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 From the Desk of Dr. Campbell:

Many women have fear and loathing about X-Ray Mammograms. They are painful to many, impersonal for most, and a radiation risk to all. Now there is a good alternative to X-Ray Mammograms - Infrared (IR)Thermography. But how does this screening method hold up to X-Ray or even the new Breast MRI test? New research is giving us some good data on this question.

In detecting breast cancer early when it has the best chance of cure, the SENSITIVITY of a test is most important. On imaging 7319 women with very early cancer, a study from Germany showed X-Ray Mammography to be only 56% sensitive (Kuhl CK et al. Lancet 2007 Aug 11; 370:485). A separate study showed only a 36% sensitivity for X-Ray mammography (Warner E et al., JAMA. 2004 Sep 15;292(11):1317-25). Compare this to a recent study from the USA which showed Breast Thermography to be 97% sensitive (Arora N et al., Am J Surg. 2008 Oct;196(4):523-6).

Breast MRI showed a sensitivity of 92-98% in the study by Kuhl and 77% in the study by Warner, which is much better than X-Ray Mammography and about equal to IR Thermography. But MRI is very expensive, is difficult for those with claustrophobia, and often requires the intravenous injection of contrast agents. Nevertheless, Breast MRI is being strongly advised by radiologists for those women with a high genetic risk for breast cancer.

So why are these radiologists not advising breast screening by IR Thermography? The main reason is that they have invested billions of dollars in the past 40 years in mammography and MRI equipment and training, and they want their investment to pay off. They are therefore afraid of competition from a new imaging test that has been developed by another specialty - Biomedical Engineering. This is an unfounded fear, however, as anyone with an abnormal IR Thermogram should be referred for confirmatory X-Ray Mammogram, Ultrasound, and maybe Breast MRI. The radiologists have even gone so far as to lobby the AMA to delete Thermography from the list of Clinical Procedures (CPT) in 2008, thus depriving women of insurance coverage for what could be a lifesaving thermogram.

We at Integrative life Solutions are pleased and proud to buck the system and provide the women of the Triad with Breast Thermography done with proper technique including good preparation and thermal cool-down for the best diagnostic images possible. As there is no radiation involved, young women can get Breast Thermography without fear. A "baseline" image around age 22 is recommended, with follow-up scans at yearly intervals or sooner for those with strong family history of breast cancer. We'll talk more about thermography in future letters.


Here's hoping for health and wellness for all,

Doctor Jim

James S. Campbell, MD.

P.S: Breast Thermography works in MEN, too. If you guys discover a
lump in your breast, have it checked out. - JC, MD


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 From the Desk of Dr. Campbell:

Thermal Diagnosis - it's been around for centuries...

For several evenings recently, my wife and I watched the very fine historical documentary on President John Adams produced by HBO. One of the seven episodes included his daughter's fight with breast cancer. Mr. Adams had the famous Dr. Benjamin Rush examine her, and she told the doctor that she had a hot lump in her breast. In those days of no central heat, she had noted by herself that one breast was warmer than the other. Dr. Rush understood the gravity of the situation and performed a total breast removal with no anesthesia, alas to no avail. The president's daughter died later when the cancer returned.

So how does this apply to health and diagnosis in this modern world? In my experience with thermography, I sometimes include a standard manual breast examination after the thermography images are taken. (Doing a manual exam before the thermography might distort the image findings). These exams have shown me that the 2 to 4 degree Fahrenheit rise in breast temperature caused by an underlying cancer can easily be detected by a manual exam done properly. Like President Adam's daughter experienced, the affected breast feels warmer than the other breast.

If you have been following the medical news recently, you might have heard that breast self-exams are said to be worthless for cancer detection. That may be true if detection of lumps is the only sign to watch out for, but my experience tells me that if a woman (or man) detects a warm, non-painful area of the breast under the proper conditions, cancer should be suspected and further testing done. Any painful area is more likely to be infection than cancer, but infection can also become a large problem, so have any warm area checked out further by a professional practitioner.

To do this "thermal breast self-exam" (T-BSE), you must disrobe from the waist up for 15 minutes at a room temperature of 68 to 70 Fahrenheit. Humidity should be 60% or less. You may be standing, sitting, or lying down. Do not touch your breasts during these 15-minutes of time. After this "cool-down" period, gently check the surface temperature of each breast using the palm of ONE hand. Go from one breast to the other quickly, pressing gently to detect the temperature difference. Healthy breasts should have almost the same temperature from side to side. Use just one hand for this exam - attempting to detect a temperature difference by placing one hand on one breast and the other hand on the other breast will not work. Certainly if there is a painless lump associated with any area of warmth, your suspicion of cancer should be doubled.

Should you detect a lump or temperature difference in your breast, further diagnostic "workup" is recommended. We here at the Thermography Service can perform thermal imaging under controlled temperature conditions to confirm and quantify any thermal abnormalities, and advise you on to how to proceed. Or see your local physician or practitioner right away, but don't be surprised if they do not know about heat being associated with breast cancer. The diagnostic clues known back in the days of Dr. Rush have somehow been forgotten - until now.
In health,
James Stewart Campbell, M.D.

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Beware of Poor Breast Thermograms

James S. Campbell, MD

ILSI Thermography Service

21 NOV 2012

 
   
 Clinical thermography for breast cancer detection is just now being introduced into mainstream medicine, but unfortunately not every thermographer is using the best technology and technique.   Even FDA-registered thermal systems may give very poor images.

