Using Thermography as a Pre-Screening Technique for Breast Cancer

MPH 622: Communicating for Healthy Behavior and Social Change

School of Nursing and Health Professions
University of San Francisco
nna llison
!"#"2$#%
Using &hermogra'hy as a Pre(Screening &echni)ue for Breast Cancer
*n the early #+6$s, mammograms -ecame the gold standard of -reast cancer screening
./ennedy, 0ee 1 Seely, 2$$+23 *n an effort to catch cancer early, 4omen over 5$ years of age
4ere encouraged to undergo a yearly mammogram3 But des'ite early and e6tensive testing,
-reast cancer remains the second leading cause of cancer death in North merican 4omen
./ennedy, 0ee 1 Seely, 2$$+23 s the years 'assed, and the data 'iled u', it -ecame clear that
early and fre)uent mammograms 4ere not the 7ey to defeating -reast cancer3 *n 2$$+, the United
States Preventative Services &as7 Force issued ne4 guidelines for -reast cancer screening3
8omen !$ years and older 4ere to get a mammogram every t4o years3 Some acce'ted the ne4
guidelines 4ith 'raise, 4hile others res'onded 4ith outrage .CM9, 2$#$23
Critics of mammograms -elieve that the -enefits of mammograms may -e e6aggerated in
the 'u-lic o'inion, 4hile the ris7s may -e do4n'layed .:renstein, 2$#%23 Mammogram
sensitivity is -elieved to -e a''ro6imately ;+ 'ercent, -ut that figure decreases for 4omen under
!$, 4omen 4ith a family history of -reast cancer, or 4omen 4ith dense -reast tissue .National
Cancer *nstitute, 2$#%23 Ho4ever, the real concern 4ith mammograms lies not in the sensitivity
of the test, -ut in the ris7s associated 4ith the radiation and false 'ositives3 For 4omen under !$,
the ris7s may out4eigh the -enefit of 'otentially catching cancer early ./ennedy, 0ee 1 Seely,
2$$+23
mong 4omen 4ho get regular mammograms, there is a slight increase in detection of
late stage cancer3 Ho4ever, the decrease in -reast cancer death is attri-uted to im'roved
treatment, not 4ith early detection .National Cancer *nstitute, 2$#%23 Some 'hysicians 4orry
that e6'osing younger 4omen to radiation may unnecessarily increase their ris7 of develo'ing
cancer and not dramatically reduce the chance of catching -reast cancer -efore it metastasi<es3
=et des'ite the negative conse)uences, there is still a 'revailing -elief in the general 'o'ulation
that 4omen 5$ and u' should -e receiving -iannual or even yearly mammograms .:renstein,
2$#%23
>ue to the ris7s associated 4ith mammograms .false 'ositives, e6'osure to radiation2
thermogra'hy is 'ro'osed as a 're(screening techni)ue in 'lace of mammograms for certain
'o'ulations3 Some studies have demonstrated that thermogra'hy has a higher sensitivity in
diagnosing -reast cancer than mammograms, and it can -e used 4ithout any ris7 to the 'atient3
8hile the results of thermogra'hy studies are mi6ed, the techni)ue could -e used to screen
4omen 4ho do not have a large ris7 of develo'ing cancer3 dditionally, 4hen thermogra'hy
and mammograms are used in con?unction, sensitivity ?um's to +! 'ercent ./ennedy, 0ee 1
Seely, 2$$+23 &his intervention 4ould 'rovide a ris7 free 4ay for 4omen to access their -reast
cancer ris7, 4hile lo4ering the cost and discomfort associated 4ith mammograms, false
'ositives and radiation3
Target Population
Mammograms are not effective for 4omen under !$ years of age3 For every one death
'revented, #+$5 4omen 4ould need to -e screened for #$ years .CM9, 2$#$23 &hat single life
saved does not out4eigh the -urden 'ut on the other #+$% 4omen3 Ho4ever, 4omen 4ith a
family history of cancer, or those 4ho have 4itnessed friends e6'erience cancer first hand, 4ill
understanda-ly 4ant to -e the one in #+$5 saved3 For these 4omen, thermogra'hy 4ould -e an
effective solution3 &hermogra'hy could also -e utili<ed in young 4omen to access ris7 in the
future3 8hile thermogra'hy has 'roduced a high rate of false 'ositives, one study @re'orted that
the results of thermogra'hy can -e correct A(#$ years -efore mammogra'hy can detect a mass
and that the error in thermogra'hy is that it is Btoo right too earlyC ./ennedy, 0ee 1 Seely, 2$$+23
