She didn't believe the diagnosis; she hadn't even felt any lumps in the breast. Instead, she decided on a second opinion at the healing centre, which had recently started to offer thermographic screening. Doctors discarded thermographic screening back in the early 1980s and, in the UK, it is used only at airports for lie detection. Radiologists say there is no evidence that the technology works, and not a single screening unit in the UK offers it. However, for 30 years, it had been complementary to mammography. Where a mammogram sees mass, a thermograph sees activity, usually from the heat emitted by fast, cancerous growth.
Pauline's first thermographic image showed large areas of green all around her breast and chest-which suggests absolutely no cancerous activity (see box, page 12). After expert evaluation, Pauline was recommended to adopt a 'watchful waiting' approach-regular inspection for any breast lumps, plus a strict diet and vitamin supplements.
Three months later, a second thermograph confirmed the first reading-there was no cancer in the breast. And so it has proved to this day. Had Pauline believed the advice of the doctors-who had, in turn, believed the mammogram results-she would no longer have her right breast, and would probably be on debilitating chemotherapy to stop the spread of a cancer that was never there.
An invitation arrives
Pauline's journey began as it begins for every healthy woman who reaches her fiftieth birthday. She was invited to begin regular mammogram screening-a 'just-in-case' measure that is supposed to detect early signs of breast cancer. Around 75 per cent of the invited women will take up regular screening; not surprisingly, as mammography is promoted as a life-saver that stands between her and the disease she fears above all others, one that kills around 40,000 American and 12,000 UK women every year.
But the letter won't tell her what many scientists now believe: that she's better off staying at home, and that mammogram screening is so imprecise that its benefits for detecting early-stage cancers are far outweighed by the many false readings it gives.
In fact, scientists and health officials are now seriously out of step, and women are caught in the middle, unaware that mammog-raphy is not fit for its purpose. The final rift occurred last December, when scientists confirmed a controversial report that had suggested that mammography's risks outweigh any benefits. Worse, they also discovered that the mass screening programme-which began in the UK in 1988-was based on faulty and incomplete data (BMJ, 2011 Dec 8; 343: d7627; doi: 10.1136/bmj. d7627).
Things are a little better in the US. There, radiologists are being forced by law to reveal to the woman the limitations of mammography, especially if she is below the age of 40 or if she has dense breast tissue: in either case, mammography is incapable of giving a true reading. Instead, the radiologist must offer an alternative screening technology, such as ultrasound or thermography.
Even for older women and those with normal breast tissue, mammograms are a shot in the dark. For every woman whose cancer is correctly detected by a mammogram, 10 healthy women will go through unnecessary worry, further tests and even treatment, possibly for a year or longer, before doctors realize that they had been misled by a wrong reading, or false positive, that 'saw' a tumour that wasn't there.
Essentially, mammography cannot see cancer at its earliest stages-often, a tumour will have developed for eight years before it is detected by a mammogram-and fails to pick up the aggressive and fast-growing tumours that are often lethal. It is unable to see the cancers that will kill you. Yet, it will subject women to a cumulatively high level of radiation that can be carcinogenic, and the screening process itself requires the breast to be compressed in a way that spreads any cancer that is present.
Mammography's rise as the dominant screening technology has relegated others, such as thermography, to the role of bit-players when they have a vital part to play in helping women survive breast cancer.
Mass mammogram screening was introduced in the UK in 1988 on the basis of the recommendations of the Forrest report, which suggested that it would reduce deaths from breast cancer by a third and with "few harms" (Forrest P. Breast Cancer Screening. London: HMSO, 1986). However, those conclusions were based on just two studies-and both were wildly inaccurate.
At the time, Forrest and other researchers didn't realize the extent that mammograms could produce false positives. To this day, false positives, or overdiagnosis, remain a foreign concept to patients and even radiologists who interpret the screening results, says the World Health Organization (WHO, International Agency for Research on Cancer, 2002). For every true case of breast cancer a mammogram detects, it also sees 10 false-positive results. This false reading triggers a process that may involve biopsies, further tests, even a lumpectomy or a mastectomy, when the breast is removed-and a further 200 women will suffer unnecessary stress and worry for months after an initial false-positive result (Pol Arch Med Wewn, 2010; 120: 89-94).
