A large percentage of the female population in the United States, (approximately 50%), simply does not get routine mammography. A very challenging question this country must face and answer regarding mammography as a “gold standard” for breast cancer screening is, “how many breast cancer deaths are avoided by mammography and at what expense?”
As time goes by, I’m struck more by what’s not being said in regards to this question than what is being said. It has been 50 years since a randomized trial of screening mammography has been done in the United States. Why is this? How can the medical profession in the United States so blatantly support the mammography “gold standard” test and chastise other breast cancer screening tests (based on their presumed lack of medical research support), if the efficacy of mammography has not been tested in our country by our own medical research standards (randomized trials) for 50 years? Given the exposure of the millions of American women to this intervention which involves close contact ionizing radiation, perhaps we should consider this medical contradiction. In countries, such as this European study, that do investigate and analyze the effect mammography has on female mortality, mammography screening often is found not to play a direct part in the reductions in breast cancer mortality.
Recent studies have led to a lot of confusion over mammograms. In 2009, the U.S. Preventive Services Task Force (USPSTF) caused a stir when it changed its recommendations on mammograms, which had long advised women to have one every year, starting at age 40. The USPSTF recommended against routine screening mammography in women aged 40-49 years, but instead in women age 40 to 49 years of age, clinicians should periodically perform individualized assessment of risk for breast cancer to help guide decisions about screening mammography before age 50.These guidelines were largely ignored and unlike the USPSTF, the American Cancer Society still suggests that women start yearly mammograms at age 40.
Yet, Dr. Otis Brawley, chief medical officer for the American Cancer Society, states “Mammography does appear to save lives, but it’s not as effective as people have thought,” and Brawley goes on to say, “there’s a second line to the recommendation that doesn’t get quoted in the media. “The “second line” says doctors should also tell women about the limitations and potential harms of screening, so they can make an informed decision. “I’ve long been worried that we’re overselling the benefits of mammography,” Brawley said. He stressed though, that “even though the benefit is less than promised, there’s still a benefit.”
To quote the conclusions of the 2013 Cochrane Database System Review, which updated that of the 2011 Screening for breast cancer with mammography.
If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening (by mammography).
What is meant by, the incidence of advanced cancers with screening? In other words…. not DCIS. Experts now know that many findings on mammogram (DCIS for example) never progress to the point where a lump would be felt or that cancer will evolve. Some will even go away on their own. But with screening, those cancers are detected and treated. The risk that concerns most is “overdiagnosis” — where women with tumors that would never have threatened their lives go through needless surgery, chemotherapy and radiation. “We have no way of knowing which patients will progress,” said Keating, associate professor of Health Care Policy at Harvard Medical School and associate professor of medicine at Brigham and Women’s Hospital in Boston. “So we have to treat everyone we diagnose.” It’s hard to estimate the number of women who are overdiagnosed with breast cancer, Keating said. Nancy Keating is the co-author of the most recent BIG NEWS review of 50 years’ worth of research done at Harvard Medical School and Brigham and Women’s Hospital.
The review published in the April 2, 2014 issue of the Journal of the American Medical Association strongly suggests that the benefits of mammography are overestimated. This controversial report, adds to the growing uncertainty building over the years regarding the value of mammography screening. Data from 50 years of research was analyzed and those conducting the research review state “The benefits of mammography screening are probably oversold AND any benefit comes with some risks of its own , especially “overdiagnosis” . The risk of overdiagnosis is greatly underappreciated” states co-author, Dr. Lydia Pace, who goes on to say,
“It is really important to have informed discussions with our patients to help them understand the chances that a mammogram will benefit them as well as the possible downsides of getting a mammogram, so that they can incorporate their own values and preferences in making the right decision for themselves.”
Isn’t this what the US Task Force stated 5 years ago?!
This is the largest review to date of mammography and finds that mammograms do save lives, but not as many as people believe. But based on the studies her team reviewed, a “best estimate” is that 19 percent of cancers diagnosed over 10 years of screening are actually overdiagnoses. “We think mammography has a benefit,” Keating said, “but it’s smaller than many people believe. And the risk of overdiagnosis, in particular, has not received a lot of attention.” These conclusions are disputed by many “breast cancer experts”, just as the 25 year Canadian study released earlier this year in February 2014 was discredited by such “breast cancer experts” when it caused an uproar stating that mammograms don’t save lives.
