Newsletter #60–Jul./Aug. 2000

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.