Mammography and Thermography
By Robin Bernhoft, MD
Recent changes in federal recommendations for breast cancer screening have created quite an uproar. Many women suspect the goal of the panel was to cut medical expenses, at the cost of delaying the diagnosis of many cases of breast cancer. I do not think those fears are valid. The Preventive Services panel recommended moving the date of first mammogram from age 40 to 50, and stopping mammograms after age 75. They also recommended women no longer be taught breast self-examination (BSE). Their reasons balanced lack of clear benefit in certain age groups with concern about potential harms. Their recommendations are not unreasonable, for several reasons. First, as regards BSE, a whole series of studies have shown that it does little or nothing to improve diagnosis of breast cancer, nor long term outcomes. As regards cutting off mammograms after age 75, here too a series of studies have failed to show that mammograms offer clear health or survival benefit to women over that age. (Breast cancer usually grows very slowly after age 75, and mammographic detection has no clear impact on outcome after that age, although some studies do suggest slight possible benefit.) As to moving the starting age from 40 to 50, there is an increasing concern in breast cancer treatment circles (medical and surgical oncologists, as opposed to diagnostic radiologists) that frequent mammograms increase the lifetime risk of developing breast cancer. The chief suspected reason is cumulative radiation exposure. A leading breast surgeon at Harvard estimates that frequent exposure to mammograms increases lifetime risk 25%. Additionally, many oncologists fear that the mechanical breast compression which mammography requires may facilitate the spread of breast cancer cells to distant locations. Data on these points are not clear-cut. However, there is considerable evidence that mammography leads to overdiagnosis and unnecessary breast biopsy surgery, especially in women ages 40-49. These fears being backed by a fair amount of data, the Panel I think quite reasonably moved the date of first mammogram ten years older, to balance the various risks they discussed against possible benefits. It is important, also, to recall that digital infrared thermography is now available which is 88 to 96% reliable in various studies around the world. This technique exposes the patient to no radiation. It merely uses an infrared camera to find “hot spots” caused by blood vessel changes associated with tumors. Since these changes occur quite early in the growth of breast tumors, thermography has the ability to pick up breast cancer at a much earlier, smaller, and probably more curable stage of development than mammography (which generally does poorly with small tumors). Thermography does not completely replace mammography, buts is available and FDA-approved for women wishing to use a non-radiation approach to early detection.