Thermograms versus Mammograms: Which test is best?

Thermogram. Circles show inflammation in the skin of the woman's left breast (right side of image).

Thermograms detect infrared rays to show patterns of body temperature.

What most people I know who have gotten a thermogram don’t seem to have been told is that thermograms only detect surface bloodflow, so any cancer growth deeper than a few millimeters may not be detected unless it also happens to be large enough to disturb the surface blood flow patterns.

Mammograms use radiation to find calcifications hiding anywhere in the breast tissue, even deep ones.

What most people who’ve gotten mammograms don’t often hear is that mammograms are really difficult to interpret.

The true power of any diagnostic image lies not in the technology but in the human brains behind the technology. Over decades, mammographers have been getting smarter and smarter, learning from mistakes and successes.

Mammogram. Arrows show abnormal calcifications in the breast tissue.

Radiologists have learned to detect cancers earlier and earlier because there’s been a group who have systematically studied cancer cases, going back to look at earlier mammograms to see if there were any abnormalities in the area of the tumor that, in retrospect, have become obvious.

This information is dissemenated at medical meetings and in journals, textbooks and so on. So now, after four decades of experience using the technology, mammograms can detect very tiny (1 mm), early cancers.  Compared to this massive collective intelligence improving the interpretation of mammograms, thermography is in its infancy.

Thermography professionals have small and scattered associations. Mammography professionals have huge and highly organized associations and frequent meetings. The network of intellect behind mammography is huge. Thermography, not so. Not yet.

Diagram showing glands tracking deep into the breast tissue down the the muscle. Thermograms don't penetrate this deep.

Bottom line: If you want to find a cancer, you want to get a mammogram. Thermographic results are interesting when used in combination with standard mammography, but right now their diagnostic and prognostic value are too limited and I would recommend that women who want to use thermograms as a replacement for mammograms reconsider their position.

Now the real question is, if you find breast cancer early, does it prolong your life? You might be surprised by the answer. (See my other post, Breast Cancer: Is Early Detection a Good Thing)

Breast Cancer: Is Early Detection A Good Thing?

When it comes to breast cancer, not all “cancer” is really cancer, study says.

According to the ACS, something like one in seven women will be diagnosed with breast cancer in their lifetimes. That’s scary, not only for women but for the family and friends who love them. But a recent study from the well-respected Cochrane Commission says that there is reason for hope.

According this meta-analysis (a meta-analysis is a study of many studies), many growths often presumed to be deadly cancers based on mammogram and biopsy results may not be as life threatening as we once thought. They may still be cancerous–just not in the way we typically think of cancer, as something outside the immune system’s control and necessitating radical intervention. According to the study, “for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition [however], 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.”

The terrifying implication for women who have undergone surgery and other aggressive therapies is, of course, the possibility that they may among those who have been treated “unnecessarily.” This is so disturbing that it makes discussing the findings of the study confusing and difficult for doctors alike. One thing’s for sure, if you’ve had cancer surgery, there’s still a very significant chance that it did in fact save your life.

Here’s what makes me hopeful: this and other cancer research is leading the medical community closer and closer to the idea that the human body has miraculous, and as-yet little understood, powers to heal itself. A strong immune system bolstered by healthy traditional foods, exercise, and a conscious effort to reduce stress can, it seems, hunt down and destroy incipient cancer cells and even, conceivably, relatively more advanced growths.

None of this suggests that we should make any radical retreats away from diagnosing early cancers. But the knowledge that some cancer-like tumors may be receptive to holistic treatments may deserve inclusion in a frank and open discussion with your oncologist. In the meantime, I hope that this news encourages all of us—whether free of cancer or not—to treat our bodies in such a way that our natural defenses can add to the fight to keep us healthy.

Breast Cancer Information

 Breast Cancer Information

Remember, Early Detection Helps Save Lives

Be sure you and your loved ones follow the recommended guidelines from the American Cancer Society for early detection of breast cancer. If there is a history of breast cancer in your family consult your doctor on the need to begin these steps at an earlier age.

