posted September 19, 2000 09:58 AM         

Dear Dottie,

Thank you for bringing up the topic of thermography (also called thermal imaging). Thermography is FDA approved to help detect breast cancer and may be used as a supplement to mammography and other breast imaging tests (such as ultrasound). However, mammography is currently the only FDA approved screening exam to help detect breast cancer in women who do not show any signs or symptoms of the disease.

Though thermography is sometimes used to help detect breast cancer (in addition to mammography, etc.), the exam is not widely used. Thermography also has a false positive rate of approximately 25%. A false positive result indicates cancer when cancer is not present.

Imaginis.com provides information on computerized thermal imaging (CTI), an experimental new breast imaging exam that is being developed based on the principles of thermography. If CTI gains FDA approval, it may be used as an supplemental exam to mammography on some women. To learn more about CTI, please visit http://www.imaginis.com/breasthealth/thermal_imaging.html

We hope this information is helpful. We encourage others to share their experiences/opinions/thoughts about thermography and other breast imaging exams.

Sincerely,

Imaginis.com Breast Health Team http://www.imaginis.com/

Sign up for a free subscription to
the Imaginis.com Breast Health Newsletter at http://www.imaginis.com/breasthealth/newsletter/

posted September 20, 2000 10:43 PM         

Thank you for the information. I looked at your website with great interest.

Question: Has thermography been shown to detect occult ductal or, in particular, lobular cancer?

posted September 21, 2000 06:13 PM           

As far as your question is concerned, yes. Breast thermography can detect these forms of cancers. Breast thermography is the earliest known method of breast cancer detection. The procedure can detect cancer, and even more importantly pre-cancerous tissue, from 8-10 years before any other method. The reason for this is that breast thermography is a physiological imaging procedure unlike mammography, MRI, ultrasonography, etc. which are anatomical imaging tools (they look for the physical presence of a mass). When breast tissues are changing (mutating), or cancer cells are growing, they demand more nutrients to fuel their accelerated growth. In order to do this the cells cause new blood vessels to form (neoangiogenesis) and they also send out chemicals to dilate and keep existing blood vessels open. This translates into increased heat, which can be detected by the sensitive infrared cameras used in breast thermography. These changes can be detected even in the smallest of masses as deep as the chest wall.

It was interesting to read the post by the site manager. A few of the items mentioned need to be clarified. First of all it is true that the FDA cleared breast thermography for use as an adjunctive screening procedure in the 1980's. But it is interesting to note the sentence near the end of the paragraph that states, "If (some other thermography camera system manufacturer) gains FDA approval, it may be used as an supplemental exam to mammography on some women". As the site manager previously and rightfully mentioned, breast thermography has been cleared for this for well over a decade. This is a strange set of sentences. It was also mentioned that breast thermography has a false positive rate of 25% -- this isn't true. Over 800 peer-reviewed studies in the prestigious index medicus, incorporating over 250,000 women, have demonstrated the efficacy of this procedure. Breast thermography has a sensitivity of 90% (10% of cancers missed -- the vast majority of which are slow growing and non-invasive leaving a very good prognosis), in contrast mammography will miss 20% of all cancers (80% sensitivity). Breast thermography also has a specificity of 90% (10% false positives -- However, since breast thermography can detect pathologies so far in advance, follow up studies out to 20 years need to be performed). Mammography produces 25% false positives with this number increasing significantly over 10 years of screening according to the NEJM 1999.

Let me be perfectly clear that breast thermography is NOT a substitute for mammography. However, mammography is also not a substitute for thermography. The tests are completely different and detect completely different processes. They complement each other. According to leading experts in the field of early detection, no one procedure can detect 99-100% of all cancers; thus, no one procedure is totally adequate as a stand-alone screening tool. The studies and statistics bear this out. Since early detection holds the key to survival at this time, we need to do everything we can for women in order to provide the tools necessary to do this.

