THERMOGRAPHY’S PLACE IN BREAST CANCER DETECTION | Robert A. Erickson, M.D.
I was recently reviewing my notes from an ACAM (American College for the Advancement of Medicine) conference on Integrative Oncology held in Las Vegas in 2008 when I came across a presentation by Alexander Mostovoy, M.D. on breast thermography for early breast cancer detection. Dr. Mostovoy is a homeopathic doctor and board certified in Clinical Thermography specializing in women’s health at his practice in Toronto, Canada. He provides thermographic reporting and consulting services to numerous clinics across North America, and is a frequent guest on radio shows. He also publishes articles in health magazines, educating women on how to take charge of their own health.
He made the point that early cancer detection saves lives but mammography is not “early detection.” It’s late detection, showing cancers 7 – 10 years after problems started. He stated thermography is an “early warning system.” Dr. Mostovoy and I emphasize thermal breast imaging is not a stand alone screening examination, a diagnostic examination nor a replacement examination. It is a method of detecting physiological changes associated with the presence or increased risk for the development of breast cancer. It is safe and non-invasive, and if integrated into a multi-imaging approach can provide an early warning signal of an abnormality. Thermography, just like mammography, is not 100% accurate. It may not detect very slow growing tumors.
In 1965, Gershon-Cohen, a radiologist and researcher from the Albert Einstein Medical Center, introduced infrared imaging to the United States. Since the late 1970′s numerous medical centers and independent clinics have used this procedure in hundreds of thousands of patients. In 1982 the FDA (Food and Drug Administration) approved breast thermography as an adjunctive diagnostic breast cancer screening procedure. Unfortunately, thermography has not been accepted by most mainstream medicine physicians. This dates back to a poorly constructed study in the 1970′s that concluded thermography should be placed in the “no improvement over mammography” category and that “further study was needed.” There were serious design flaws in that study where many of the personnel were poorly trained in taking thermographic images and protocol design was also a problem. For example, a temperature controlled environment was not consistently used and some of the study participants were even scanned in trailers without air-conditioning. Mammography became the modality of choice.
With established protocols in place for proper imaging and a multitude of large-scale studies demonstrating the value of thermographic imaging, thermography is rapidly becoming an important tool in early breast cancer detection and in the evaluation and monitoring of painful conditions. There has been a high level of refinement in DITI (digital infrared thermal imaging) since the early 1990′s due to advances in sensitivity, reliability, and the huge technological advances that have taken place in computing, solid state miniaturization, and declassification of military electronic super cooling and infrared technology. Today’s DITI scanners have super-cooled thermally stable receiver units capable of reading accurate to 100th of a degree C. At Gainesville Thermography, Inc., all thermographers have gone through a comprehensive training program certifying them, and the physicians who interpret the studies have also undergone advanced training specific to this discipline.
How and What Type of Information Does Thermography Give Us?
All living organisms, including humans, radiate heat energy in specific patterns. Using a special medical infrared digital thermal imaging camera, images of the infrared energy emitted by the skin’s surface are taken and recorded on a computer system. These thermal images can be interpreted by a qualified physician where skin temperatures, thermal and vascular patterns, and sympathetic nervous system responses can be distinguished between normal and abnormal physiological functions of the body. Tests of physiology may be a new concept to the reader. This is totally different than imaging studies such as X-rays, mammograms, MRI scans, ultrasounds or CT scans, which look at structure. For example, an EKG is a physiological test of heart electrical function. Among other things, the sympathetic nervous system controls core body temperature by increasing (vasodilatation) or decreasing (vasoconstriction) skin blood flow and surface temperature, keeping core temperature stable. The sympathetic nervous system originates in the spine, and goes through various organs until exiting in the skin. Medical thermography looks at the first 5mm of the skin’s surface, which is connected to the sympathetic nervous system. There is a system of dermatomes which have been mapped out that correlate to different organs. We are looking at these dermatomes with thermography. We are not looking at the organ itself. In other words, thermography looks “into the body” at the body’s response through the sympathetic nervous system. So it doesn’t matter what “depth” the problem is; it’s not conducted heat. We are looking at neural information and in particular, thermal patterns and temperature differentials rather than the temperatures themselves.