&his finding indicates that instead of ?ust a diagnostic tool, thermogra'hy could have great
'redictive 'o4er for 4omen at ris7 of develo'ing -reast cancer in the future3 *f a young 4oman
.2! to %+ years of age2 7no4s that she may have a heightened ris7 of -reast cancer, 'erha's she
4ould decide to -egin mammogra'hy at 5$ instead of !$, or may choose to undergo a yearly test
instead of -iannually3
Significance of the Problem
*n 2$#$, 563A 'ercent of 4omen ages 5$ to 5+ re'orted undergoing a mammogram 4ithin
the last year, 623% 'ercent re'orted undergoing a mammogram 4ithin the 'ast t4o years .Center
for >isease Control, 2$#%23 &his means that many 4omen are continuing to see7 -reast cancer
screening des'ite the recommendations of the United States Preventative Services &as7 Force3
&hese 4omen could see7 early screening -ased on a recommendation -y their doctor due to
family history of elevated ris7, or they could -e 'rescri-ing to outdated information a-out
mammogram 'rocedures3 Su-stituting thermogra'hy for mammogra'hy could 'rovide a via-le
su-stitute for many of these 4omen 4ho 4ant cancer screening -ut donDt sho4 elevated ris73
8hile many 4omen and 'hysicians may ta7e the, @-etter safe than sorryC a''roach to
mammograms, the ris7s are not insignificant3 &o 'ut it into 'ers'ective, one mammogram
e6'oses a 4oman to 3#% millisieverts of radiation .Center for >isease Control, 2$$523 &hat
radiation e6'osure is e)uivalent to four round tri' flights from 0os ngeles to Ne4 =or7 or
roughly seven chest 6(rays3 &herefore, if a 4oman 4as to get a mammogram every year from her
5$th to !$th -irthday, she 4ould rac7 u' #3% millisieverts of radiation, or the e)uivalent of ;$
chest 6(rays3 &hen, if she decided to reduce her testing after !$, and follo4 the guidelines set
forth -y the United States Preventative Services &as7 Force, she 4ould continue to get screening
every t4o years3 *f this continued until she 4as ;!, she 4ould -e e6'osed to 23+ millisieverts of
radiation or the e)uivalent of #!; chest 6(rays .Center for >isease Control, 2$$523 8hile this
amount of radiation may not out 4eigh the -enefits of early screening for some 5$(year(old
4omen, the ris7s only com'ound as the 4omen -eing tested get younger3 *f a 4oman started
screening at %$, the ris7s of radiation(induced cancer may e)ual the -enefit of catching it early3 *f
she 4ere to -egin at 2$, the mammograms 4ould cause more cases of cancer than it 4ould catch
./ennedy, 0ee 1 Seely, 2$$+23 Beginning mammograms at 2$ may -e unheard of, -ut -reast
cancer fear can start as young as 'u-erty3 For many young girls, information a-out monthly self(
-reast e6ams is a routine 'art of middle school health class .:renstein, 2$#%23
*f thermogra'hy 4as used as a 're screening techni)ue for 4omen 4ho are not in
mammogra'hyDs target audience, it 4ould not only cut do4n on false 'ositives, -ut 4ould allo4
4omen to undergo -reast cancer screening 4ithout the ris7s associated 4ith mammogra'hy3 *f a
4omenDs thermogra'hy test reveled a-normalities, a mammogram could -e done to confirm,
follo4ed -y a -io'sy if necessary3 &hermogra'hy and mammogra'hy have a very high
sensitivity 4hen used in con?unction3 dding the e6tra ste', and 'rescreening 4ith thermogra'hy
4ould cut do4n on unnecessary -io'sies, radiation and false 'ositives3
Intervention Design
n ada'ted version of the Precaution do'tion Model is to -e the frame4or7 for this
intervention3 &he techni)ues found in this model are ideal for assessing 4omenDs readiness to
ado't an alternative to -reast cancer screening and to guide them through the ste's that 4ould
allo4 them to ma7e an educated decision a-out the -est screening o'tions for them3 Unli7e other
models, the Precaution do'tion Model is effective for relating to 4omen 4ho have already
ado'ted routine mammograms and may not 7no4 the ris7s, are considering mammogram
screening, or 4ho are una4are of the issue entirely3 Ste's for individuals utili<ing the Precaution
do'tion Model are -elo4:
