Breast Cancer Awareness Month
Which breast screening tool is right for you?
Are you confused about what type of breast screening you are supposed to do?
What about frequency of screening depending on your age?
We have all heard the scary statistics
* About 1 in 8 U.S. women (about 12.4%) will develop invasive breast cancer over the course of her lifetime.
* In 2018, an estimated 266,120 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 63,960 new cases of Ductal Carcinoma in Situ, (DCIS)- a noninvasive breast cancer.
* About 1 in 1,000 men will develop breast cancer
“Does it make sense to squish my boob and give me radiation annually to find a cancer when we know these things can cause cancer?”
“Why can I not get an ultrasound instead of a mammogram since it does not have radiation and when the mammogram is abnormal they send me for an ultrasound anyway?”
“ What is all of the hype about a thermography these days? “
These are all great questions and I hope you can gain some insight and clarity today as I sort through the current guidelines and facts on breast screening. Ultimately, we all want to protect ourselves, yet cause the least amount of damage and injury in the process. I know this can be very confusing, so my intent is to give you resources to make the best educated decision for your own breast health.
The current recommendations for breast screening are:
The US Preventative Task Force systematic review concluded in 2015, that mammographic screening benefits women over 50 and that biennial, not annual, screening was recommended for women ages 50–74.
After weighing the balance of harms and benefits for women aged 40–49, screening was not recommended routinely for women in their forties. Instead, the USPSTF suggested an individualized approach taking patient risk and personal preference into account.
In contrast, 2017 guidelines from the American College of Radiology and the Society of Breast Imaging currently recommend annual screening starting at age 40.
The American Cancer Society has revised their guidelines and recommend annual mammograms for women over 45 of average risk, with women between the ages of 40–44 provided the opportunity to begin annual screening. Women over the age of 55 are recommended to receive biennial screening, although annual screening may be considered.
NO WONDER WE ARE ALL CONFUSED!
For the Center of Disease Control and Prevention (CDC) comprehensive list of screening recommendations by different organizations, please click on the link below
For your information, the U.S. Preventative Task Force stopped recommending teaching self-breast exam in 2009, which is unfortunate, as I have had a few patients whose mammogram was clean yet shortly after they found a mass by a self-examination that turned out to be invasive cancer. Therefore, I still recommend self-breast examinations monthly between menses in the shower or in a warm, relaxed position.
A mammogram is an X-ray of the breast. “Screening mammograms” are routinely administered to detect breast cancer in women who have no apparent symptoms.
“Diagnostic mammograms” are used after suspicious results on a screening mammogram or after some signs of breast cancer alert the patient or health care provider to check the tissue.
What do they detect?
According to the American Cancer Society, they detect microcalcifications, masses, breast density and Ductal Carcinoma in Situ, (DCIS).
* Microcalcifications are typically non-cancerous conditions that show aging of the breast arteries, inflammation and injury.
If we see this on your scan I am also concerned it’s a sign of arterial calcification, so I recommend those women and men to get a heart scan for further evaluation. (https://www.frontrangepreventiveimaging.com/ebt-heart-scan/)
*Masses can be non-cancerous solid tumors called Fibroadenomas or a cancerous mass. If this is found the next step of order is to get an ultrasound
*Cysts are non-cancerous fluid filled sacs
*Breasts with high density which can be linked to higher risk of breast cancers, but this seems to be controversial. It has been noted that 50 percent of women have dense breast tissue. Both dense breast tissue and cancer appear white on an X-ray, thus it’s extremely difficult and practically impossible for a radiologist to detect cancer with this type of tissue based on an X-ray.
Unfortunately, new breast screening technology, 3-D mammography, is said to double the amount of radiation exposure yet does not necessarily detect more problems. Therefore, if you do get a mammogram please ask for single topography image of breasts instead. (Dr. Kelly McAleese agrees, see below)
According to the American College of Clinical Thermology, a “Thermography is a painless, noninvasive, 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 50 where mammography is less effective.”