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
• Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
• Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Important U.S. Facts About Breast Cancer

• Approximately 178,480 women and 2,030 men will be diagnosed with breast cancer this year
• 40,460 women and 450 men in the U.S. will die from the disease annually.
• There are over 2 million breast cancer survivors in the U.S. who have been treated for breast cancer
• Every 3 minutes, there is a new diagnosis of invasive breast cancer
• There are more than 250,000 women under the age of 40 in the U.S living with breast cancer, and over 11,000 will be diagnosed this year
• A woman has a 1 in 8 chance of developing breast cancer in her lifetime
• Every 13 minutes, a life is lost to breast cancer
• White, non-Hispanic women are more likely to develop breast cancer but African-American women are more likely to die from it.
• Breast cancer is the most commonly diagnosed cancer among Hispanic women and is the leading cause of cancer deaths among this group.

Men Get Breast Cancer, Too

• Survival for men with breast cancer is similar to survival for women, when their stage of diagnosis is the same.
• Men at any age may develop breast cancer, but it is usually found in men between 60 and 70 years of age.
• Male breast cancer makes up less than 1% of all cases of breast cancer.
• Male breast cancer is sometimes caused by inherited gene mutations, and a family history of breast cancer can increase a man’s risk.

Help, Support and Guidance

These national organizations, funded by the Avon Foundation, offer lifesaving information and direct services. For more information and to find resources in your community, please find the most recent Breast Health Resource Guide.

• Avon Breast Cancer Crusade Bulletin Board has an online support group where breast cancer patients and survivors share information, support and hope.  http://avoncompany.com/women/avoncrusade/bbsindex.htm
• AVONCares Program at Cancer Care provides a wide range of support services nationwide, including patient navigation, financial assistance, and emotional support.  http://www.cancercare.org/   or 800-813-HOPE (4673).
• American Cancer Society has regional offices where reliable information, support groups and other resources can be found.  http://www.cancer.org/ or 800.ACS.2345 
• Cancer and Careers is for working women, who are balancing work demands with their cancer diagnosis and treatment.http://www.cancerandcareers.org/   or 212-685-5955. The Avon Foundation is a founding sponsor of this program.
• Look Good, Feel Better program offers free seminars to help overcome the appearance related effects of cancer and cancer treatment.  http://www.lookgoodfeelbetter.org/  or 800.395.LOOK
• National Cancer Institute  is a reliable resource for up-to-date information on all cancers. They also have an online mechanism called "Live Help," through which an individual can be connected "real time" with a cancer specialist.http://www.cancer.gov/  or 1.800.4.CANCER
• National Breast Cancer Coalition Fund/Project LEAD is a breast cancer advocacy organization that specializes in providing medical education to the public and training breast cancer advocates on legislative and medical developments.http://www.stopbreastcancer.org/  or 202-296-7447.
• Breast Cancer Network of Strength offers community education and support. http://www.networkofstrength.org/  or 1-800-221-2141 (English) or 1-800-986-9505 (Spanish)
• Young Survival Coalition addresses the unique issues and needs for women diagnosed under the age of 40 http://www.youngsurvival.org/ or 800.YSC.1011

Doctors Catch Cancer Earlier with Special MRI

Detecting Breast Cancer Early
Doctors Catch Cancer Earlier with Special MRI

January 1, 2006 — A new kind of MRI machine helps doctors diagnose breast cancer earlier. Patients lie on their stomach and their breasts are placed in two coils, which focus radio waves and allow for more complete images that give a three-dimensional look inside the breast.

WHITE PLAINS, N.Y.--Two-hundred thousand women will be diagnosed with breast cancer this year in the United States. Mammograms, however, may not be the best way to detect it. Now, there's a new test to help doctors pinpoint and treat breast cancer.

Suzette Lipscomb knows how to get the most out of every moment and she plans to share most of those moments with her little girl, Ava. "I always wanted a little girl, but I was a little afraid that I may pass on some type of tendency toward the disease," Suzette says.

The disease she feared? Breast cancer. Her grandmother beat it and so did she. It wasn't easy though, during her battle she was forced to make a difficult decision. Suzette says, "I was trying to make a decision as to whether or not to remove both my breasts."

