Download The Breast Test Doctors Fight About

Taken from Bottom line publishers November 6, 2011, by Tamara Eberlein
The Breast Test Doctors Fight About
Utter the word thermography in a roomful of breast specialists
and you’re likely to set sparks flying. Some doctors say that this
imaging technique can detect breast cancer sooner and more safely
than mammography—but others dismiss the test as unproven and
even potentially dangerous because it sometimes is misused.
The FDA, for its part, approved thermography nearly three
decades ago as an adjunctive tool to screen for breast cancer. But
in June, it warned women against using thermography as a
substitute for mammography, saying it was “unaware of any valid
scientific evidence showing that thermography, when used alone, is
effective in screening for breast cancer.”
I contacted integrative cancer therapy expert Nooshin K. Darvish,
ND, a former Bastyr University faculty member and medical director
of Holistique Medical Center in Bellevue, Washington, to discuss this
controversial issue. She explained that thermography uses an
infrared camera to detect variations in body heat. It is based on the
idea that diseased tissues—including infected, inflamed,
precancerous and cancerous areas—produce increases in metabolic
activity, blood vessel formation and blood flow that, in turn,
increase temperature. Thus, these areas appear as “hot spots” on
infrared images. Proponents say that the technique’s benefits
include...
Early detection. Thermography can spot areas of abnormal heat
before they show up on conventional tests. “Whereas
mammography, ultrasound, CT and MRI are used to identify cancer
after the tumor has formed, thermography can identify the first
thermal and chemical changes that may lead to cancer prior to the
existence of a tumor,” said Dr. Darvish. This may provide
opportunities for early intervention to reverse the abnormality.
Effectiveness. In a small study published in 2008 in The
American Journal of Surgery, thermography accurately identified 58
out of 60 breast malignancies (as confirmed by biopsy) among 92
patients—an accuracy rate of 97%. Comparison: According to the
National Cancer Institute, screening mammograms miss up to 20%
of breast cancers that are present at the time of screening.
Inaccurate results occur more often among younger women and
those with dense breasts.
Safety. Unlike mammography, which uses X-rays, an infrared
thermography camera emits no harmful radiation.
Comfort. Thermography is noninvasive and does not require
painful breast compression. However, you do have to spend time in
a cold room.
THE CONTROVERSY
All this sounds encouraging. So why would this test bring doctors
nearly to blows? Several reasons...

Since the technology was first FDA-approved in 1982, there
have been advances in infrared camera quality, computer
technology and standards for training thermographers, Dr.
Darvish said. However, while some small studies (such as the
one cited above) reflect these improvements, there is an
admitted shortage of recent large-scale studies on
thermography.

Many European doctors are clinically trained to use, and do
use, thermography as an adjunct to mammograms, Dr.
Darvish said. But, in the US, medical doctors generally are not
trained in or experienced with thermography and often dismiss
its value.

Some conventional doctors complain that thermography has
too high a rate of false-positive results. Thermography
proponents argue that many supposed false positives actually
indicate precancerous conditions that won’t show up on
mammograms for years and should be “watched.” What’s
more, mammography also is prone to false positives—a new
study in Annals of Internal Medicine concluded that 61% of
women who get annual mammograms starting at age 40 are
recalled for additional testing due to false-positive results by
the time they reach age 50.


Some thermography clinics promote the test as a substitute
for mammography. This potentially dangerous
misrepresentation leaves some doctors leery of thermography
as a whole... and has prompted the FDA to issue warnings to
clinics that violate its regulation classifying thermography as
an adjunct rather than an alternative to mammography. Most
thermographers, however, agree with the FDA that the
technique is best used in addition to conventional tests.
Reasons: While
thermography can identify general areas of abnormality, it
cannot pinpoint an exact area of suspicion the way
mammography and ultrasound can... “cold” tumors (ones with
low metabolic activity) are difficult to identify on thermal
images... and no screening test can actually diagnose breast
cancer—for that, a biopsy is needed.
WHO CAN BENEFIT
According to Dr. Darvish, all women can benefit from
thermography. The test is thought to be particularly useful for those
who...
Are premenopausal. Younger women generally have denser
breasts, so mammograms are less accurate in detecting
premenopausal breast cancers—yet these cancers are potentially
the deadliest because they tend to grow fastest, Dr. Darvish said.
She recommended that women get breast thermograms every two
years from age 19 to 30 and yearly thereafter.
Have a family history of breast cancer and/or carry the
BRCA gene. Thermography provides an extra layer of precaution
for such high-risk women. Dr. Darvish has several patients who’ve
had negative mammograms but whose thermograms found
abnormalities that turned out to be cancer.
Have breast traits that make mammography less accurate.
Mammograms are likelier to miss masses in breasts that are large,
dense, fibrocystic or have implants.
Use hormone replacement therapy or birth control pills.
These medications may increase breast cancer risk. Thermography
helps monitor the safety of hormone use, Dr. Darvish said.
Are undergoing breast cancer treatment. A patient’s
response to therapy can be safely assessed with thermography.
A breast thermogram costs about $280, which most insurance
policies do
not cover. For the most accurate test results: Use a physiciansupervised facility whose images are read by a doctor certified by
the International Academy of Clinical Thermology (www.iactorg.org) or the American Academy of Thermology
(www.AmericanAcademyOfThermology.org).
Testing procedure: You remove your shirt and bra and sit in a
cool room for about 15 minutes while your body adjusts to the
ambient temperature. Then you hold your arms in varying positions
while pictures of your breasts are taken from different angles, which
takes five to 10 minutes. Images are sent to the interpreting doctor.
If suspicious areas are identified, a follow-up appointment is made
to discuss the best course of action.
Bottom line: If you decide in favor of breast thermography,
remember that it is best used as a complementary screening tool
along with mammography. According to Dr. Darvish, sensitivity for
early detection of breast cancer increases to approximately 95%
when thermography and mammography are used together.
Source: Nooshin K. Darvish, ND, is medical director and founder of
Holistique Medical Center in Bellevue, Washington. She is a former faculty
member of Bastyr University, has completed a fellowship in integrative cancer
therapies and is the doctor-on-call for the internationally broadcast radio
program The Dr. Pat Show. Dr. Darvish also is vice president of the World
Federation of Chinese Medicine Societies—Specialty Committee of Natural
Therapy and is in the process of publishing new research on clinical studies
involving thermography.