As you know I am not a fan of thermography as it misses breast
cancer and routinely detects heat changes in the breast that are not
due to cancer but necessitate further workup.
I was alarmed to hear from one of my OBGYN colleagues recently
many of her patients are opting to have a thermogram instead of a
In October 2017 the US food and drug administration (FDA) put
out an update reminding women that thermography is not a
substitute for mammography. The update stated that
“Thermography has not been shown to be effective in detecting
early-stage breast cancer.” The update said “in fact the greatest
danger from thermography is that those who opt for this method
instead of mammography may miss the chance to detect cancer at
its earliest stage.”
Thermography has suddenly become very much more available in
Arizona since several thermography clinics in California have
been shutdown for false advertising. I fear that Arizona is now
being targeted with a pretty aggressive marketing campaign on
behalf of these thermography clinics.
So where does that leave us in the breast screening debate in 2018?
Mammography is still the only accepted FDA approved screening
modality which is usually covered by most insurance companies.
Is a 3D tomosynthesis, now heavily marketed to women in the
United States and Europe, better than 2-D digital mammography?
There are numerous studies saying 3D tomosynthesis does
decrease callback rates (true in my professional opinion) but only
increases the cancer detection rate by 1.2 cancers per thousand
women screened. In women with dense breast tissue however there
are many studies confirming that screening whole breast
ultrasound detected nearly twice as many cancers as 3D
tomosynthesis! Another way of looking at this is that 3D misses
half of the invasive breast cancers! In a recent study 3D
tomosynthesis detected 4 cancers per thousand women scanned
and ultrasound detected 7.1 per thousand women scanned. Not
only does ultrasound detect nearly twice as many cancers in dense
breast tissue but the number of false positives (detected lumps that
turned out to be not cancer on needle biopsy) was the same for
ultrasound and 3D tomosynthesis.
Another very effective screening tool in high risk women is MRI.
In addition to mammography, MRI tends to detect smaller cancers
at earlier stages and detects both invasive ductal and preinvasive
DCIS. Unfortunately MRI is expensive and requires an injection of
Gadolinium and is less well tolerated by many women.
In summary in 2018:
Thermography is not an effective tool for finding early breast
3D mammography is only slightly better than 2D mammography at
detecting breast cancer in dense breast tissue.
Whole breast screening ultrasound, hand held or automated,
detects nearly twice as many breast cancers as 3D tomosynthesis.
If you have dense breast tissue you may still benefit from
additional screening with ultrasound as it detects nearly twice as
many invasive ductal cancers. In dense breast tissue
mammography alone detects 53% of breast cancers and
mammography plus ultrasound detects 82% of breast cancers.
MRI is very effective at finding early stage cancers in high risk
women with dense breast tissue.