Essentially, the pathophysiological phenomena suitable for a DITI screening investigation can be divided into three broad categories:
- Inflammatory phenomena such as arthritis, soft tissue injuries (e.g. whiplash), and infections.
- Vasomotive phenomena such as seen with radicular neuropathies e.g. nerve compression (“pinched nerve”), reflex sympathetic dystrophy (RSD), and neuropathic pain such as in diabetic neuropathy.
- Vascular phenomena such as in circulatory (ischemic) phenomena or thrombophlebitis, or in angiogenesis (new blood vessel growth from tumors).
A 1998 study published in The Breast Journal reviewed 100 patients who were evaluated with thermal imaging and also mammography and physical exam. Mammography had an 85% sensitivity which increased to 95% with the addition of thermal imaging and 98% with thermal imaging and physical examination. Dr. Keysealingk, who is an oncologist, did this study. In a 2003 American Journal of Radiology article, 769 subjects with 875 mammographic lesions were studied with thermal imaging. All lesions were recommended for biopsy based on the mammographic findings. What was found was that thermal imaging provided a 97% sensitivity and 95% positive predictive value, significantly increasing the accuracy of the mammogram at biopsy. This is important as roughly 80% of all mammogram related biopsies are negative for malignancy. This high degree of false-positive tests was one of the concerns that led to new guidelines on breast cancer screening both here in the USA and in Canada.
New Breast Screening Guidelines
In 2009 the U.S. Preventive Services Task Force (USPSTF) issued new guidelines on breast cancer screening. This panel of experts recommended screening mammograms every 2 years for women aged 50 to 74, and to no longer do them annually. The Canadian Task Force on Preventive Health Care in November 2011 also issued new recommendations with a longer screening mammogram interval of once every 2 or 3 years. Both task forces recommended women ages 40 to 49 who are at average risk for breast cancer not get routine mammograms. What the task forces concluded after looking at the evidence (600,000 women who participated in 10 randomized trials of approximately 10 years follow up) was more frequent screening didn’t have an impact on the outcome and breast cancer death rates. There was also concern with the risk for false-positive tests and then unnecessary workups and over-treatment. These new recommendations were met with a lot of controversy within the medical community here in the USA. I agree with the new recommendations but would add consider a screening breast thermography annually, starting at age 40 or even earlier.
Although not addressed by the U.S. and Canadian task forces, there are a growing number of physicians who are concerned about exposing pre-menopausal female breasts to radiation on an annual basis. A Johns Hopkins study published in 2009 in the Journal of the National Cancer Institute warned radiation exposure from annual mammograms could trigger breast malignancies in women with a strong family history of breast and/or ovarian cancers who have altered genes (identified as BRCA1 or BRCA2). Contrary to conventional assurances that radiation exposure from mammography is trivial, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads or radiation for each breast.
Also, mammography is not as accurate in diagnosing malignancies in dense breast tissue as is found in many younger, pre-menopausal women. But 1/3 of all breast cancers occur in women below the age of 45. Because breast thermography does not expose a person to any radiation and it’s accuracy is not affected by dense breast tissue, it should be incorporated into an annual health screening program. Finally, thermography has the additional advantage of revealing thermal changes from a hormonal condition called “estrogen dominance.” Estrogen dominance is a risk factor for breast and ovarian cancer development, and is a physiological condition that does not show up on mammography. Estrogen dominance can be found in women who have conditions such as fibrocystic breasts, ovarian cysts, uterine fibroids or PMS. For additional information on thermography, please go to our website www.prevent-doc.com and choose the “Thermography” link.