Richard Reitherman, a breast radiologist at CAD Imaging Sciences in White Plains, N.Y., used the new cadsciences breast imaging system to help decide which treatment would work best. For the test, patients lie on their stomach with their breasts in two coils, which help focus radio waves for more complete images.

"She and her surgeon know exactly how big the tumor is, so it gives her the best treatment," Dr. Reitherman says. For Suzette it showed her second breast was clear.

A dye injected into the patient helps pinpoint cancer and if chemotherapy treatments are working. In the scan, the red areas are cancer -- cancer that was missed in a mammogram. In fact, 20 percent of women who don't have the cad-sciences MRI will need a second surgery, something Suzette was able to avoid.

"I feel like the luckiest woman alive that not only did I have my cancer caught early enough that I'm alive, but that I was able to have a child," Suzette says.

Not all women are candidates for this cadsciences MRI. It's used for women who have already been diagnosed and need to know a course of action. It's also used for women who are high risk and have a family history of the disease. The procedure takes about 30 minutes; results are available 15 minutes later.

BACKGROUND: Women have a new imaging tool set to help diagnose breast cancer. The 3TP method generates a unique color-coded map by measuring changes (color and intensity) in contrast agent concentration in normal and cancerous tissues over time. It provides information that is not readily available from traditional mammography or MRI. In addition, the 3TP system is ergonomically designed to be comfortable for the patient, regardless of breast size.

HOW MRI WORKS: Magnetic resonance imaging uses radiofrequency waves and a strong magnetic field instead of X-rays to provide clear and detailed pictures of internal organs and tissues. These radio waves are directed at protons in hydrogen atoms -- one of the most abundant atoms in the human body, because of the body's high water content. The waves "excite" the protons, and when they "relax," they emit strong radio signals. A computer can turn those signals into a high-contrast image showing differences in the water content and distribution in various bodily tissues. It is becoming increasingly popular as an alternative to traditional X-ray mammography for the early diagnosis of breast cancer because women aren't exposed to the same radiation they experience with X-rays

Lasers May Be Gentler Alternative to Breast Cancer Surgery

 Doctors in England and Arkansas are working on a technique that someday may be able to treat small breast cancers in the time it takes to go to the dentist ... without leaving so much as a scar.

"We think we may have a simple technique. It's looking promising for treating small cancers without the need for surgery, as an alternative to surgery, and any further treatment for those patients would be along conventional lines," says Stephen G. Bown, MD. Bown is director of the National Medical Laser Center in London, England.

Along with researchers at the University of Arkansas for Medical Sciences in Little Rock, the British researchers have been using a laser to burn away the cancer. It's called interstitial laser photocoagulation, or ILP. Brown presented some early results at the Department of Defense Breast Cancer Research Program Meeting here this weekend.

It's very "attractive because we don't require [putting the patient to sleep]," no hospital stay is needed, and it's safer, Bown says. The process, adds Bown, also doesn't leave a scar or change the shape or size of the breast.

Up to four needles threaded with thin optic fibers are placed through the skin, into the breast. The needles are placed where the tumor can best be attacked. A low power laser light then gently heats and kills the cancerous tissue. The body takes care of the dead cells through its normal healing process. The patients also undergo chemotherapy or radiation therapy afterward, as would happen after traditional breast cancer surgery.

Bown tells WebMD some women describe the process as feeling "like a mildsunburn under the skin."

Steven E. Harms, MD, with the University of Arkansas, tells WebMD the process can be done in about an hour.

Both doctors made it clear the process is not for everyone, only those with small tumors that have not spread to other parts of the body, such as the lymph nodes. But Harms tells WebMD that about 30% of women with breast cancer would fit the category, and with the ongoing success of screening methods, that number is likely to rise to 50%.

The success of the treatment all hinges on whether an imaging procedure calledmagnetic resonance imaging, or MRI, can accurately determine if the laser has destroyed all the cancer. To do this, the researchers have performed the procedure on about 100 women. Ultimately, Bown hopes to recruit up to 500 women to prove the procedure works.