The word OVERDIAGNOSIS being thrown around here is often synonymous with the diagnosis of Ductal Carcinoma In situ (DCIS). The problem with DCIS and mammography, is there is no way to determine if DCIS found on mammography will ever evolve into a true malignant tumor and become cancer. It is currently accepted that it is impossible to know with mammography which abnormal mammograms can be safely observed and which need to be scrutinized by biopsy. In the Harvard study, the review cites findings that roughly 19 percent of women who are diagnosed based on findings from a mammogram are overdiagnosed. That means that roughly 36 of 190 women who received annual mammography for 10 years and were diagnosed with breast cancer would receive unnecessary surgery, chemotherapy or radiotherapy. In addition, more than half of women who get annual screenings for 10 years can expect to have a false positive mammogram that requires additional images, and about 20 percent of these false positives result in unnecessary biopsies.
ENOUGH IS ENOUGH!!! LET’S FACE IT!!! MAMMOGRAPHY HAS VAST LIMITATIONS and is a terrible “gold standard” for breast cancer screening!
Thermography is able to evaluate the breast tissue for cellular activity in these cases of OVERDIAGNOSIS and provide women with not only more information, but the option to avoid tissue biopsy when the thermography is reassuring. The most common use of thermography is for breast health screening. In short, thermography is a tool to monitor breast health, not just a way to find disease. Is this not the true definition of “screening”; to assess the body’s cell health; and insure no potential for upcoming morbidity and mortality?
The diagnostic sensitivity of X-ray mammography is significantly diminished for premenopausal women, pregnant or lactating women; women with fibrocystic/dense breasts, women with implants, women with unusually large or small breasts, women with prior biopsies, women with mammoplasty or reductions, menopausal women taking HRT, and women with fast-growing carcinomas. What are these women to do? THERMOGRAPHY!
Thermography is able to detect breast cancer early in women in the face of normal breast mammography and ultrasound. As a true breast cancer screening tool, just as thermography is able to assess the cellular activity in the breast tissue that mammography questions may have cancer, the cell activity associated with breast cancer is often detected by Thermography before both the mammogram and the breast ultrasound.
MM is a woman who had just this medical scenario.
MM presented to The Cometa Wellness Center for her first thermogram, ready to start the new chapter in her life after she had recently retired. She was concerned because she had a lump under her right arm and a friend had told her about the Thermography Center at The Cometa Wellness Center (CWC).
Below are the Infrared Images taken with the Meditherm camera, the day MM presented to the CWC for her Thermogram.
It is clearly apparent on these images that this woman has hyperthermia throughout the outer aspect of her right breast and in the right armpit. This heat on her thermogram is found clinically as some mild swelling under the R arm in the armpit, but without a palpable mass in the breast area on exam.
To evaluate this severely abnormal thermogram, an ultrasound as well as mammogram was ordered.
Neither the ultrasound or the mammogram were able to find any sign of cancer in the right or left breast. The lymph nodes were enlarged on the ultrasound on the right side. HOW can this be you ask? Cancer is a cellular process before it is a measurable tumor. That is what we see on MM’s thermogram… the cellular manifestation of cancer.
A breast MRI was still very unhelpful as can be seen below. Finally, the MRI guided pathology returns and confirms breast cancer.
The advantage of Thermology not carried by mammography is in the ability of a thermogram to detect physiologic changes in the tissue. An evolving cancer, found in its early cellular phase—sometimes years before it is detectable mammographically, is much more amenable to less invasive intervention and treatment than it will be later in its evolutionary development.Thermography, with its ability to assess risk and monitor breast health, leads to perhaps the most important point that’s never mentioned in this debate, which is that breast cancer risk is largely modifiable.
Thermography was approved as an adjunctive diagnostic breast cancer screening procedure by the FDA in 1982. In women who simply don’t wish to have a mammogram, breast thermography is a great option—one that certainly should be considered. It is also a strong consideration for the number of women listed above where the diagnostic sensitivity of mammography is diminished.
Ideally, I like to use thermography to monitor physiological changes in women’s breasts, allowing for preventative treatment. If significant abnormalities are seen on thermology, the patient and I will then move forward with an ultrasound, mammogram and biopsy as indicated.
The practice of medicine in this country is slowly coming around to the fact that there is no one-size-fits all approach or treatment program in the practice of medicine. As the medical paradigm has always been very slow to shift in this country, the USPSTF studies forced the medical community and patients alike to consider that there is quite likely an “oversell” so to speak going on with the routine use of mammography for screening breast cancer.
Let us know if you would like to learn more about Thermography or would like to schedule you, a friend or a family member for a thermogram at our Thermography Center of Charleston, located in the heart of Mt. Pleasant. Please see our Thermography Services page on this website for more information or contact us.
To your Health and Wellness,
Dr. Ariane Cometa, the holistic MD
Charleston Integrative Medicine 