Here at the Thermography Service of Integrative Life Solutions, I often see thermograms done in other clinics that are of extremely poor quality.  Some of the thermography systems that have been marketed around the USA are simply inadequate to detect breast cancer reliably.  They either have poor image resolution (not enough pixels of the breast in the image) or poor thermal resolution (not enough color differentiation to detect small thermal differences) – see figure 1. Some images have been so poor as to be non-diagnostic.  You can tell a human is standing there, but not much more. This is simply not acceptable in the important field of breast cancer detection. Obviously you want the best, highest resolution image to detect problems at the earliest time.  

I have also seen some thermographic images that have no color-coded temperature scale included alongside each picture (compare fig. 1 to fig. 2).  Without such a scale, you cannot see what temperatures the colors (or gray image) represent, and it is impossible to tell whether a breast image is normal or abnormal without knowing the actual temperatures seen in the image.

 
   
 

 

Figure 1 - Poor thermal resolution (images not taken by ILSI Thermography)

 
   
 

I am also very concerned about thermographic reports that do not include the images.  A long-winded report dictated by an “expert” is only as accurate as the images seen by that interpreter.  Without the images, the report may be meaningless to compare with future thermograms.   Because thermographic images of a person should remain fairly stable though the years, it is important for people to save copies of their images, either in print or digitally, for comparison over time.   Insist on getting a copy of your images, either digitally or in print.

Another alarming thing I hear from people who have had thermography done at other sites is that they were not cooled down before the images were taken!  This is a grave error on the part of that thermographer.  The thermogram of a warm person does not show whether arteriolar constriction caused by being cold is taking place properly.  This constriction (or lack of it) is absolutely necessary for the detection of breast cancer, body inflammation, infection, pain syndromes, nerve injury, and circulatory changes.  Thus an un-cooled thermogram for breast cancer is not reliable at all, and the woman’s money and time are wasted and her future health is put in jeopardy by such an inadequate exam. 

Besides being properly cooled, the area(s) of the body to be imaged should be completely unclothed and uncovered during the cool-down period.  Wearing even the thinnest exam gown or drape during cool-down will distort the infrared image because the cloth (or paper) touching the skin will affect the local surface temperatures.  These very subtle skin surface temperatures are diagnostic in thermography, thus distorting the pattern with clothing will affect the diagnosis.  So be sure the part of your body being examined is completely unclothed and uncovered during the cool-down period and while the images are being taken.

An additional problem with many thermography exams for breast cancer screening is that the underside of the breast is not imaged.  If a woman with a B-sized or greater cup size is cooled down in a standing or sitting position, the underside of the breasts naturally fold down against the chest wall.  This prevents the underside of the breast from cooling down, and a cancer in the lower portion of the breast will not be detected.  Some thermographers have the woman pull up on the upper breasts to image the underside of the breasts, but this is useless unless the underside has been properly exposed to air during the cool-down time.  The only really practical way to cool the underside of the breasts is to have the woman lie down on her back with arms away from her sides during the cool-down period.  Then the first image is taken of the undersides before the woman stands up for the remainder of the images. 		 
   
 

 

        Figure 2 - Abnormal Underside of Right Breast (an ILSI Thermography image)

 
   
 

How important is the imaging of the underside of both breasts?  Figure 2 shows a problem with the underside of this woman’s right breast.  All the other images were normal.  Because of this abnormal image, the woman underwent biopsy and removal of an early breast cancer that would have been missed by “standard” thermography without the supine (underside) view demonstrated here.  In my experience at the Thermography Service, we have seen several such cases.  Thus it is important to seek a thermographer who does a really complete close-up image series of all parts of both breasts. This is our standard protocol here at ILSI Thermography Service, and we encourage all thermographers to provide similar complete and high-quality breast thermograms for their clients.

One more point about breast thermography:  It is not necessary to have the woman put her hands in cold ice water to get good diagnostic images.  Our experience here at the Thermography Service agrees with the several studies done to test the effect of this cold water challenge.  As long as the woman has been adequately cooled – and this can easily be verified by seeing if her nose is cold at the time of the imaging – further cold applications do not improve the diagnostic quality of the breast images.  In fact, if such cold immersion causes the woman to shiver, the images can become non-diagnostic due to muscular shiver generating heat beneath the breasts.

So beware of poor thermograms!  Until standardization and accrediting of Clinical Thermography comes about, it is up to you to be sure that the procedure is done right and the images taken are the best quality.  For complete diagnostic breast screening, be sure you are cooled properly.  Most studies advise cooling the subject unclothed from the waist up at 68-70F for 15 minutes before breast images are taken.  For most women, lying down on her back with the arms away from the sides is best for cool-down.  The first image is taken in this position, then the woman stands up for the other images, which should include a full frontal view, a close-up of each breast, the inner and outer surfaces of both breasts, and an image of the face to detect fever or inadequate cool-down.  These images are best taken in the cool room with a hand-held professional infrared camera, not a stationary “camera-on-a-stand” as used by many commercial systems.   Hand-held cameras are the best at this time for obtaining the close-up, underside, and oblique views needed for a good diagnostic breast thermogram.   I strongly advise checking with your thermographer to be sure they follow the basic rules outlined here so you get the best diagnosis and advice for your future wellness.

For the advancement of science in health,

 
   
 James Stewart Campbell, MD.
Director of Thermography Services
Integrative Life Solutions, Inc. 		 
   
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