“Thermography's role in breast cancer and other breast disorders is to help in early detection and monitoring of abnormal physiology and the establishment of risk factors for the development or existence of cancer. When used with other procedures the best possible evaluation of breast health is made.”
“This test is designed to improve chances for detecting fast-growing, active tumors in the intervals between mammographic screenings or when mammography is not indicated by screening guidelines for women under 50 years of age.”
According to Dr. Philip Getson, D.O. who has been a medical thermographer since 1982.
“Since thermal imaging detects changes at the cellular level, studies suggest that this test can detect activity eight to ten years before any other test. This makes it unique in that it affords us the opportunity to view changes before the actual formation of the tumor. Studies have shown that by the time a tumor has grown to sufficient size to be detectable by physical examination or mammography, it has in fact been growing for about seven years achieving more than twenty-five doublings of the malignant cell colony. At 90 days there are two cells, at one year there are 16 cells, and at five years there are 1,048,576 cells—an amount that is still undetectable by a mammogram. (At 8 years, there are almost 4 billion cells.)”
Thermography can detect the subtle physiologic changes that accompany breast pathology, whether it is cancer, fibrocystic disease, an infection or a vascular disease. Breast thermography is a 15-minute noninvasive test of breast physiology.
After the brief thermography screening, your report will be interpreted by a physician who then will rate your estrogenic activity, evaluate inflammation and blood flow as we know cancers are fed by blood and evaluate your lymphatic circulation and possible congestion “breast health”.
The biggest difference with a Mammogram and a Thermograms is that Thermograms study function, ie inflammation, while mammograms and ultrasounds study structure, ie masses. Thermograms may suggest signs of inflammation and risk many years before anatomical signs are observable. Thermography screening can help you make adjustments to your diet and lifestyle to transform your cells before they became cancerous.
For more specific information http://www.iact-org.org/articles/articles-review-btherm.html
A breast ultrasound is using Doppler imaging with high frequency sound waves to create black and white images of the breast tissue and structure and will assess blood supply in any breast lesions. It can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor), fluid-filled (such as a benign cyst) or both cystic and solid. This screening can detect early signs of breast cancer and does not emit radiation.
Breast ultrasound can help identify aggressive and invasive breast cancers that would than warrant a biopsy and/or surgery.
Other reasons why a breast ultrasound may be performed include:
to assess unusual nipple discharge
to evaluate cases of mastitis or inflammation of the mammary tissues
to evaluate breast implants
to assess symptoms, such as breast pain, redness, and swelling
to assess skin changes, such as discoloration
to help monitor existing benign breast lumps
to help read the results of other imaging tests, such as magnetic resonance imaging (MRI) or mammogram
My preferred imaging center and radiologist is The Women’s Imaging Center in Denver, Dr. Kelly McAleese and the breast ultrasound cost is $250. (unfortunately, most insurances won’t cover unless you have had a mammogram first)
Magnetic Resonance Imaging (MRI)
MRI is the preferred recommended screening tool for women who are at high risk for breast cancer, usually due to a strong family history and/or a mutation in genes such as BRCA1 or BRCA2.
A study published in the British Medical Journal in 2012 proved that women carrying the BRCA 1/2 mutation are extremely susceptible to developing radiation-induced cancer, meaning that mammograms are much more harmful to them. Women with this mutated gene who were exposed to diagnostic radiation before the age of 30 were found to be twice as likely to develop breast cancer in comparison to women without that mutation. This study supports the use of non-ionizing radiation imaging techniques (such as magnetic resonance imaging) as the main tool for surveillance in young women with BRCA 1/2 mutations.
Dr. Kelly McAleese’s imaging center will perform the MRI for $500
Now that you have a more clear picture around breast screening tools, let’s dig into some varying opinions and other ways of thinking about our current recommendations.
Let’s discuss why there is controversy around Ductal Carcinoma in Situ (DCIS).
