Breast Screening


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.

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