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While most of my clients utilize DITI (Digital Infrared Thermal Imaging) for breast imaging, there are actually many uses of this technology.

I was asked recently to present to a group called Mended Hearts in Tucson.  This organization is made up of people who have had cardiac events of some type.  They meet to support those who may be facing heart surgery, a diagnosis of coronary artery disease or some other cardiac condition.

Prior to this presentation, one of the group members asked if DITI could monitor for heart disease or detect cardiac problems before someone suffered a heart attack or worse.

As it turns out, DITI is wonderful at monitoring full body health, including cardiac function.

In the American Journal of Cardiology, 1993, a study was done to determine if DITI could detect and help with management of coronary artery disease (CAD).  Two questions were posed and tested to find the answers.

The first question was simply:  Do people with coronary artery disease (CAD) have asymmetrical patterns across the chest region?

Remember, DITI is used to compare thermal patterns and temperatures on the body and where there are asymmetrical findings is where further investigation should take place.

This idea of asymmetry on the body when disease/dysfunction is present is actually based on something Hypocrites determined many, many years ago.  He put wet mud on his patients and the areas that dried first or that dried faster than the contralateral region was where he found disease.

“In whatever part of the body excess of heat or cold is felt, the disease is there to be discovered.”   ~ Hippocrates, 440 BC

So the question posed in the study, “Is there asymmetry in the precordial (chest) region in patients with CAD?” is deeply grounded in medical history. The first image to the left may answer the question even for the untrained eye.

As you can see, the left chest region on this male client is hypothermic (cool) in comparison to his right chest region.  This type of thermal finding is consistent with cardiac dysfunction and further testing revealed this male client had CAD.

Here is another example of that suspicious finding of hypothermia over the heart region.  This again was determined to be due to CAD after DITI detected this asymmetry.

However, due to the breast tissue of women, testing for cardiac function is not as easily seen and additional images need to be taken for a full thermographic assessment of cardiac function.

See if you can determine where there is thermal asymmetry in the images below.

The anterior view may show you slight thermal asymmetry on the left breast due to a linear pattern of hyperthermia (red line) in the inner quadrant of the left breast.
 
Realize that this client has had three thermal images (initial, 3 month follow up and annual) and all thermal findings in the breast region are stable. There were no suspicious thermal patterns for breast disease, but look a little again…

…can you find the asymmetry seen between the lateral left and right views?  Look for hypothermic (cool colors) patterns when you compare both views.

If you can see the blue region over the lateral left thoracic region compared to the right lateral thoracic region, you could be a thermologist in training! 

The thermologist’s findings noted that this asymmetrical pattern is suspicious for cardiac dysfunction and further testing was recommended. 

Ladies, realize that your cardiac function is also assessed with each of your thermal breast scans.  You may not realize this unless there is a suspicious finding, but cardiac and pulmonary function are assessed with each breast scan and more than just breast health is being evaluated.

So the study in the American Journal of Cardiology found that the answer to their first question about thermal asymmetry is a resounding YES – thermal asymmetry is seen 94% of the time in those with significant coronary artery disease. 

The second question of the study asks:  “Can revascularization reduce thermal asymmetry?”  The study cited states that “successful revascularization changed the asymmetric precordial pattern to a more symmetric one.”

This study concluded:  “Infrared thermography is a promising technique for the detection of CAD before and after revascularization.”  (Am J Cardiol 1993; 72: 894-896)

Heart disease is one of the top killers in our country and unfortunately, in about 50% of the cases of CAD, the first symptom is a fatal heart attack or sudden cardiac death.  I have several friends whose fathers passed away suddenly due to cardiac arrest and of those fathers, many had been given a clean bill of health by their PCP just prior to their passing.

Since DITI is a preventative screening, if you or your loved one is interested in having a thorough cardiac evaluation, you would want the following images taken:

Carotid Artery Screening (head/neck):  Those who are diagnosed with CAD or are scheduled for surgery (bypass) are told to have a carotid ultrasound because disease or blockages in the heart may also be found in other arteries. This woman had further testing that revealed a right carotid occlusion (blockage).

