Breast Cancer Screening

June 4, 2006 Breast Cancer Screening Breast cancer is the most commonly diagnosed cancer among American women and the second leading cause of cancer death (lung cancer is the first). This year, the American Cancer Society estimates 212,920 new cases of invasive female breast cancer will be diagnosed in this country. About 40,970 women will die from the disease. Generally, the sooner a cancer is detected, the better the chance of successful treatment. According to guidelines published by the American Cancer Society, women should begin performing a monthly breast self-exam sometime in their 20s. Any unusual changes or lumps that are found should be reported to a health care provider. Women should also start getting a clinical breast exam (CBE, an exam performed by a health professional). A CBE is recommended every three years from 20 to 40 and annually after 40. The gold standard for breast cancer screening is mammography (X-rays of the breast). An annual screening mammogram is recommended for all women beginning at 40. Limits of Screening Mammography and breast exams are not perfect screening tools. Some women dislike the discomfort and embarrassment sometimes associated with mammography. Mammography may not give a clear result in women with very dense breasts. In addition, research suggests one in five women will receive a false positive clinical breast exam in their lifetimes (i.e., the screening indicates possible breast cancer, but a biopsy shows there is no cancer). Over ten years of screening, half of all women will receive at least one false positive result from a screening mammogram. False positive tests can lead to high levels of anxiety for the patient and unnecessary biopsies. There is also a risk that screening will miss a cancer (called a false negative result). Studies show 20 to 40 percent of women with breast cancer have a false negative mammography screening. Thermography for Breast Cancer Screening Some health care professionals are now offering a different kind of breast screening, called thermography (also known as digital infrared imaging). Thermography uses infrared technology to detect areas of heat in targeted areas of the body. When cancer develops, the tumor needs a blood supply to get nutrients and grow. The cancer cells send out signals that cause the development and growth of blood vessels that connect the tumor to a blood supply. That process creates heat, which can be detected on a special, digital, infrared camera. Images produced by thermography produce a colored map of the region that highlights areas of tissue by color (reflecting the amount of heat generated in a specific area). Breast thermography is a very comfortable procedure for patients. It doesnt require breast compression or injection of contrast dyes to get a clear image of the tissues. Thermography is also capable of detecting much smaller areas of abnormality than can be seen on a mammogram. The procedure may even detect small pre-cancerous changes in breast tissue, allowing doctors to intervene before a cancer develops. Thermography can also be used to monitor changes in the breast when a woman is receiving treatment. Thermography is not meant to replace mammograms as a screening tool. Its not 100 percent accurate. A positive result could be caused by infection, a benign tumor or fibrocystic disease. Instead, some experts are recommending thermography be used to establish a baseline image for younger women and then combined with standard mammography in older women. Research shows a combination of mammography and thermography increases screening sensitivity to 93 percent. When clinical breast examinations are added to the screening, sensitivity increases to 98 percent. Experts also remind women that no screening method can diagnose cancer - only a biopsy can do that. The American College of Clinical Thermology (ACCT) recommends all women have breast thermography done every three years between 20 and 30. Annual screenings are recommended in women 30 and older. Screening at a younger age gives doctors a baseline record to which they can compare future screenings for changes. It also enables physicians to detect earlier signs of breast cancer or pre-cancerous conditions. For a list of ACCT-approved facilities, log onto the organizations website at http://www.thermologyonline.org. Thermography is not yet covered by most health insurance policies. AUDIENCE INQUIRY For information on thermography: American College of Clinical Thermology, http://www.thermologyonline.org/ International Academy of Clinical Thermology, http://www.iact-org.org For information on breast cancer: American Cancer Society, http://www.cancer.org, or contact your local chapter National Cancer Institute, http://www.cancer.gov BIBLIOGRAPHY "ACCT Approved Thermography Clinics," Colorado Springs: American College of Clinical Thermology, downloaded from website (http://www.thermologyonline.org), April 12, 2006. "Breast Cancer," Atlanta: American Cancer Society, downloaded from website (http://www.cancer.org), April 12, 2006. "Breast Cancer: Screening," Bethesda: National Cancer Institute, downloaded from website (http://www.cancer.gov), April 12, 2006. "Breast Thermography Guidelines," Redwood: International Academy of Clinical Thermology, downloaded from website (http://www.iact-org.org), April 12, 2006. Dillon, Mary, et al., "The Accuracy of Ultrasound, Stereotactic, and Clinical Core Biopsies in the Diagnosis of Breast Cancer, with an Analysis of False-Negative Cases," Annals of Surgery, November 2005, Vol. 242, No. 5, pp. 701-707. Elmore, Joann, M.D., et al., "Screening for Breast Cancer," Journal of the American Medical Association, March 9, 2005, Vol. 293, No. 10, pp. 1245-1256. Fikackova, H., and E. Eckberg, "Can Infrared Thermography be a Diagnostic Tool for Arthralgia of the Temporomandibular Joint?" Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology and Endodontics, December 2004, Vol. 98, No. 6, pp. 643-650. Hu, L., et al., "Effect of Forced Convection on the Skin Thermal Expression of Breast Cancer," Journal of Biomechanical Engineering, April 2004, Vol. 126, No. 2, pp. 204-211. Ng., E., et al., "Statistical Analysis of Healthy and Malignant Breast Thermography," Journal of Medical Engineering and Technology, November-December 2001, Vol. 25, No. 6, pp. 253-263. Ng, Eddie, and N. Sudharsan, "Computer Simulation in Conjunction with Medical Thermography as an Adjunct Tool for Early Detection of Breast Cancer," BMC Cancer, 2004, Vol. 4, No. 17. "Screening Mammograms: Questions and Answers," Bethesda: National Cancer Institute, downloaded from website (http://www.cancer.gov), April 12, 2006. Sun, Pi-Chang, M.D., et al., "Assessing Foot Temperature Using Infrared Thermography," Foot and Ankle International, October 2005, Vol. 26, No. 10, pp. 847-853. "Thermography Guidelines," Redwood: International Academy of Clinical Thermology, downloaded from website (http://www.iact-org.org), April 12, 2006. Varju, G., et al., "Assessment of Hand Osteoarthritis," Rheumatology, July 2004, Vol. 43, No. 7, pp. 915-919. "What is Breast Thermography?" Colorado Springs: American College of Clinical Thermology, downloaded from website (http://www.thermologyonline.org), April 12, 2006. "What is Breast Thermography?" Redwood: International Academy of Clinical Thermology, downloaded from website (http://www.iact-org.org), April 12, 2006.