.#2 Being una4are of the issue
.22 Being a4are of the issue for not 'ersonal engaged
.%2 Being engaged and deciding 4hat to do
.52 Having decided to act or not to act
.!2 cting
.62 Maintenance
Step 1: Identifying the Facilities
8hile thermogra'hy first sho4ed 'romise in the #+A$Bs, it 4as largely discredited -y one
study that found it identified -reast cancer less effectively than mammograms ./ennedy, 0ee 1
Seely, 2$$+23 Since then, there have -een vast im'rovements made to thermogra'hy, and there
have -een many successful trials3 Ho4ever, thermogra'hy remains a fringe techni)ue in many
hos'itals, and is therefore not covered -y most insurance 'lans3 *n order to more accurately
assess the 'otential of thermogra'hy, more information is needed3 *t 4ould -e necessary to ma7e
thermogra'hy e)ui'ment availa-le to several clinics across the United States3 &he 'ro'osed
clinics are -elo4:
shland Community Hos'ital, 9ac7son County :E
vista dventist Hos'ital, 0ouisville C:
St3 Frances Ca-rini Hos'ital, le6andria 0
St3 9ohnDs Healtheast Hos'ital, Ma'le4ood MN
Magee 8omenDs Hos'ital, Pitts-urgh P
&he a-ove hos'itals 4ere chosen for the 'ilot study of thermogra'hyDs effectiveness as a
're(screening techni)ue -ecause :regon, Colorado, 0ouisiana, Minnesota and Pennsylvania all
have elevated -reast cancer incident rates3 Fach state e6'eriences more than #2% ne4 cases 'er
#$$,$$$ 4omen .Center for >isease Control, 2$#%23
Step Two: Implementing monthly awareness panels
Many 4omen 4ho see7 mammograms in their forties may not -e a4are of the ris7s
associated 4ith mammograms, and may -elieve it is a standard 'rocedure regularly acce'ted -y
the medical community3 &herefore, each of the 'ilot hos'itals 4ill host a monthly 'anel for
4omen of any age that are interested in learning more a-out -reast cancer screening3 &hese
'anels 4ill consist of the doctors from a variety of s'ecialties and -ac7grounds3 &hey 4ill
discuss the ris7 factors associated 4ith -reast cancer and give information a-out screening
o'tions, including mammogra'hy and thermogra'hy3 &hese 'anels 4ill -ring 4omen to either
ste' one to t4o of the Precaution do'tion Model3
Step Three: Referring eligible women
&he 'ur'ose of this intervention is not only to encourage 4omen 4ho are not screening for
-reast cancer to see7 screening -ut to 'rovide 4omen 4ho 4ould li7e -reast cancer screening an
alternative o'tion3 &herefore, it 4ill -e u' to 'hysicians to assess their 'atients, and decided
4hether thermogra'hy is a good o'tion for them3 *f a 4omen comes to one of the a-ove five
hos'itals, is under !$ years of age, is eligi-le for thermogra'hy, and 4ould li7e -reast cancer
screening, they 4ill -e enrolled in the hos'itals thermogra'hy 'rogram3 &his -rings the 'atient to
ste' three, and then ste' four and finally ste' five of the Precaution do'tion Model3
Step Four: Managing data, assessing the results
:nce an eligi-le 4omen sho4s interest in thermogra'hy, she 4ill receive an initial
thermogra'hy scan3 *f the scan seems a-normal, she 4ill -e referred for further testing and 4ill
-e treated accordingly3 Ho4ever, if the initial scan is normal, her results 4ill -e logged, and she
4ill come -ac7 for another scan the follo4ing year3 Fach year the hos'ital 4ill call to remind her
to schedule yearly thermogra'hy a''ointments3 &his 4ill -ring the 'atients to ste' si6 of the
'recaution ado'tion model3 &his 'rocess 4ill continue for each 4oman until she is !$ years of
age, or for #$ years 4hen the trial 4ill end3 Eesults from the study may -e 'u-lished 'eriodically
throughout the course of those #$ years3 Goals and criteria for success 4ill -e discussed later in
the 'a'er3
Avancing !ealth Infrastructure
&he 'ro'osed intervention directly advances the goals of Healthy Peo'le 2$2$3 'rimary
goal of Healthy Peo'le 2$2$ is to reduce the num-er of ne4 cases of cancer, as 4ell as illness,
disa-ility and death related to cancer .U3S3 >e'artment of Health and Human Services, 2$#%23
Breast cancer, and effective mammogram screening is an integral 'art of the cancer goal3 &he