With this in mind, breast thermography can also provide a woman with a future risk assessment. In the absence of any other positive tests, an abnormal breast thermogram indicates a 22 times greater risk for future breast cancer. This gives a woman time to act. To change lifestyle habits to decrease her risk factors in an attempt to preempt the future possibilities. Regardless, this woman can be watched very carefully with serial breast thermograms (since the procedure is completely harmless, imaging can be performed as often as necessary). Each woman's thermogram is as individual as a fingerprint. What we watch for is any change in the print.

Many studies have made one thing very clear, when thermography is added to a woman's regular breast health check ups (as an addition to mammography and clinical physical examination) 95% of stage 0-1 cancers will be detected. This translates into a 95% cure rate. Breast thermography brings a great deal of good news to all women.

If you want more information, please visit our site at www.breastthermography.com

posted September 21, 2000 08:31 PM         

Taking into consideration women with family history and other risk factors, dense breasts, the uncommon but very real occurrence of "occult" cancer, particularly lobular: Wouldn't you agree that thermography Should be used for women who do not show any signs or symptoms?

I don't understand how they can let so many suffer and die, when apparently other viable means of detection exist.

posted September 22, 2000 02:55 AM           

Should this technology be used to help detect breast cancer in women who do not show any signs or symptoms of the disease? Absolutely! We detect many occult cancers and precancerous masses every year.

posted September 22, 2000 05:09 PM           

1. If breast thermography was used extensive as a screening tool in the 1980s as you say, why was it stopped? Is it because mammography is considered more accurate than thermography?
2. And out of curiosity, what is your medical background? Are you a medical doctor?

Thank you.

posted September 23, 2000 02:36 AM           

[QUOTE]Originally posted by joan:
[B]Thank you, Dr. Amalu, for giving this information on thermography. I have a few questions which are extenstions of Catlover's questions.

As far as the topic of accuracy is concerned, please refer to my previous post.

Why was it stopped? Please call me at (650) 361-8908 and I will gladly answer your question.

William C. Amalu, DC, CCT
Board Certified Clinical Thermographer
Vice President International Academy of Clinical Thermology

posted September 24, 2000 07:13 PM           

Many cancer tumors are too small to be imaged by mammography much less an technology that requires a large "heat signature" to determine any type of abnormality. I'd love to see some long-term studies in some of the conventinal journals proving the efficacy of this technology (JAMA etc.).

I've been burned too many times before with claims that a technology or new discovery WILL detect breast cancer.

posted September 25, 2000 03:07 AM           

As I mentioned in a previous post, over 800 studies, many long term and including large numbers of women participants (37K, 58K, 116K, totalling over 250,000), have all been published in "conventional journals". They are available at any good medical library for your review.

I hope that this has cleared up the why's and how's of breast thermography. Please visit our site if you wish an in-depth review of the procedure.

posted October 02, 2000 11:25 PM         

(Copied from "FAQ's" section on the website) -- pacificchiro.com/breast_thermography/digital_infrared_imaging.htm

(See also A Review of Breast Thermography from "For Physician's" on same website.)

Is Digital Infrared Imaging (breast thermography) safe?

The procedure uses no radiation or intravenous injection; therefore, DII poses absolutely no health risk to the patient.

Why haven’t I heard of Digital Infrared Imaging before?

Due to a poorly constructed and performed (with regards to DII (Breast Thermography)) research study back in the 1970’s, DII was placed in a "further study needed" and "no improvement over mammography" category. Along with this study, health care politics and insurance cost-containment issues caused interest in this technology to be put on hold. However, with the combination of a multitude of large-scale studies performed in the 80’s and 90’s, and recent advances in technology, DII has become one of the most important front-line methods in early breast cancer detection.

I mentioned Digital Infrared Imaging to my doctor and was told that the procedure is outdated and useless, is this true?

Unfortunately, many physicians either do not know about this technology or are knowledgeable about a single poorly performed (with regards to DII) research study; the BCDDP (Breast Cancer Detection Demonstration Projects). The BCDDP was a large study done in the 1970’s which collected data from many centers around the United States. Three methods of breast cancer detection were studied: physical examination, mammography, and infrared imaging (breast thermography).

With regards to infrared imaging, the BCDDP was seriously flawed in four critical areas.