Along with screening for occlusions, my thermologists look for increased thermal activity in your carotid arteries and IF they find this, they suggest you have a C–Reactive Protein (h/s CRP) test to measure the amount of inflammation in your body.

Elevated CRP AND lots of thermal activity in your carotid arteries shows a STRONG correlation to the early development of CAD.

Chest/Breast Imaging:  Naturally, this region is imaged for women who come in annually for comparative studies. Please know that the woman who shows thermal asymmetry on the lateral left compared to her lateral right side (breast images above) was just in for her annual breast scan. I know that a few of my clients prefer to come in every 2 years and I strongly encourage you to re-examine this decision.

Breast imaging is NOT like mammography which simply looks for a tumor/calcification.  Mammograms have their place, but a positive mammogram offers NO opportunity to intervene early with diet and lifestyle changes as it is not a preventative screening tool.

Also, mammograms do NOT offer cardiac or pulmonary function assessment or lymphatic congestion, hormonal imbalances, neovascularity screening. . .all which contribute to poor health and increase risk for disease development.

Abdominal Imaging:  Often, someone with Congestive Heart Failure also has a congested liver so imaging this region may help guide further testing and/or healing modalities to consider.  Also, imaging this region can help rule in/out GERDs as the symptoms can sometimes be similar.  Kidney function plays a big role in blood pressure regulation, so imaging of kidneys is done with abdominal scans, too. 

Lastly, we would want to do a leg scan looking for peripheral artery disease (PAD) as that too is a concern for those with CAD.

As you can see, using DITI to assess cardiac function is a great idea and having your annual breast scan to detect any suspicious findings is a great start. However, if you want to use DITI to help detect early signs for the possibility of developing CAD, you would want more than just the breast scan.  A full body and breast/chest scan is needed.

 
As always, we welcome your questions and comments and encourage you to post them here or on our Facebook page! 

Yours in health,

Lynda Witt, CCT
Proactive Health Solutions, LLC
Tucson, AZ

As we begin 2013, we want to call your attention to a new grading system available to American College of Clinical Thermology (ACCT) thermographers for evaluating breast health that was introduced in the summer of 2012.  It is called the Thermography Breast Imaging-Reporting and Data System, also known as T BI-RADS and utilized only by our interpreting physicians at Electronic Medical Interpretation (EMI).  In addition, we want to be sure you know what elements comprise your breast health score, what your T BI RADS score means and how to use this grading system to your advantage in monitoring breast health. 

Historically, the Breast Imaging Reporting and Data System (BI-RADS) was developed by the American College of Radiology in 1993. This system provides a standardized classification for mammographic studies and demonstrates the likelihood of breast malignancy. The BI-RADS system can inform family physicians about key findings, identify appropriate follow-up and management and encourage educational and emotional support to patients. The BI RADS system was developed to standardize mammographic reporting, to improve communication, to reduce confusion, to aid research, and to facilitate outcomes monitoring. 

Similarly, the T BI-RADS system was designed to help the referring doctor integrate the thermography results into a familiar reporting system. 

Considerations Made in Your Breast Score

Your T BI RADS score is assigned from all available information including:  history and symptoms, the interpreting physician’s clinical impressions from your thermograms and the proprietary software utilized by the EMI doctor.

The TBIRADS Scoring System: What Your Breast Health Score Means

To help you understand your breast health score, we can liken the T BI RADS system to the standard grading system that we use in education:  A, B, C, D, and F. 

Within normal Limits/Normal:  Grade A
This indicates a normal thermal profile with no thermal findings consistent with risk for disease or other developing pathology. 

At Low Risk/Non Suspicious:  Grade B
This indicates thermal activity which may be associated with benign changes such as glandular hyperplasia, fibrocystic tissue and the development of cysts and fibroadenomas. This does not rule out existing non-active or encapsulated tumors.  (This point will be discussed further in the February Newsletter).

At Some risk/Equivocal:  Grade C
These findings indicate thermal activity likely to represent benign changes such as inflammation, acute cysts or fibroadenoma, or infection. 

At Increased Risk/Abnormal:  Grade D
This represents a significant risk for existing or developing malignant breast disease. Clinical correlation is justified and additional testing is indicated, including a 3-month follow-up thermogram.

