequently, thermography is the earliest known risk indicator for the future development of breast cancer. It is for this reason that an abnormal infrared image is the single most important marker of high risk for developing breast cancer. Thus, thermography has a significant place as one of the major front-line methods of breast cancer detection.”
This non-invasive, radiation-free infrared technology can identify changes in the breasts and surrounding tissues by identifying unusual blood vessel and heat signatures, which accompany cancerous and pre-cancerous growth. Proponents say that this technology can detect early changes as soon as 8-10 years before they become full blown cancer identifiable by mammography, even in dense breast tissue. According to the authors of the above-mentioned site, “Studies show that the earliest detection is realized when multiple tests are used together. This multimodal approach includes breast self-examinations, physical breast exams by a doctor, mammography, ultrasound, MRI, thermography, and other tests that may be ordered by your doctor.”
Since thermography’s 1982 approval by the FDA, the government agency issued a warning in 2011 that thermography itself is not diagnostic on its own for breast cancer: “The FDA is not aware of any valid scientific data to show that thermographic devices, when used on their own (bolding mine), are an effective screening tool for any medical condition including the early detection of breast cancer or other breast disease.” Though the FDA has said thermography on it’s own is not diagnostic for breast cancer, which present day proponents of thermography seem to agree with, it seems that the FDA is saying that it is a useful tool in conjunction with other confirmatory methods such as MRI, Ultrasound, mammography, and other breast cancer diagnosis methods. According to thermography proponents and the vast majority of over 800 published studies, the technology appears to be an excellent early warning tool that can identify signals which are consistent with breast cancer and pre-breast cancer states. The website listed below has references and sites over 64 of these peer reviewed studies: www.breastthermography.com/infrared_imaging_review.htm.
A 2008 study published in the American Journal of Surgical Effectiveness, entitled “Effectiveness of Digital Infrared Thermography in the Detection of Breast Cancer,” stated that “Sixty of 94 biopsies were malignant and 34 were benign. DITI identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value depending on the mode used.” Those are pretty good statistics for any diagnostic procedure and certainly better than mammography in terms of sensitivity.
In future scenarios it is hoped that thermography could be used in some manner as a tool that would decrease the amount of radiation exposure that is presently being recommended with annual and biennial mammographies for women over 45.
In many medical practices, insurance coverage often dictates what a physician prescribes and many physicians won’t offer a test if they think insurance won’t cover it. Thermography is not offered in most medical offices, but some practitioners are opening up to it. There are numerous thermography centers in Iowa and many other Midwestern cities such as Madison, WI for which a woman can self-refer. A simple Internet search of “thermography in Iowa” turned up five centers within an hour and a half of Dubuque. Thermography is not covered by insurance, but is inexpensive – about $150-$300 – considering the information it provides.