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Ask the doctor: Is thermography a good screening tool for breast cancer?

Q. When you talk about breast cancer screening, why don’t you mention thermography? I’ve been using it for several years instead of mammography, which uses radiation.

A. The short answer is, we don’t have good evidence that thermography is useful, and it definitely is not a substitute for mammography.

Thermography uses infrared cameras to detect temperature differences at the surface of the breast. Cancerous tissue generally has a higher temperature than normal tissue because of its richer blood supply and higher metabolic rate; scientists reasoned that infrared “hot spots” in the breast could signal the presence of cancer. However, you can also have hot spots with benign breast disease, such as mastitis.

When thermography of the breast was introduced in the early 1960s, some regarded it as a potential competitor to mammography. But it fell out of favor in the late 1970s, after the Breast Cancer Detection Demonstration Project found that its sensitivity — the rate at which it detected cancer when present — was only 42%, compared with 92% for mammography. Thermography also falsely identified cancer in normal tissue 25% of the time. Proponents say the technology has improved, but in a study examining 126 breasts, of which 20 were ultimately diagnosed with cancer, thermography identified only five as cancerous, giving it a sensitivity of 25%. In the same patients, mammography had a sensitivity of 84%.

Mammography does have shortcomings as a screening tool. It can be uncomfortable; it uses small amounts of radiation; it misses up to 20% of breast cancers; and up to 10% of the time, it misidentifies normal tissue as possibly cancerous. Digital mammography has improved detection, especially in dense breast tissue. But if a suspicious area is found on a mammogram, we still need to follow up with other imaging techniques, such as ultrasound or MRI. So, there’s no question that we need better ways to find breast cancers early on, when they’re most curable. But for general breast cancer screening, thermography is not the answer. And being unproven, thermography isn’t covered by insurance.

— Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women’s Health Watch

Posted by: Dr.Health

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