At High Risk/Suspicious:  Grade F
This represents a high risk of malignant breast disease; urgent clinical correlation is indicated with a comprehensive panel of testing and evaluation, including a 3-month follow-up thermogram.

How to Use the Scoring System to Your Advantage

For the clients who have achieved an “A ” on their breast health score, fantastic!  Your lifestyle choices that you’ve implemented are contributing to optimal breast health.  Keep up the good work!

If a client has a known history of fibrocystic changes and/or breast cysts and receives a breast health score of a “B, ” we would first encourage you to work with your health practitioner to reverse glandular hyperplasia, fibrocystic changes and the development of cysts and/or fibroadenomas through diet and address any hormonal imbalances.  You may also want to rule out estrogen dominance and measure estrogen metabolites.  Ultimately, it is possible and advisable to work with your practitioner to optimize your score.

If you have a grade of a “C ” as your breast health score, it is time to take more proactive measures at reversing the inflammation associated with this process.  Estrogen dominance and estrogen metabolism needs to be evaluated as soon as possible.  Other contributing factors to this breast health score may include:  hormonal imbalances, lymph congestion, inadequate thyroid support, inflammatory diet, overwhelming or poorly-managed stress just to name a few.  Ultimately, it gives you an opportunity to discover what pieces of your health you’ve been neglecting or denying. 

Thermography does not diagnose cancer.  This can only be achieved through breast biopsy.  If you receive a score of a “D ” or an “F, ” certainly additional imaging (mammography, MRI and ultrasound) is mandatory.  If a positive diagnosis is made, you may want to continue to utilize thermography to monitor for healing after surgery as well as recurrence of cancer.  Understand, a grade of “D ” or “F ” is NOT a positive diagnosis and requires additional information to rule-out or rule-in developing pathology.

In summary, thermal imaging is utilized as a tool to watch for changes over time.  With continued breast health, the thermograms remain identical to the initial study. Changes may be identified that may represent physiological differences that warrant further investigation.  

The T BI-RADS gives women an opportunity to improve breast health or maintain their optimal breast health.  The T BI RADS System for scoring breast health is only utilized by ACCT thermographers like us at Proactive Health Solutions.

Recently, mammography, specifically screening mammography, is falling under scrutiny in the scientific and medical community.  As we are aware, mammography is utilized as a screening tool on an annual basis for otherwise healthy women to monitor for any evidence of cancer. 

A second way mammography is used is in a diagnostic mode.  If a woman has a detectable lump, mammography has proven to be effective in detection and ruling-out or ruling-in evidence for exiting disease. 

It is the debate of the effectiveness of mammography as a screening device that is causing controversy.  In this month’s newsletter, we explore this controversial subject.

We begin screening mammography usually around the age of 40 with the belief that “early detection” is the key to the best prognosis for survival.  So let’s ask a few questions:

1.  If screening mammography is recommended at age 40, what is the real benefit for this young population of women?

The benefit for the younger women, aged 40-49 is actually less than 1% reduction in absolute risk.  The data show that the real benefit for number of lives saved by annual mammographic breast screening actually is in women aged 50-74.  This data was first reported in 2009 when the US Preventive Services Task Force performed a meta-analysis.  The results led them to recommend mammography beginning at age 50 and then alternating years up till age 74.  Mammography was not recommended after age 74.

Some medical doctors still recommend annual screening mammography beginning at age 40.

2.  If “early detection” increases survival, does screening mammography find cancers at “early” stages of development?

All breast cancers are NOT the same in how fast they grow and what stimulates them to grow.  According Donald Berry, PhD and chairman of the Department of Biostatistics and Applied Mathematics at M. D. Anderson Cancer Center (Houston, TX), technology has brought a new understanding to the different types of breast cancers and can be best-described in the following manner:

a. Turtles
Some breast cancers are non-progressive, very slow-growing tumors and sometimes characterized as “stationary” tumors.  Breast cancers that are described as “turtles” could be found by either breast self exam or clinical breast exam and because of their slow-growing nature could be treated successfully without annual mammograms.  Women with this type would not necessarily benefit from annual mammographic screenings.

b. Bears
These types of breast cancers are sometimes hibernating or slow-moving tumors. At times they may show no aggression or advancement.  However, if awakened, this type can become aggressive, spread and potentially lead to metastatic disease and death.  There is a possibility that women with this type could be helped by screenings.

