Dear Patients and Friends:
This is the last quarterly newsletter for 2014 and we hope you have been enjoying them. We also publish this information on the Preventive Medicine Center website as a service to our patients. As the new year is upon us, our staff and I want to say ATHANK YOU@ for all of your referrals this past year. Our heartfelt wishes go out to you and your families for a healthy and joyous holiday season. Many of you have worked hard to improve your health and we celebrate your successes. The holidays can be especially stressful and I find it helpful for one to be kind to oneself and to count ones blessings.
An Update on Breast Thermography, Mammography and Breast Cancer Screening
In 2012 I published an article on the place breast thermography had in screening for breast cancer. This article is in the “Articles” section of our website www.prevent-doc.com. Statistics show one in seven women will get breast cancer in their lifetime in this country. There continues to be controversy among physicians and healthcare advocate groups regarding the efficacy of mammography screening. In 2009 the U.S. Preventive Services Task Force (USPSTF) issued new guidelines on breast cancer screening, recommending screening mammograms every 2 years for women aged 50 to 74, rather than the traditional annual mammogram. The Canadian Task Force on Preventive Health Care in November 2011 also issued new recommendations with a longer screening mammogram interval of once every 2 or 3 years. Both task forces recommended women ages 40 to 49 who are at average risk for breast cancer not get routine mammograms. What the task forces concluded after looking at the evidence (600,000 women who participated in 10 randomized trials of approximately 10 years follow up) was more frequent screening didn’t have an impact on the outcome and breast cancer death rates. There was also concern with the risk for false-positive tests and then unnecessary workups and over-treatment.
A New Canadian National Breast Screening Study
Since my 2012 article a 25 year follow up of the Canadian National Breast Screening Study was published in 2014 in the British Medical Journal with the conclusion there was no mortality benefit of annual mammography screening for breast cancer compared to physical exam alone. In this study almost 90,000 women were randomly assigned to five annual mammography screens or no mammography during 1980 to 1985. Women aged 40 to 49 in the mammography group and women aged 50 to 59 years in both groups received annual physical breast exams, and women aged 40 to 49 in the control group received a single breast exam followed by breast exams in their community. During the 5 year screening period, 666 invasive cancers were diagnosed in the mammography group and 524 were diagnosed in the control group. An additional 2,584 and 2,509 were diagnosed during further follow-up. At the end of the 25 year follow-up, there was no significant statistical difference in mortality due to breast cancer between the groups with a death rate of around 10%. The investigators concluded “Our data shows that annual mammography does not result in a reduction in breast cancer specific mortality for women aged 40 to 59 beyond that of physical examination alone or usual care in the community. The data suggest that the value of mammography should be reassessed.” But instead of reassessing the place mammography has in breast cancer screening in asymptomatic women, this study resulted in criticism or denial of the findings, primarily by radiologists.
Calls to Redefine the Word “Cancer”
I should point out that the study was also critical of the harm from “false-positive tests.” Studies have shown that one in five breast cancers are being “overdiagnosed” by screening mammography, referring to a condition called DCIS (ductal carcinoma in situ). This is a pre-malignant condition that most often never progresses to cause clinical disease and is too small to feel on breast exam, but is found on mammography. Many doctors agree this is not a cancer.
A group of some of the top experts in cancer research at the National Cancer Institute have recommended changing the definition of cancer and eliminating the word from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment. These recommendations were published in The Journal of the American Medical Association in 2013. They say ductal carcinoma in situ and other lesions detected during breast, prostate, thyroid, lung and other cancer screenings should be renamed to exclude the word carcinoma so that patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments. Instead, they should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”
“We need a 21st-century definition of cancer instead of a 19th-century definition of cancer, which is what we’ve been using,” said Dr. Otis W. Brawley, the chief medical officer for the American Cancer Society, who was not directly involved in the report.
The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm in a person’s lifetime.
Breast Thermography Information from the Biomedical Engineering Handbook
The use of infrared thermal imaging in health care is not a recent phenomenon, and extensive research has gone on in breast thermal imaging since the late 1950s. Over 800 papers can be found in the indexed medical literature and over 300,000 women have been included in these studies. A number of these studies involve 10,000 to 85,000 women and some patients have been followed up to 12 years in order to establish thermography as a risk indicator. We are often asked about thermography as a substitute for mammography. Thermography was approved by the FDA in 1982 as an adjunctive breast cancer screening procedure (i.e. complementary to mammography). From a scientific standpoint, mammography and infrared thermal imaging are completely different screening tests. Mammography attempts to detect structural tissue shadows or calcifications that might be indicative of a tumor. Thermography observes for changes in the thermal patterns or temperature differentials of the breasts which indicate subtle metabolic changes in breast milieu. So mammography and thermography examine completely different aspects of the breasts. Even so, research has been performed that allows for a statistical comparison of the two technologies.
I recently reviewed parts of Chapter 25 in the 2006 edition of The Biomedical Engineering Handbook, 3rdEdition, Medical Devices and Systems. Joseph D. Bronzino, editor of the handbook states “Medical Devices and Systems is an authoritative reference text and is considered ‘the bible’ of biomedical engineering. The third Edition presents an excellent summary of the status of knowledge and activities of biomedical engineers in the beginning of the 21st century.”
The principle author of this chapter, Dr. William Amalu, was joined by three other world-renowned experts in this field to present the state-of-the-art in infrared breast imaging (breast thermography). The Chapter contains a review of the literature along with a presentation of infra-red physics, a brief historical background, laboratory and patient imaging standards and protocols, and a look at the future of this lifesaving technology.