Most false-positive readings occur when the mammogram picks up a case of DCIS (ductal carcinoma in situ) which, despite its name, very rarely develops into cancer. Because of the mammo-gram's limitations, an oncologist must assume that every DCIS detection is malignant, and so begin a process of testing and even surgery. Around 60,000 new cases of DCIS are detected by mammogram screening every year in the US alone and, yet, less than 5 per cent, or 3000 cases, develop into breast cancer. This suggests that around 57,000 American women go through the trauma of unnecessary worry, biopsies and surgery every year for no good reason (JAMA, 2009; 302: 1685-92).
Forrest also overestimated the number of lives that mammograms could save. Researcher Peter Gotzsche, of the Nordic Cochrane Centre in Copenhagen, Denmark, says that women who have regular mammogram screening do not live longer than women who have never been screened. Mammograms do not reduce the overall risk of dying from breast cancer, he says (The Guardian, 22 January 2012; www.guardian. co.uk/science/2012/jan/23/breast-cancer-screening-not-justified).
Far from saving the lives of a third of women with breast cancer, mammograms are picking up just one case of breast cancer per 1000 women screened over a 10-year period that would otherwise have resulted in death (The New York Times, October 24, 2011; http://well.blogs.nytimes.com/2011/10/24/mammograms-role-as-savior-is-tested/?ref= preventiveservicestaskforce). Most of the cancers it detects could have been picked up by clinical examination with the same successful outcome, or were growing so slowly that the woman would die with the tumour, but not from it.
Radiation and breast compression during the screening procedure are other dangers that Forrest and other researchers have failed to take into account. Radiologists argue that the X-ray radiation from a single mammogram screening is trivial, equivalent to one chest X-ray, which exposes the patient to one-thousandth of a rad (radiation-absorbed dose). As it takes one rad to increase breast cancer risk by 1 per cent, radiologists estimate that the risk is negligible.
However, they are not taking into account the cumulative effect of mammograms. Often, four separate images are taken for each breast at one mammogram screening, which alone increases exposure to around 1 rad-so one mammogram screening increases cancer risk by 1 per cent. Typically, a woman will have around 10 separate mammogram screenings over a period of 10 to 15 years, so her real risk increases to 10 per cent, which is far from trivial (National Academy of Sciences-National Research Council Advisory Committee. Biological Effects of Ionizing Radiation. Washington, DC: 1972).
The risk is magnified fourfold in women who are unwitting carriers of the A-T (ataxia telangiectasia) gene, thus increasing their risk to close to a 50-50 chance of getting cancer from a mammogram (J Natl Cancer Inst, 1994; 86: 1571-2). Women with the A-T gene who have regular mammograms account for up to 20 per cent of all new breast cancers in the US (N Engl J Med, 1992; 326: 1357).
A mammogram is also a very uncomfortable, and sometimes painful, experience, and one that spreads cancerous cells that are already in the breast. The breast is tightly compressed between two plates while the X-ray is taken-which is exactly how a breast that potentially is cancerous should not be handled. Even back in 1928, doctors knew to handle "cancerous breasts with care, for fear of accidentally disseminating cells" and spreading the cancer (Radiology, 1928; May: 338-46).
Compressing the breast for a mammogram-and especially in women who have not reached the menopause-can lead to the spread of malignant cells by rupturing small blood vessels in and around undetected cancers (Lancet, 1992; 340: 122). Mammography is a very limited technology. It sees mass and structure, but not activity, and so
is unable to tell the radiologist whether the lump is cancerous or aggressive. Around a third of all breast tumours that are aggressive, even doubling in size in a month, are not detected by mammograms, but are instead found either by the woman herself when she inspects her own breasts or by a clinician (Cancer, 1992; 69: 599-600).
Mammograms also miss cancers when the breast tissue is dense, which is fairly common in younger women who have not reached the menopause (J Natl Cancer Inst, 1999; 91: 833-8), and in those who take hormone replacement therapy (HRT) after the menopause (J Natl Cancer Inst, 1996; 88: 643-9). Around 20 per cent of postmenopausal women have dense breast tissue, which makes an accurate mammogram impossible.