1.) Completely untrained technicians were used to perform the scans.

2.) The study used radiologists who had no experience or knowledge in reading infrared images.

3.) No standardized reading protocol had yet been established for infrared imaging.

4.) Proper laboratory environmental controls were completely ignored. In fact, many of the research sites were mobile trailers with extreme variations in internal temperatures.

Of considerable concern was the reading of the images. It wasn’t until the early 1980’s that established and standardized reading protocols were introduced. Considering these facts, the BCDDP could not have properly evaluated infrared imaging. With the advent of known laboratory environmental controls, established reading protocols, and state-of-the-art infrared technology, a poorly performed 20-year-old study cannot be used to determine the appropriateness of DII.

Who is qualified to take and interpret Digital Infrared Images?

Only health care practitioners who are licensed to diagnose (i.e. MD, DC, DO, etc.) are qualified to interpret thermographic images. The doctor should also be board certified as a clinical thermographer (with extended training in infrared breast imaging interpretation) from a reputable authority (the only currently active and recognized agencies are as follows: International Thermographic Society, American Academy of Medical Infrared Imaging, International Academy of Clinical Thermology, American Academy of Thermology). Any individual wishing to perform DII in their office – with the images sent for outside interpretation – must be certified as an infrared imaging technician by one of the above organizations.

What other centers perform Digital Infrared Imaging?

Because of the special training, technical expertise, and unique clinical environmental needs necessary to perform DII, many centers do not have this technology as of yet. Currently, independent digital infrared imaging centers and highly specialized independent breast clinics are the most common place to find this technology.

Does Digital Infrared Imaging replace mammograms?

Absolutely not! However, do mammograms replace DII? The answer to this is also a resounding no; the two tests complement each other. The consensus among health care experts is that no one procedure or method of imaging is solely adequate for breast cancer screening. The false negative and positive rates for mammography are too high for the procedure to be used alone. DII can pick up many of the cancers missed by mammography. A positive infrared image is also the single most important marker of high risk for developing breast cancer. It is DII’s unique ability to monitor the abnormal temperature (physiological) changes produced by diseased breast tissue that allows for extremely early detection. Since it has been determined that 1 in 8 women will get breast cancer, we must use every means possible to detect these tumors when there is the greatest chance for survival.

Is Digital Infrared Imaging costly?

No, DII of the breast is very reasonable considering the sophistication of the technology involved. However, costs do vary depending upon the location of the imaging lab and if special studies need to be performed. Our center’s fee for a DII scan is $125.00.

posted October 03, 2000 09:23 AM         

Title
A reappraisal of the use of infrared thermal image analysis in medicine. [Review] [27 refs]

Source: IEEE Transactions on Medical Imaging. 17(6):1019-27, 1998 Dec.

posted June 28, 2001 05:06 PM         

[On Friday July 13, 2001 from 10 to 6:45, a certified clinical thermographer, Carol Chandler will be doing thermography scans in
Saugerties New York ...] So as not to be accused of "spamming" I have omitted the rest of this paragraph.

Thermographic breast screening is brilliantly simple. Thermography measures
the radiation of infrared heat from our body and translates this information into anatomical images. Our normal blood circulation is under the control of our autonomic nervous system, which governs our body functions without our conscious will.

To screen for breast cancer, a thermographer blows cool air over a woman¹s breasts. In response, our autonomic nervous system reduces the amount of blood going to the breast, as a temperature-regulating measure. However, the pool of blood and primitive blood vessels that cancer cells create is
not under autonomic control and is unaffected by the cool air. It will therefore stand out clearly on the thermographic image as a "hot spot."

Thermography is a painless, non invasive, state of the art clinical test without any exposure to radiation and is used as part of an early detection program which gives women of all ages the opportunity to increase their
chances of detecting breast disease at an early stage. It is particularly useful for women under 40 where mammography is less effective.