In order to determine the value of thermography, two issues must be considered. The first is what is the sensitivity of thermography – in other words, if a breast thermogram is taken preoperatively in patients with known breast cancers, how accurate will thermography be in demonstrating the disease. The second issue is specificity – looking at the incidence of normal or abnormal breast thermograms in asymptomatic populations who may or may not have disease, and determining the presence or absence of malignancy in each of these groups. The studies quoted in this reference book indicate infrared imaging, using strict standardized interpretation protocols (which are used at Gainesville Thermography and by the interpreting physicians at EMI), has an average sensitivity and specificity of 90%. As a future risk indicator for breast cancer, a persistently abnormal breast thermogram caries a 22 times higher risk and is 10 times more significant than a first order family history of the disease.
What About Mammography?
What about the sensitivity and specificity of mammography? From a review of the cumulative literature database, it can be found that the average sensitivity and specificity for mammography is 80% and 79% respectively for women over the age of 50. A significant decrease in sensitivity and specificity is seen in women below this age. The conclusion of the authors was that mammography as the current gold standard for breast cancer screening leaves much to be desired as a stand-alone screening procedure, but they also state that infrared imaging should also not be used alone as a screening test. The two technologies are of a complementary nature. The authors also state that thermography has the ability in 7 out of 10 cases to detect signs of a cancer before it is seen on mammography, and that thermography can signal an alarm that a cancer may be forming up to 10 years before any other procedure can detect it. “And when thermography is used as a multimodal approach along with clinical breast examination and mammography, 95% of all early stage cancers will be detected.”
Unfortunately, there is no “perfect” breast screening modality. I have been an advocate of integrating thermography of the breasts as part of a preventive health program for women. Breast thermography does not expose a person to any radiation. One third of all breast cancer patient are under the age of 45 and because the accuracy of thermography is not affected by dense breast tissue found in pre-menopausal women, I advise women between the ages of 40 to 50 undergo this screening. Thermography has the additional advantage of revealing thermal changes from a hormonal condition called “estrogen dominance.” Estrogen dominance is a risk factor for breast, uterine and ovarian cancer development. It is a physiological condition that mammography does not demonstrate. Estrogen dominance can be found in women who have conditions such as fibrocystic breasts, ovarian cysts, uterine fibroids or PMS. Estrogen dominance can be treated with hormonal or herbal therapies and comparison breast thermography can be obtained to document the physiological improvement after treatment.
For additional information on thermography, please go to our website www.prevent-doc.com and choose the “Thermography” link. To schedule a thermography appointment, please call Gainesville Thermography, Inc. at 352-332-7212.
Patient Success Story – Reversal of Thermography Findings on Progesterone Therapy
Mrs. D is a 48 year old patient who had been undergoing annual breast thermography screenings since age 40. She had a history of fibrocystic breasts, migraine headaches, heavy periods and PMS. She was also having more difficulty in staying asleep. A recent breast thermography was interpreted as showing a significant change in thermal patterns with an increase in thermal activity compared to her earlier studies although a mammogram ordered by her gynecologist was normal. The thermography findings were suggestive of estrogen dominance and a subsequent female hormone panel showed her serum progesterone had become low relative to her estrogen levels. This can be a common finding as a women enters perimenopause.
Mrs. D was placed on a low-dose topical micronized progesterone crème that she applied each night to her skin and breasts. Within two months her symptoms improved and a later breast thermogram had returned to baseline, documenting the patient was no longer having an estrogen dominant effect on the breasts.
Patient Success Story – Releana Diet Program Results in 45 Pound Weight Loss
Dr. W is a 69 year old physician who consulted me with complaints of fatigue, high blood pressure and being overweight. He stated over the past 10 years his weight slowly increased to where his BMI was 33, placing him in the moderately obese category. (Body massindexis a measure of body fat based on height and weight that applies to adult men and women). He had been able to lose a modest amount of weight on different diets in the past including Nutrisystems, Adkins diet, and a diet program at a local health and fitness center. In each instance his weight would return to pre-diet levels. He was also concerned about his blood pressure and was taking two different blood pressure medications to control his hypertension. He stated a friend of his who was in my medical practice went on the Releana diet program and lost a considerable amount of weight and felt great. This diet program was originally developed by a British physician, Dr. Simeons, and the program consists of using a 500 calorie daily low carbohydrate diet, HCG, specific electrolyte replacements and supplements, and weekly vitamin B12 shots. Dr. Simeons found his patients would lose between ½ and 1 pound a day.
Dr. W’s initial screening physical exam revealed a weight of 214 pounds, a blood pressure of 162/80, and was otherwise unremarkable for age. Lab work revealed a fasting glucose reading of 125mg/dL and fasting insulin suboptimal at 21. This was indicative of pre-diabetes. His lipid panel showed normal total and LDL cholesterols and normal triglyceride fats. Dr. W was place on the Releana diet program and by the end of the first month he lost 25 pounds. His waist size dropped from 44” down to 40” and his previous knee pain was gone. His fatigue had also resolved. At that point we started to taper one of his blood pressure medications and by the end of the second month totally eliminate it. His blood pressure readings were now in the 120/70 range and his fasting glucose had become normal at 97mg/dL and fasting insulin an optimal 9. He had cured his pre-diabetes. His finally weight loss was a total of 45 pounds.
Arsenic in Rice and Rice Products
In 2012 Consumer Reports found inorganic arsenic in all 60 rice products it tested. Further testing was done to determine whether different types of rice had more or less arsenic than others. In its most recent publication it found brown rice to contain almost twice as much arsenic as white rice. White basmati rice from California, India and Pakistan and sushi rice from the U.S. carry, on average, half the amount of arsenic than that found in most other types of rice. Organic rice was found to take up arsenic just like non-organic rice. Rice milk also was found to contain arsenic. My advice – limit your consumption of rice to no more than twice a week.