DICS is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer and is listed as Stage 0 Cancer. DCIS is noninvasive, meaning it hasn't spread out of the milk duct and has a low risk of becoming invasive. Most Mammogram enthusiasts say there is no other way to detect DICS than in a mammogram, which is only partly true as a Thermography can also screen for DICS (but is not a diagnostic tool).
Dr. Esserman, who directs the Carol Franc Buck Breast Care Center, is one of only a few surgeons in the United States willing to put women with D.C.I.S. on active surveillance instead of performing biopsies, lumpectomies or mastectomies. She and other critics of vigorous intervention point to the potential side effects and risks of sometimes disfiguring treatments for premalignant conditions that are unlikely to develop into life-threatening cancers.
She has also challenged the conventional wisdom surrounding screening, arguing that while mortality from breast cancer has decreased over the past three decades, the approach to screening needs to change. She points out that the most lethal breast cancers appear between screens, while mammograms are finding more slow-growing cancers with a very low chance of metastasis. In addition, screening has revealed a reservoir of D.C.I.S., also known as Stage 0 Cancer. According to an article published in October, 2015 in JAMA Oncology, Dr. Esserman says that DCIS accounts for approximately 20% to 25% of screen-detected breast cancers. Yet, long-term epidemiology studies have demonstrated that the removal of 50,000 to 60,000 DCIS lesions annually has not been accompanied by a reduction in the incidence of invasive breast cancers. Dr. Esserman is lobbying to get the word “cancer” removed from this diagnosis all together.
This has certainly given me a pause regarding the aggressive attitude to diagnose DCIS using mammograms as well as the aggressive interventions used to treat this noninvasive and slow growing disease.
Now back to the idea of Mammograms as a “lifesaving screening tool"
In a 2009 Cochrane Database Systematic Review of breast cancer screening and mammographs, the authors concluded “Screening led to 30 percent over-diagnosis and over-treatment, or an absolute risk increase of 0.5 percent. This means that for every 2000 women screened for 10 years, one will have her life prolonged, and 10 healthy women who would not have been diagnosed if they had not been screened, will be treated unnecessarily.
Of course, there have been many lives saved with Mammography screening, however this is simply giving us another look at the risks vs benefits using this tool.
The Swiss Medical Board also has a differing opinion and recommendation on mammograms than the United States, which is worth mentioning. The Swiss Medical Board was an independent health technology assessment initiative. The board was asked to create an unbiased review of mammography screening. The board comprises a medical ethicist, a clinical epidemiologist, a pharmacologist, an oncologic surgeon, a nurse scientist, a lawyer, and a health economist.
The Swiss Medical Board reported that for every breast-cancer death prevented in U.S. women over a 10-year course of annual screening starting at age 50:
490-670 women will likely have a false positive mammogram with repeat examination
70-100 will likely have an unnecessary biopsy
3-14 will likely be over-diagnosed with a breast cancer that would never have become clinically apparent
They found that after 25 years of follow-up, 106 of 484 screen-detected cancers (21.9%) were over diagnosed, which means that 106 of the 44,925 healthy women in the screening group were diagnosed with and treated for breast cancer unnecessarily, which resulted in needless surgical interventions, radiotherapy, chemotherapy, or some combination of these therapies. In addition, a Cochrane review of 10 trials involving more than 600,000 women showed there was no evidence suggesting an effect of mammography screening on overall mortality
Given the overwhelming amount of research showing the ineffectiveness of mammograms, the board recommended completely abolishing mammogram screenings.
Please read this article on their findings in the New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/nejmp1401875
The Canadian Task Force on Preventative Health Care recommendations on mammograms are:
For women aged 40–49 we recommend not routinely screening with mammography.
(Weak recommendation; moderate quality evidence)
For women aged 50–69 years we recommend routinely screening with mammography every 2 to 3 years.
(Weak recommendation; moderate quality evidence)
For women aged 70–74 we recommend routinely screening with mammography every 2 to 3 years.