Of course, breast density needs to be part of the equation to determine if a woman would benefit from annual mammograms since mammograms are limited by the density of breast tissue.  The denser the tissue, the more difficult it would be for a tumor to be seen.

c. Birds
Characterized as fast-growing, aggressive tumors these types of breast cancers do not respond to treatment, no matter how small the tumor is when found.  Early detection would not play a role in survival as these aggressive tumors develop quickly and no current medical intervention leads to survival.  Sadly, women with this type would also not be helped by screening mammography because the end result would be the same.

Although we now know about the different types of breast cancers, researchers still cannot distinguish between the different types of breast cancers in how they behave.

Statistics show that mammography most effectively detects the slow growing tumors that would be treated successfully regardless of when and how they are found. 

Additionally, pathologists grade cancer cell aggression according to the “mitotic count”— the rate at which the cells are dividing, not the size of the tumor when detected.  Below is a simple study that clearly defines these facts:

Pathologist Peggy Porter analyzed four hundred and twenty-nine (429) breast cancers that had been diagnosed over five years at the Group Health Cooperative of Puget Sound:

• 279 breast cancers were detected by mammography
• Majority detected at Stage 1
• 18% with lymph node involvement
• 70% of the 279 tumors had “low” mitotic counts

Further analysis of the findings indicated the following:

• 150 cancers were missed by mammography
• Majority were in Stage 3
• 28% with lymph node involvement
• Three-times more likely to have “high” mitotic counts

The majority of the undetected breast cancers didn’t exist at the time of the mammogram. These cancers were found in women who had had regular mammograms, and who were legitimately told that they showed no sign of cancer on their last visit. In the interval between X-rays, however, either they or their doctor had manually discovered a lump in their breast.  These tumors were so aggressive that they had gone from undetectable to detectable in the interval between two mammograms.

Although the above study is small, the findings with mammography continue to be the same and this is the reason it is now questioned as an effective screening tool for breast cancer.

Also, screening mammography has not changed the rate women are diagnosed with late stage cancer or metastatic breast cancer.  The decreased rate of death from breast cancer is not due to the screening method but rather, the treatments available. 

Screening mammography is finding tumors that may not be lethal and creating “over diagnosis” leading to over treatment.  Because doctors cannot distinguish between the different types of breast tumors most cases will lead to surgery and possibly radiation and chemotherapy or hormone therapy.  Thus, some women are receiving unnecessary treatment that is not beneficial yet carries toxic and significant side effects.

The “war on cancer” began back in the 1970’s when it was believed that tumor size was directly related to survivability.  It was this understanding that may have fed the idea that annual mammographic screening could lead to early detection and the familiar mantra, “early detection saves lives.”

Science and technology has a greater understanding that it is the behavior of cancer (Turtle, Bear or Bird) that plays a role in survival, not the size of the tumor.  And therefore, for all these reasons above, the use of mammography as a screening tool is questioned. 

As Level III Clinical Thermographers, we ask ourselves what role thermography may play in these findings.  Please look for your April newsletter to discuss this next topic. 

Yours in prevention,
Brenda and Lynda

Sources:  The Picture Problem: mammography, air power and the limits of looking – Malcolm Gladwell

The Oversimplification of Early Detection: Screening Mammography and Breast Cancer Overdiagnosis – Breast Cancer Action (online presentation – March 12, 2013)

In our March newsletter we explored the questionable use of screening mammography due to its limitations when imaging women younger than age 50.  The data continues to show that utilizing mammography for women age 40-49 is NOT effective at saving lives and the previous recommendation to begin annual mammographic imaging starting at age 40 is challenged in the medical community.