'ro'osed thermogra'hy intervention 4ill not only ma7e mammograms ultimately more effective,
-ut 4ill ho'efully catch early stage a-normalities that mammograms may miss3 *f used
effectively, the descri-ed intervention 4ill allo4 mammograms to -e utili<ed as a follo4 u' test
for 4omen under fifty3 8hen screened for ten years, over half of 4omen 4ill receive at least one
false 'ositive .Hu--ard, /erli7o4s7e, Flo4ers, =an7as7as, Hhu 1 Miglioretti, 2$##23
&hermogra'hs are ultimately safer, less e6'ensive, and can -e used to reduce the emotional
-urden of needless mammograms that 'roduce a high 'ercentage of false 'ositives3
Assessing the "esults
ssessing the results of this intervention 4ill involve 7ee'ing a careful record of each
'artici'antDs medical record, scans and tests3 Ultimately, the 'ro?ect 4ill -e deemed a success if
the rate of -reast cancer incidence across all stages remains com'ara-le to 'revious years3 &his
4ill indicate that thermogra'hy may -e as effective a 4ay to screen 4omen under fifty3
*deally, this intervention 4ill lead to more lives saved3 *n 'art, this translates to4ards
aggressive tumors caught in time to remove them successfully3 ggressive tumors usually
metastasi<e )uic7ly, and arise -et4een mammograms3 *f they could -e caught on thermogra'hy
scans, 'erha's they could -e removed early ./ennedy, 0ee 1 Seely, 2$$+23 >ata gathered from
the five hos'itals listed can -e com'ared to other hos'itals in similar geogra'hic locations3 *f
thermogra'hs are an e)ually effective screening method for 4omen under !$, it 4ould -e
'rudent to e6'and the 'rogram to include more hos'itals, and ultimately offer thermogra'hy as a
standard 'ractice for young 4omen3
Conclusion
&his intervention has the 'o4er to not only 'rovide young 4omen 4ith a safe cancer
screening o'tion, -ut to restore some of the faith that may have -een lost in the medical system3
Mammograms and early screening 4as su''osed to -e the ans4er to defeating -reast cancer3
Sadly, that hasnDt -een the case3 n e)ually im'ortant 'art of the descri-ed intervention is to
allo4 4omen to ta7e control of their medical decisions, 4ith the hel' of a )ualified 'hysician3
&hey can ma7e informed decisions a-out their -reast cancer ris7, and decide to they -elieve
mammograms are necessary -efore !$, or if another o'tion might -e the 4ay to go3 Fear -ased
advertising leads 'eo'le to ma7e rash and sometimes unnecessary decision a-out their health3
&his intervention 4ould allo4 them to -e decision ma7ers, and 'artners, and finally 'art of the
conversation a-out -reast cancer screening3
"eferences
Center for >isease Control3 .2$$523 Breast cancer rates by state3 Eetrieved from
htt':""4443cdc3gov"cancer"-reast"statistics"state3html
Center for >isease Control3 .2$#%23 Breast cancer3 Eetrieved from
htt':""4443cdc3gov"cancer"-reast"statistics"state3html
CM93 .2$$+23 Ne4 United States mammogram guidelines ignite de-ate3 anadian Medical
!ssociation "ournal, Eetrieved from 4443cma?3ca
Hu--ard, E3, /erli7o4s7e, /3, Flo4ers, C3, =an7as7as, B3, Hhu, 83, 1 Miglioretti, >3 .2$##23
Cumulative 'ro-a-ility of false('ositive recall or -io'sy recommendation after #$ years
of screening mammogra'hy: a cohort study3 !nn Intern Med, 1#$.A2, Eetrieved from
htt':""4443nc-i3nlm3nih3gov"'u-med"22$$;$52
/ennedy, >3, 0ee, &3, 1 Seely, >3 .2$$+23 com'arative revie4 of thermogra'hy as a -reast
cancer screening techni)ue3 Integrati%e ancer Therapies, $.+2, Eetrieved from
htt':""ict3sage'u-3com"content"A"#"+
National Cancer *nstitute3 .2$#%23 Breast cancer: &re%ention, genetics, causes3 Eetrieved from
htt':""4443cancer3gov"cancerto'ics"'revention(genetics(causes"-reast
:renstein, P3 .2$#%, 5 2!23 :ur feel(good 4ar on -reast cancer3 The 'ew (or) Times3 Eetrieved
from htt':""4443nytimes3com"2$#%"$5"2A"maga<ine"our(feel(good(4ar(on(-reast(
cancer3htmlI'age4antedJall
U3S3 >e'artment of Health and Human Services3 .2$#%23 *ealthy people +,+,3 Eetrieved from
htt':""4443healthy'eo'le3gov"2$2$"default3as'6