Thermography: An Alternative to Mammography
by Lauren John

Imagine a diagnostic machine that could check for breast cancer without squashing your breasts. (In fact, the machine wouldn't touch your breasts at all.) Imagine that the procedure could be done without exposing you to radiation. And imagine that the machine could determine precancerous changes at an earlier, and theoretically more treatable, stage?months or even years before those changes would be felt as a lump or be visible on a mammogram. You may not have to use your imagination after all. Some
clinicians, many of whom are chiropractors trained in a new method of breast imaging, claim that infrared technology can be used to examine breasts in exactly this way. What is the theory behind this technique? The
Pacific Chiropractic and Research Center in Redwood City, California www.pacificchiro.com)?a center that offers so-called thermal breast imaging, or thermography, as a cancer screening tool?presents the following explanation on its Web site:

Thermography, also referred to as digital infrared imaging (DII), is based
on the principle that chemical and blood vessel activity in both precancerous tissue and the area surrounding a developing breast cancer is almost always higher than in normal breast tissue. In an ever-increasing
need for nutrients, cancerous tumors increase circulation to their cells by
opening existing blood vessels and creating new ones. This process frequently results in an increase in regional surface temperatures of the breast.

DII uses ultra-sensitive infrared cameras and sophisticated computers to detect, analyze, and produce high-resolution diagnostic images of these temperature variations. Because of DII's extreme sensitivity, these temperature variations may be among the earliest signs of breast cancer and/or a precancerous state of the breast. While mammography relies primarily on finding the physical tumor, DII is based on detecting the new blood vessels and chemical changes associated with a tumor's genesis and growth.

It is a theory that is at least worth considering, according to a number of
respected medical journals. "[Breast cancer lesions] with a rapid growth rate and less favorable prognosis can be detected earlier if thermographic studies are used in conjunction with classical physical and X-ray
examinations," claim the authors of a 1980 report that appeared in the journal Cancer.1 More recently, in the summer of 1998, a Canadian study published in the Breast Journal looked at the relative ability of a
physical breast exam, a mammogram, and infrared imaging to detect cancer in
100 women diagnosed with ductal carcinoma in situ or Stage I or Stage II breast cancer. The study, which had been presented earlier at the 1997 annual meeting of the American Society of Clinical Oncology (ASCO),
indicated that 83 percent of these women had "abnormal" or "suspicious" infrared images. Mammograms picked up 85 percent of the abnormalities, and when both imaging systems were used, the detection rate was 95 percent.

Sixty-one women presented with a suspicious lump.2

"Our initial experience would suggest that, when done concomitantly with clinical exam and mammography, high-resolution digital infrared imaging can provide additional, safe, practical, and objective information," the abstract from that report read. "Further evaluation, preferably in controlled prospective multicenter trials, would provide valuable data."3 According to the Food and Drug Administration, no such trials are in progress ? though thermography equipment manufacturers may run trials
independently of the agency and not report on them publicly until they decide to seek FDA approval.

Clinical Implications

Is thermography, as it is used today, an effective alternative to the mammogram? "It looks to me like there is not a reasonable alternative to mammography," says Ellen Mahoney, a breast surgeon and cofounder of the Community Breast Health Project in Palo Alto, California. "If something non-squishing proves to be as good, it will probably be magnetic resonance imaging (MRI)?but even that is not there yet for screening." She points to a 1999 study prepared by the Women's Imaging Center, a private practice in Delaware, which acknowledges the limitations of mammography in (a) differentiating benign from malignant disease and (b) diagnosing cancer in
patients with dense, glandular breasts. But the study also concludes that thermography is not a reliable alternative and in fact has "a more limited utility [than mammography] for breast cancer diagnosis," because heat fluctuations can be the result of a number of physical changes that don't
necessarily indicate cancer.4

If thermography is to be used as a diagnostic tool for breast cancer, it
should be used in addition to mammography, not as a replacement, says William Amalu, a chiropractor and board certified clinical thermographer at the Pacific Chiropractic and Research Center.

