We are kicking off this Breast Cancer Awareness Series with a chat about mammograms. If you are a woman over 40, you more than likely plan to have a mammogram every year. And if you’re reading this thinking my doctor hasn’t mentioned an annual mammogram to me and I’m over 40, don’t be alarmed, but definitely keep reading…
Based on the 2016 Breast Cancer Screening from the United States Preventative Services Task Force (and no, it hasn’t been updated since then), it is the decision of the patient to determine if they want to have an annual mammogram every year once they reach the age of 40 years. Most people do continue to follow the previous recommendation that women over the age of 40 should have a mammogram every year, hence why I started this blog the way I did. The reasoning behind this is that screening too early may contribute to more false positives, overdiagnosis, and unnecessary biopsies.
The question is though, are mammograms still the gold standard?
Mammograms are x-rays of the breasts that can detect breast cancer in early stages before it can be detected on clinical exam. Even though in theory mammograms should detect what we don’t on clinical and self-breast exams, it is possible that mammograms can miss something that a self-breast exam could later pick up. That’s why it’s so important that we don’t just rely on that annual screening and every month perform a self-breast exam. But here’s something you might not know about mammograms.
Mammograms identify slow-growing lesions that women would die ‘with‘, not ‘from‘…
This little-known fact is best described as spontaneous regression, the partial or complete disappearance of a proven malignant tumor in the absence of all treatment.
So what then are we to do? Are there other options besides the self-breast exam and annual mammogram? Let’s talk about breast ultrasounds and thermography.
Breast ultrasounds are helpful often as an adjunct to mammograms, but in some cases, they can be considered as an alternative. Ultrasounds essentially read breast tissue by sending sound waves through the tissue that the echoes are then read on a screen. Ultrasounds don’t involve radiation and are more comfortable than mammograms. To illustrate an example for you, an ultrasound can tell the difference between a cyst and a lump, which can be unclear using mammography.
Ultrasounds are helpful for women on hormone replacement therapy, women with implants, women who have already had radiation to their breasts, and women with dense breast tissue, (i.e.) usually women with larger breasts and African American women. Breast density is important to note, as breast density is an independent predictor of breast cancer risk. This risk can range from 1.2 to 2 times greater than women with average breast density.
In multiple studies, Black women tended to have statistically significant higher absolute breast area density when compared to White women.
Another option is thermography. Thermography is a noninvasive technique that records the amount of heat emanating from breast tissue (or other tissues as well). Essentially the thermogram is looking for “hot spots” or inflammation within the tissue. These “hot spots” appear red on thermography whereas the other tissue will show as yellow, blue, or green. Much like ultrasounds, thermography is a good option for women who have dense breast tissue, implants, or a previous history of radiation to the breasts. Despite this, however, in general, clinicians don’t typically recommend thermography because there aren’t long-term outcomes available studying its use, if they identify “hot spots” they will still refer you to have a mammogram, it is unclear if thermography is helpful in early detection, and although approved by the FDA in 1982, it is not regulated by the FDA.
So, based on all that, you might now be wondering, if thermography is in fact really an option. Here’s why I say yes…
Abnormal heat patterns in the body signal cellular inflammation, a well-documented precursor for cancer. So yes, as I mentioned above, if there is significant inflammation and a high suspicion of cancer, a mammogram can be ordered to confirm. While that is true, in the majority of cases, thermography will indicate a tendency toward breast abnormalities long before a mammogram would identify those same abnormalities. So in this case, thermography is prevention whereas mammograms and self-breast exams are not. You can then monitor that thermogram and easily detect a decrease in cellular inflammation on follow-up screens.
It is true though that thermography is not regulated by the FDA to ensure certain standards across the different locations that may offer thermography.
My preferred site to identify the nearest location to you is the American College of Clinical Thermology (ACCT). Put in your zip code and it will identify the locations closest to you that are approved ACCT-certified clinics. Now the caveat here is that thermography is not likely covered by your insurance. So be prepared to pay out of pocket for these services. This should only be done annually so the cost is reasonable given you only go once per year. On average, exams are less than $400 which is about $33 a month.
Personally, this is an annual exam for me and I use it to monitor not just my breast tissue, but cellular inflammation throughout my entire body. Remember, inflammation is a precursor for disease, and knowing your baseline is helpful as you take action by eating certain foods, taking certain supplements, and moving your body. It is a way to measure the impact of making healthier choices over time.