Breast density limits the effectiveness of a mammogram.  Women have dense breast tissue for various reasons.  Young women, almost by definition, have dense breast tissue as well as women on Hormone Replacement Therapy (HRT) or Bio-identical Hormone Replacement Therapy (BHRT).  Some women have high breast density due to a genetic component.  Other factors that influence breast density are environmental influences.  Our world is becoming more estrogenic (fracking, GMO’s, pollutants, insecticides, etc) and this is (or will) contribute to the increased incidence of high breast density, thereby leading to increased risk for breast cancer.

In California, Governor Jerry Brown signed a bill to improve breast cancer detection in women with dense breast tissue. Senate Bill 1538, authored by State Senator Joe Simitian (D-Palo Alto), will require that following a mammogram, women with dense breast tissue be informed of the following:

• They have dense breast tissue
• That dense breast tissue can make it harder to evaluate the results of a mammogram
• That it is associated with an increased risk of breast cancer
• That information about breast density is given to discuss with their doctor
• That a range of screening options are available

California is now the 5th state to have a “Breast Density Notification” law. 

Roughly 40% of the women who have mammograms have dense breast tissue. Because dense breast tissue appears white on a mammogram, and cancer also appears white, it can be difficult to see the cancer. A January 2011 study by the Mayo Clinic found that in women with dense breast tissue, 75 percent of cancer is missed by mammography alone. The risk for women with extremely dense breast tissue is five times greater than the risk for women with low breast density.

Above: Example of before HRT (left) and after taking HRT.

Lastly, a study published in JAMA in February 2013 reports that advanced breast cancer in young US women is increasing.
Summarize what we know so far:

• Our “screening” tool we use to detect breast cancer is limited by breast density
• Women with dense breasts have a five-fold increased risk for developing breast cancer
• Environmental contributors that influence breast density is increasing
• Breast cancer in younger women is on the rise  (Incidentally, male breast cancer is also increasing)

Is DITI the answer?  Can DITI fill the gap for the 40-49 year old women where mammography has shown to NOT be effective?  Can DITI add value to a mammogram for a woman with known dense breasts?  Yes…and No.

Breast Density

DITI does not image deep into the body looking for a tumor.  DITI is NOT a test of structure, but of physiology (function).  Physiologic changes occur within the body on average 6 to 8 years before the formation of a breast tumor.  These are the changes DITI identifies which give proactive women an opportunity to intervene quickly.

Many individuals, including allopathic doctors, do not understand thermography and compare it to mammography. The two technologies are not comparable, because mammograms only evaluate anatomy (structure) and cannot determine the physiologic nature (function) of what is seen. Evaluating physiology is the strength of digital infrared thermal imaging (DITI).

DITI cannot replace mammography simply because it is NOT designed to detect what mammography detects: structure.

Thermography watches for changes away from a previously established stable baseline.  This is known as a “thermal fingerprint” and it is the foundation of these clinically useful images.

One’s thermal fingerprint is remarkably stable over a lifetime. Only when pathology develops does the pattern change due to the abundance of neural pathways through which temperature regulation occurs. DITI detects physiologic changes (NOT inactive tumors) deep in the breast tissue, even though it only images the skin as the developing pathology affects the surrounding sympathetic neural fibers, which relay the message to the skin surface where the local temperature is measured.

It is the shift away from one’s stable baseline that is the telltale sign of developing disease. If a woman is alerted to these physiologic changes, she can intervene much earlier and work with her practitioner to address diet, stress management, hormone status, vitamin deficiencies and other aspects of healthy living in an attempt to reverse/prevent the progression of disease. These physiologic changes offer women 6 to 8 years prior notice that disease may be developing before a tumor is found on a breast exam or mammogram.

The effectiveness of thermography is NOT limited by breast density and therefore, is a phenomenal option for a young woman or any woman with a mindset of prevention. 

In an ideal world, where prevention is the goal, the best option would be for women to begin thermographic screening beginning at age 25 or 26 to establish a stable baseline.  Annual visits will confirm stability and no new active, developing disease.

Environmental influences on breast health (and overall health) are not diminishing.  We believe it’s time to stop doing the same thing and expecting different (better?) outcomes.  Prevention is the best option.  This is where DITI can fill the gap.

Yours in prevention,

Brenda and Lynda