American politicians have recognized this limitation. The US Congress passed the Breast Density and Mammography Reporting Act of 2011, which requires radiologists to explain the problems with mammography to women with dense breasts, and to offer them an alternative screening technology, such as ultrasound or thermography.
Women are never told about mammography's limitations and dangers. Instead, doctors and health regulators continue to feed them the party line that regular mammogram screening saves the lives of 1400 women in the UK, and 26,000 in the US, every year. As the technology is unable to see the fast-growing tumours that can be fatal, the claim is not supported by any research. When the Health Services Research Unit (HSRU) at Oxford University reviewed 35 years of studies into mammography, it concluded that it neither raises the detection rate of aggressive cancers nor lowers the overall mortality rate for breast cancer. It also made no difference at all for women aged 50 years and over, who lived for roughly the same number of years whether they had regular mammogram screening or not (BMJ, 1998; 317: 1224-30).
The HSRU study was carried out at around the time when cracks first started to appear in the mammogram myth. One of the first to question its widespread
use was Professor Michael Baum, of University College London, who was among the team that put together the UK's screening programme in the first place. Since then, Professor Baum's concerns have been joined by those of Professor Gotzche of the Nordic Cochrane Centre, who has been a consistent critic of mass screening. He argues that women are not being told the facts about mammography: the true level of harm, usually from false-positive results, is being hidden, while the benefits are being exaggerated. Overall, he says, there is no convincing evidence that screening is saving lives (J R Soc Med, 2010; 103: 14-20).
Yet, the information sheets given out to women talk about none of this and, so, are pure propaganda, say the Cochrane researchers. A woman thinking about a mammogram is likely to get more of the same if she visits the websites of health agencies or patients' groups, many of which are funded by the pharmaceutical industry. One study visited 27 sites and found that, in the main, they played down the risks (BMJ, 2004; 328: 148-51).
The rise and dominance of mammography is the result of a potent mix of forces. Politicians have sanctioned mass screening programmes because it is a vote-winner among women, and the medical industry wants us to believe that it has the answers to a dread disease. However, health campaigner Samuel Epstein, of the Cancer Prevention Coalition in the US, asserts that mammogram's adoption by medicine is more to do with money than science. The American Cancer Society (ACS) has close connections to the mammogram industry: five radiologists have served as the group's president, while the mammography industry conducts research on behalf of the ACS, and has been a substantial backer of the ACS's Breast Health Awareness Program. "The ACS has been and remains strongly linked with the mammography industry, while ignoring or attacking the development of viable alternatives," he says (Int J Health Serv, 2001; 31: 605-15).
The forgotten alternative
From 1956 and until the mid-1980s, thermography, or digital infrared thermal imaging, was one of those viable alternatives; radiologists saw it as being complementary to mammography, and they often used the two screening technologies together. Some advocates were even suggesting that it was far more accurate at picking up cancer, especially in its earliest stages and before any detectable tumour had developed.
It is also safer than mammog-raphy, as it neither subjects the patient to a dose of radiation nor needs to have the breast compressed between plates.
Early studies supported this enthusiasm. In one, 10 per cent more cancers were detected when thermography and mammography were used together (Interamer J Rad, 1987; 12: 337-43), while another found that thermography was the better 'first alarm' in 60 per cent of cancers detected (Gautherie M, Albert E, eds. Biomedical Thermology: Proceedings of an International Symposium. New York: A. R. Liss, 1982: 269-78).
Thermography fared even better in a study of 39,802 women screened over a three-year period. In that study, the researchers discovered that 30 per cent of the cancers would never have been detected had mammography been used exclusively (Ann NY Acad Sci, 1980; 335, 492-500). Overall, an abnormal infrared image is the highest risk indicator for the future development of breast cancer, and is 10 times as significant as a family history of the disease (Gautherie M, Albert E, eds. Biomedical Thermology: Proceedings of an International Symposium. New York: A. R. Liss, 1982: 279-301).