Bown tells WebMD, "We're playing with fire here," so extreme precautions are being taken to be sure the cancer is gone. The women first undergo a MRI before the procedure, then again after the procedure. But because the researchers are not sure that the MRI is adequately showing the full extent of the cancer, surgery is performed to verify the entire cancerous area in the breast. That tissue is then examined under a microscope and compared to the findings of the MRI scan.

"The real aim is to say, 'has the laser treatment completely destroyed the cancer or have we left a bit behind,'" Bown says. "If we can be confident the laser has got everything, then we will get to the stage where we don't need conventional surgery as well. We're just about getting to that stage now."

In fact, the researchers report that results so far show MRI is "remarkably good" at detecting the extent of the cancer and detecting whether the laser destroyed all of it. Harms tells WebMD it's important to note that "surgery's not perfect either" when it comes to removing all the cancer, adding "we are very confident in our MRI technology."

Harms is confident enough in the MRI that he's performed the laser process on three women, without conventional surgery afterward. The women instead are undergoing extremely vigilant follow-up for five years. One patient is still doing well one year after surgery, Harms says.

There is a third part to the research that has yielded a beneficial "side effect," Bown says. It came about because the doctors had to be sure the areas treated by the laser did in fact heal safely and did not cause an infection or other problem in the breast.

To do this, women with harmless tumors were recruited. These lumps often occur in young women, and as Bown says, "in one-third of the women, the lumps will go on enlarging, one-third will stay static, and a third [of the women] will get the procedure." By procedure, Bown means lumpectomy to remove the tumor, an option many women avoid.

Because there would be no serious consequences if part of the lump were not adequately treated, the laser procedure was done on women with these noncancerous tumors. It worked. After an average of a few months, Bown tells WebMD the researchers found "[the tumors] curling up their tails and disappearing ... we've found a very effective treatment for these fibroadenomas."

Frances M. Visco, a breast cancer survivor and chair of the National Breast Cancer Coalition in Washington, says the research is very exciting and "moving us forward in the fight against breast cancer.

"The laser surgery approach, as a woman who had a lumpectomy, I find very promising and very exciting ... and I look forward to the ultimate results," Visco says. "But I want to stress, as a consumer, too, that everything we've heard today is preliminary, and our concern as consumers is that what is presented today will tomorrow somehow be turned into clinical practice."

The U.S. Department of Defense has supported the research.

Types of breast reconstruction

Several types of operations can be done to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. (A tissue flap is a section of your own skin, fat, and muscle which is moved from your tummy, back, or other area of your body to the chest area.)

Implant procedures

The most common implant is a saline-filled implant. It is a silicone shell filled with salt water (sterile saline). Silicone gel-filled implants are another option for breast reconstruction. They are not used as often as they were in the past because of concerns that silicone leakage might cause immune system diseases. But most of the recent studies show that silicone implants do not increase the risk of immune system problems. Also, alternative breast implants that have different shells and are filled with different materials are being studied, but you can only get them in clinical trials.

One-stage immediate breast reconstruction may be done at the same time as mastectomy. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant where the breast tissue was removed to form the breast contour.

Two-stage reconstruction or two-stage delayed reconstruction is done if your skin and chest wall tissues are tight and flat. An implanted tissue expander, which is like a balloon, is put under the skin and chest muscle. Through a tiny valve under the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over time (about 4 to 6 months). After the skin over the breast area has stretched enough, a second surgery is done to remove the expander and put in the permanent implant. Some expanders are left in place as the final implant.

The two-stage reconstruction is sometimes called delayed-immediate reconstruction because it allows options. If the surgical biopsies show that radiation is needed, the next steps may be delayed until after radiation treatment is complete. If radiation is not needed, the surgeon can start right away with the tissue expander and second surgery.

There are some important factors for you to keep in mind if you are thinking about having implants:

• Implants may not last a lifetime. You may need more surgery to replace them later.
• You can have problems with breast implants. They can break (rupture) or cause infection or pain. Scar tissue may form around the implant (capsular contracture), or you may not like the way the implant looks.