(Weak recommendation; low quality evidence)
These recommendations do not not apply to women at higher risk due to personal history of breast cancer, history of breast cancer in first degree relative, known BRCA1/BRCA2 mutation, or prior chest wall radiation. No recommendations are made for women aged 75 and older, given the lack of data.
According to Dr. Christiane Northrup, MD who has been an outspoken advocate for women’s health and safety for many years, she opposes mammograms for these reasons stated on her website “ Here are 5 more reasons you may want to avoid mammography”
Click this link to read her reasoning https://www.drnorthrup.com/best-breast-cancer-screening-tests/
When I assess all this information above I believe you need to take the information and make your own personal choice based on your risk factors and beliefs. My personal favorite is using the Thermography as the only true preventative tool in evaluating breast health where you can get an image and data around breath health so that you can actually make interventions in your own life, taking an active role in improving your breast health to prevent this dreaded disease.
I recently had my 2nd thermography as it had been nearly 8 years and I thought I would have “perfect looking breast” knowing I eat healthy and exercise vigorously and regularly, yet to my surprise I was having lymphatic congestion, abnormal blood flow and inflammation. Yikes! I then had my breast ultrasound screen with Dr. Kelly McAleese in Denver and was relieved to know there was no cancer. However, with the information I know (and you now have) I am making some important changes to prevent getting breast cancer in the future. I would like to share some recommendations with you below to help you be more engaged in your breast health.
Protection & Prevention
*Self-breast exam monthly
*Do not wear underwire bras! If you cannot do this than please wear them for limited time and always take them off when you are home
For large bust brands of bras consider; Warner, Wacoal, Third Love, Bali, Lane Bryant
*Lymphatic system support- breast “fluffing” daily where you simply lean forward slightly and brush your breasts upwards without a bra. You can also do the trampoline/rebounder, hot/cold showers, dry brushing skin and breast massage.
*Start day with proper pH- (I have discussed this before and have a handout for this on the patient portal library)
*Stress reduction (don’t I say this in every newsletter?)
*Exercise with elevated metabolic activity- includes biking, jogging, very brisk walking, aerobic machine workout, tennis, golfing walking and carrying the bag
* Increased Vegetables 6-8 per day
* Increase Omega 3 (fish, flax and chia seeds) and 9’s (olive oil)
*Reduce Omega 6’s (vegetable oils) and lower saturated fats from animal fats/pork (especially the non-organic, hormonally injected, grain fed meats)
*Stop all refined carbohydrates- sugars, pasta, white bread, white rice and increase complex carbohydrates with soluble fiber
*Soluble fiber- 10g per day reduces breast CA by 26% (oatmeal, apples, lentils, pears, nuts, flax, beans, peas, blueberries, psyllium, cucumbers, celery, carrots
* Increase your Organic Soy intake (non GMO only) if not allergic
Organic, Organic Organic lifestyle please!
Please read or re-read my September Newsletter around Xenoestrogens. You can find it posted under the resources tab on my website under BLOG post for September.
Vitamin D3 optimization (personalized based on labs) is critical!
Vitamin E as high gamma tocopherol as supplement or food sources
Sulforaphanes- Myrosinase is an enzyme to form sulforaphanes- 15% decrease in breast cancer (sprouts, brussel sprouts, cabbage, cauliflower, broccoli , mustards, horseradish ) The products I like are Oncoplex by Xymogen or Crucera product by Thorne
Piperine in black pepper = inhibits cellular mechanisms necessary in angiogenesis – a key process for tumor growth and progress
Some other antioxidant supplemental support to consider:
The Women’s Imaging Center
Kelly McAleese, MD
The Thermogram Center, Inc.
Lesser known personally but another tool in evaluating breast health
AlfaSight 9000- Regulation Thermometry
Book - Keeping a Breast by Khalid Mahmud, M.D., F.A.C.P.