"This is not a competing technology," says Amalu. "It was never designed to replace anything." He describes thermography as an early warning and detection system, one that indicates that a woman may already have breast cancer or be at increased risk of developing the disease. Amalu says that
on average, his office provides breast thermography to five women per week, or an estimated 300 women per year. Between March 1999 and March 2000, about 75 of these 300 women were found to have abnormalities in breast temperatures?abnormalities that warranted follow-up. The follow-up might
include mammography, a consultation with a gynecologist, or return visits for more thermography to determine if the "hot spots" are increasing or decreasing.

How many women in Amalu's practice have ultimately turned out to have breast cancer? Each year for the past few years, four to ten woman have been diagnosed with cancer based on the results of their thermography exam.

What happens to presumably healthy women who learn that they have an abnormal infrared image but show normal results on other diagnostic tests, such as mammograms and manual breast exams? We all know how terrifying a false-positive mammogram can be. How should a patient respond to an
abnormal infrared image?

Biopsies and surgery are not Amalu's first recommendation, although ultimately, where cancer is strongly suspected, a biopsy still must be performed for a definitive diagnosis. But since infrared imaging is not an anatomical imaging procedure, it cannot determine the exact location of a tumor. Given the technology's high false-positive rate and its inability to pinpoint the "hot spot," performing a surgical biopsy based solely on the results of an infrared image hardly seems advisable.

Instead, says Amalu, an abnormal infrared image gives women a chance to make lifestyle changes. In fact, according to information posted on the Pacific Chiropractic and Research Center Web site, an abnormal infrared image is a "risk marker" that gives a woman time to decrease as many known
risk factors as possible, introduce proactive anti-carcinogenic lifestyle
modifications, and maintain close monitoring of "breast health" and lifestyle modification progress with serial infrared images.

Decrease as many known risk factors as possible? Since we don't know precisely what causes breast cancer, this could be problematic. And as for "introducing proactive anti-carcinogenic lifestyle modifications": Say what? I have no idea what that string of words means exactly or what kinds of behavior it is supposed to inspire, but here are some guesses. A
high-fiber, low-fat diet sounds reasonable, but no one knows for certain if it reduces the risk of breast cancer. Sure, we can quit smoking and binge-drinking, if that's wheats meant by proactive anti-carcinogenic
modification? but do we need a thermographic exam to tell us this?

Then there's suggestion number three, about close monitoring with more images. It sounds to me like this also promotes more thermography appointments. A day after our conversation, I call Amalu and express these
concerns. He does not hang up on me; instead, he tells me about a 38-year-old woman with a family history of breast cancer who came to him for monitoring. Nothing showed up on a mammogram, but repeated thermography readings showed an increasing area of tumor activity. Ultimately the woman
went to her gynecologist, who did a thorough manual exam in the area indicated on the infrared film. A lump was discovered and biopsied, and ultimately turned out to be cancer.

This is anecdotal evidence. There is no journal article analyzing this case. Still, to Amalu's credit, he is willing to consult and work with other doctors in other fields. He is the first to admit that thermography
is just one part of a complete diagnostic process.

But there are other practitioners who advocate thermography as a substitute
for mammography. One of them appears to be Philip Hoekstra, the director of Therma-Scan, Inc. (www.thermascan.com), a blood-imaging and specialty diagnostic company based in Huntington Woods, Michigan. I say "appears to be" because, while I was unable to speak with Hoekstra personally, he was included in an article on thermography by Tom Klaber that was published in the September 1999 issue of Alternative Medicine.5

"Philip Hoekstra, Ph.D., a pioneer in the use of thermography, has scanned over 50,000 women since 1971," Klaber wrote. "In almost all conditions now, he claims, thermography is superior in detecting breast cancer earlier than mammography, especially in premenopausal women. He and many other
authorities are convinced that mammography should not be used as an initial screening device?it should be employed only as a last resort.

"Of course, radiologists have major investments in mammographic equipment,
they are familiar with [its] use, and [they] consider surgery an imperative in virtually all cases," Klaber continues. "One needn't be a radiologist to operate thermographic equipment, and therefore thermography is viewed as competition rather than as an invaluable technology to be embraced. Only
when women themselves start demanding this form of nontoxic screening technique from their physicians is there likely to be a change."5

It's important to note that thermography training varies considerably: Some
thermographers are trained by the folks who manufacture thermography machines, while others go through a more rigorous certification process sponsored by groups such as the American Academy of Medical Infrared Imaging or the American Board of Clinical Thermography.