Tissue flap procedures

These procedures use tissue from your tummy, back, thighs, or buttocks to rebuild the breast. The 2 most common types of tissue flap surgeries are the TRAM flap (or transverse rectus abdominis muscle flap), which uses tissue from the tummy area, and the latissimus dorsi flap, which uses tissue from the upper back.

These operations leave 2 surgical sites and scars -- one where the tissue was taken and one on the reconstructed breast. The scars fade over time, but they will never go away completely. There can also be problems at the donor sites, such as abdominal hernias and muscle damage or weakness. There can also be differences in the size and shape of the breasts. Because healthy blood vessels are needed for the tissue's blood supply, flap procedures are not usually offered to women with diabetes, connective tissue or vascular disease, or to smokers.

In general, flap procedures behave more like the rest of your body tissue. For instance, they may enlarge or shrink as you gain or lose weight. There is also no worry about replacement or rupture.

TRAM (transverse rectus abdominis muscle) flap

The TRAM flap procedure uses tissue and muscle from the tummy (the lower abdominal wall). The tissue from this area alone is often enough to shape the breast, and an implant may not be needed. The skin, fat, blood vessels, and at least one abdominal muscle are moved from the belly (abdomen) to the chest. The TRAM flap can decrease the strength in your belly, and may not be possible in women who have had abdominal tissue removed in previous surgeries. The procedure also results in a tightening of the lower belly, or a "tummy tuck."

There are 2 types of TRAM flaps:

• A pedicle flap leaves the flap attached to its original blood supply and tunnels it under the skin to the breast area.
• In a free flap, the surgeon cuts the flap of skin, fat, blood vessels, and muscle for the implant free from its original location and then attaches it to blood vessels in the chest. This requires the use of a microscope (microsurgery) to connect the tiny vessels and takes longer than a pedicle flap. The free flap is not done as often as the pedicle flap, but some doctors think that it can result in a more natural shape.

TRAM flap incisions The tissue used to rebuild the breast shape

Latissimus dorsi flap

The latissimus dorsi flap moves muscle and skin from your upper back when extra tissue is needed. The flap is made up of skin, fat, muscle, and blood vessels. It is tunneled under the skin to the front of the chest. This creates a pocket for an implant, which can be used for added fullness to the reconstructed breast. Though it is not common, some women may have weakness in their back, shoulder, or arm after this surgery.

Latissimus dorsi flap

DIEP (deep inferior epigastric artery perforator) flap

A newer type of flap procedure, the DIEP flap, uses fat and skin from the same area as in the TRAM flap but does not use the muscle to form the breast mound. This results in less skin and fat in the lower belly (abdomen), or a "tummy tuck." This method uses a free flap, meaning that the tissue is completely cut free from the tummy and then moved to the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels. The procedure takes longer than the TRAM pedicle flap discussed above.

 

Donor tissue site for DIEP flap After DIEP flap

Gluteal free flap

The gluteal free flap or SGAP (superior gluteal artery perforator) flap is newer type of surgery that uses tissue from the buttocks, including the gluteal muscle, to create the breast shape. It is an option for women who cannot or do not wish to use the tummy sites due to thinness, incisions, failed tummy flap, or other reasons. The method is much like the free TRAM flap mentioned above. The skin, fat, blood vessels, and muscle are cut out of the buttocks and then moved to the chest area. A microscope (microsurgery) is needed to connect the tiny vessels.

New methods of tissue support

These surgeries move sections of tissue to new places, or add fairly heavy implants, and some tissues need support to keep them in place as they heal. Doctors use synthetic mesh and other methods for this. More recently, doctors are trying a new product made of donated human skin (AlloDerm®). It is regulated by the U.S. Food and Drug Administration (FDA) as a human tissue used for transplant. But it has had the human cells removed (is acellular), which reduces any risk that it carries diseases or the body will reject it. It is used to extend and support natural tissues and help them grow and heal. In breast reconstruction it may be used with expanders and implants. It has also been used in nipple reconstruction.

This product is fairly new in breast reconstruction, Studies that look at outcomes are still in progress, but have been promising. AlloDerm is not used by every plastic surgeon, but is becoming more widely available.