In one study of 58,000 women screened with thermography, 44 per cent of those who had an abnormal reading developed cancer within five years. As the researchers concluded, "an abnormal thermograph is the single most important marker of high risk for the future develop-ment of breast cancer" (Cancer, 1980; 45: 51-6).
Despite these successes, ther-mography was quickly abandoned after the publication of the seminal study from the Breast Cancer Detection and Demonstration Project (BCDDP) in 1979, which compared it against physical examination and mammography.
One of the study's remits was to evaluate thermography and mammography, and to recommend which should become the standard system for a mass screening programme. However, thermography fared badly against mam-mography, detecting just 41 per cent of cancers compared with a 28-per-cent initial success rate for mammography, with an additional 32 per cent spotted in a second screening (J Natl Cancer Inst, 1979; 62: 641-709).
In a follow-up paper, thermographer William Cockburn argued that the researchers misunder-stood the capabilities of thermog-raphy. Thermography picks up cancer activity so early-sometimes 10 years before any tumour is apparent-that when a mammogram subsequently fails to see any mass, the result is recorded as a false positive, he says.
Thermography also highlights the limitations of medicine. While nutritional and holistic therapies have anti-cancer regimes, medicine has none, and deals only with a tumour once it has formed. As Cockburn states, "thermography's only error is that it is too right too early" (Cockburn W. Breast Thermog-raphy: A Responsible Second Look. International Academy of Clinical Thermography, 2002).
Since the BCDDP paper, thermography technology has also improved. It is now a viable complementary screening option to mammography (Integr Cancer Ther, 2009; 8: 9-16). This was borne out in a study of 92 women who were due to have a biopsy following a positive mammogram result. Of these, 60 were malignant, and thermography correctly identified 58 of them (Am J Surg, 2008; 196: 523-6).
Other viable alternatives include clinical examination and ultra-sound. Ultrasound is an accurate follow-up procedure when a mam-mogram detects an abnormality and the woman is at moderate risk (Ann Intern Med, 2003; 139: 274-84).
The failure of medicine
Medicine is failing women over the disease they fear above all others. Mammography is not capable of detecting either the lethal cancers or those in the early stages of development. Scientists already know this-but health regulators and doctors are not passing on the message. Instead, they continue to feed a line to women that they know is false, possibly because they are unaware of any viable alternative.
Yet, there is one-and, despite the claims of radiologists, the evidence is already there. But until medicine detaches itself from its cosy relationship with the mammography industry, thermography will continue to be a forgotten technology, seen only at airport security areas. In the meantime, the shocking truth is that the letters of invita-tion for a routine mammogram should contain a PS: By the way, you're better off staying at home.
Factfile: Clinics offering thermography screening
Wholistic Medical Centre
57 Harley Street
London W1G 8QS
Tel: 020 7580 7537
Medical Thermal Imaging Ltd
134 College Road
Liverpool L23 3DP
Tel: 033 3800 3003
The Chiron Clinic
104 Harley Street
London W1G 7JD
Tel : 020 7224 4622
Factfile: Mammography vs thermography
Case study: Pauline, aged 60
Pauline had 12 mammograms and 21 biopsies in one day, and was diagnosed with stage III breast cancer. She was also told she had DCIS, although she had been unable to feel a lump. The oncologist recommended an immediate mastectomy.
She refused treatment, but instead had a thermograph reading. The thermograph detected some 'thermal activity', but nothing that suggested cancer.
A second thermographic screening three months later showed that activity in the breast was stable, and Pauline was considered a low risk. Since then, there have been no signs of cancer in the breast.
Case study courtesy of Medical Thermal Imaging Ltd
Factfile: Mammography vs thermography
Case study: Wendy, aged 48
Wendy was due to have a lumpectomy after experiencing pain in one of her breasts. A mammogram had detected a lump in a different area of the breast. Thermography detected mild activity, but she was considered a low risk for breast cancer. The screening suggested the problem was fibroids.
At the three-month follow-up, there was little change in activity. Both breasts were stable and there was no cancerous activity, such as angiogenesis.
Again, the indications were of fibroids in the breast.
Case study courtesy of Medical Thermal Imaging Ltd
WDDTY VOL. 23 NO. 1, APRIL 2012