Many breast cancer activists and women's health advocates, including Breast Cancer Action, have been demanding better, non-radiation-based screening techniques for a long time, and both traditional and alternative medical practitioners generally agree that we need to find alternatives to
mammography. Mammograms miss at least 10 percent of cancers (including my own 1.4-centimeter malignant tumor, which was discovered on self-exam).

Conversely, 60 to 80 percent of the lesions recommended for biopsy are benign. "In a better world, breast images would unfailingly distinguish malignant tissue from benign, so there would be no need to remove tissue to reach a verdict," a recent issue of the Harvard Women's Health Watch noted.

"Cancers would be detected earlier, and only the malignant tissue would be removed."6

The concept of thermography, then, may be appealing to those who are opposed to mammography for any number of reasons: fear of the procedure itself, lack of confidence in the results, or a desire to avoid radiation exposure, to name a few. But for now there are not enough data to determine
whether thermography is an effective adjunct.

Last summer Daniel Berilin, former chief physiologist in the gastroenterology department at the University of California at Los Angeles, described the principles of thermography to the U.S. House of
Representatives' Committee on Government Reform. He asked that the National
Institutes of Health's Center for Alternative Medicine fund research on the
technology, which has yet to happen. Here is part of his testimony:

[Thermography] may be able to detect changes in the body that may preface the development of cancer. With regard to breast cancer, research indicates that most tumors have taken at least five years from their inception to develop into a viewable size. What has occurred to the body's immune
mechanisms during those years [to create] the pretumor and tumor? What do we know about the "fertility" of our inner soil, if you will, [that] nourishes or depletes the development of a tumor?7

Regardless of what is learned about thermography, this research approach is
more along the lines of what we would like to see.

1 Gautherie, Michel, and Gros, Charles M., "Breast Thermography and Cancer Risk Prediction," Cancer, vol. 45, 1980, pp. 51-56.

2 Keyserlingk, J.R., "Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Successive Cases of Stage I and Stage II Breast Cancer," Breast Journal, July/August 1998, vol. 4, no.
4.

3 Ibid.

4 Edell, S.L., "Current Imaging Modalities for the Diagnosis of Breast Cancer," Delaware Medical Journal, September 1999, vol. 7, no. 9, pp. 377-82.

5 Klaber, Tom, "Thermal Image Processing: Breast Cancer Detection Years Earlier," Alternative Medicine, September 1999.

6 "New Ways to Look at the Breast," Harvard Women's Health Watch, June 1998.

7 Berilin, Daniel, O.M.D., "Detection and Treatment of Women's Cancers," congressional testimony before the U.S. House of Representatives, Committee on Government Reform, June 10, 1999.
=============================================Breast Cancer News is brought to you by the The MID HUDSON OPTIONS PROJECT, INC a grassroots Breast Cancer Health Advocacy, Support and Activist Group. The information is intended for educational purposes only, in order to help you make informed health choices and may not have been touched upon by your doctors. We are not doctors and we do not recommend any particular treatments. We are sending this information to advise you of the complete scientific overview that is currently available, although we may not
necessarily endorse it.

posted July 23, 2001 04:51 PM           

It's good to see that you are still bringing this information out to those who need it so very much.

I see that you included my interview. Let me say that this was not the full interview and leave it at that.

Please take a look at our site at www.breastthermography.com we have totally updated the physicians section with references. You may also want to see what is going on at www.breasthealthonline.com I am their board mediator on this topic.

It is so disheartening to see so much misinformation on infrared breast imaging. The cost in lives and disfigurement is shameful. In this own forum Imaginis gives out blatantly wrong information. But like many others, they are probably depending on consulting physicians who are not qualified to comment on this technology.

Please take a look at our site or the International Academy of Clinical Thermology's at www.iact-org.org for factual information.

God Bless you all,