Breast Cancer Screening

By: Laurie S Evans MD, PC, FACS

Recently, I have become more aware of patient’s interest in alternative imaging, a.k.a. “thermography” for breast cancer screening. As a physician who has dedicated her career to helping women (and men) fight and win the battle for breast cancer, I would like to remind you that mammography, a low-dose X-ray image of the breast, is still the most effective breast cancer screening tool, second to the human hand, with breast self-exam (BSE) being equally important. Unfortunately, 9 out of 10 women in my clinic when asked, report they DO NOT do self-exams for one reason or another.

Some health centers are providing information that can mislead patients into believing that thermography, a type of test that shows patterns of heat and blood flow on or near the surface of the body, is a proven alternative to mammography. But the Federal Drug Administration, the American Cancer Society, the Centers for Medicare and Medicaid Services and the American College of Radiology all agree on one thing: there is no scientific evidence to support these claims.

Indeed, thermography has NOT been shown to be effective as a standalone test for either breast cancer screening or diagnosis in detecting early stage breast cancer. It is based on blood flow patterns and areas with increased flow are highlighted in a different color. Small lesions will not be seen and in point of fact, you want to find lesions BEFORE they require significant blood flow. In other words, early detection.

About 1 in 8 women will be diagnosed with breast cancer sometime in their lifetime. I am happy to report there has been a decline in breast cancer deaths in recent years, and one reason is because cancers have been detected earlier through high quality mammograms. This fact is supported by the American Cancer Society and the National Accreditation Program for Breast Centers. But please remember, even if your mammogram is “normal” and you are one of the few women who DO exams on themselves, if you feel a lump or mass in your breast, please go seek further evaluation. No test is perfect!

In fact, the greatest danger from thermography is that those who opt for this method instead of mammography may miss the chance to detect cancer at its earliest stage.

At this time thermography has only been cleared by the FDA as an “adjunctive” tool—meaning for use alongside a primary test like mammography. Patients who undergo thermography alone should not be reassured of the findings because the device was not cleared to be used other than with another testing method. The FDA has taken regulatory action (including issuing warning letters) against health care providers and thermography manufacturers who try to mislead patients into believing that thermograms can take the place of mammograms.

The FDA regulates the medical devices used for breast cancer screening. Modern mammography has a very stringent quality control regimen set forth by the FDA and the American College of Radiology in order to ensure that the best possible images are used for this important diagnostic test. In fact, mammography has more quality control than many other imaging techniques.

“Plenty of evidence shows that mammography is still the most effective screening method for detecting breast cancer in its early, most treatable stages. You should not rely solely on thermography for the screening or diagnosis of breast cancer.” Helen J. Barr, M.D., director of the Division of Mammography Quality Standards in the FDA’s Center for Devices and Radiological Health.

So, before you choose thermography over mammography, do two things. First, a breast self-exam and then ask yourself what is more important, my life or my breast? It breaks down to a very simple question. Thermography is vague at best and is not specific enough to provide quality information. If you want to keep your head in the clouds and pretend there is no problem then perhaps thermography is the test for you. But if you want answers and hope to achieve assurance that all is well, then you want a high quality, proven test such as 3D mammography. And I would add, that even if the mammogram is negative and you feel something abnormal, pursue ultrasound or other imaging with a breast specialist.

http://iopscience.iop.org/article/10.1088/0967-3334/33/3/R33/pdf – Institute of Physics and Engineering in Medicine, Feb 2012

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