Contrast-Enhanced MR Angiography of The Breast

This is an abstract copied from PubMed. Am I the only one that wonders how vessel density on MR and not the vessel density on a therm is accurate? True: thermography measures skin blood flow by temp - but more vascularity usually means more blood flow -- ????? Am I missing something?

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions Sibel Kul1 Aysegül Cansu1 Etem Alhan2 Hasan Dinc1 Abdulkadir Reis3 Gamze Çan4 Kul S, Cansu A, Alhan E, Dinc H, Reis A, Çan G 1Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon, Turkey. Address correspondence to S. Kul (sibel_ozy@yahoo.com). 2Department of General Surgery. Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 3 Department of Pathology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 4 Department of Public Health, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 􀀷􀁏􀁍􀁅 􀁎 􀀇􀁓 􀀀 􀀩􀁍􀁁 􀁇 􀁉 􀁎 􀁇 􀀀 􀁳 􀀀􀀯 􀁒 􀁉 􀁇 􀁉 􀁎 􀁁 􀁌 􀀀 􀀲 􀁅 􀁓 􀁅 􀁁 􀁒 􀁃 􀁈

AJR 2010; 195:1250–1254 0361–803X/10/1955–1250 © American Roentgen Ray Society

MRI is the most accurate method of detection of invasive breast cancer, having nearly 100% sensitivity. The specificity, however, is only moderate (72% overall specificity in 44 studies) and varies widely across studies of the diagnostic performance of breast MRI related to cancer prevalence and the criteria used to differentiate malignant and benign lesions [1]. Developments in MRI systems, image acquisition protocols, and image interpretation methods are continuing to improve specificity. The results of previous studies have shown an association between breast cancer and ipsilateral increased blood flow at laser Doppler imaging [2] and PET [3]. It is possible to obtain MR angiograms of the breast with postprocessing of 3D dynamic contrast-enhanced MR images. Maximum-intensity-projection (MIP) reconstruction of subtracted dynamic MR images shows enhancing lesions and the breast vasculature at the same time. Increased vascularity adjacent to breast cancer lesions and in the ipsilateral breast as a whole has been found Keywords: breast, contrast-enhanced MRI, MR angiography, MRI, vascularity DOI:10.2214/AJR.10.4368

Received January 28, 2010; accepted after revision March 25, 2010. W O M E N ’ S I M A G I N G

􀀯􀀢􀀪􀀥􀀣􀀴􀀩􀀶􀀥􀀎 The purpose of this study was to investigate the role of evaluation of breast vascularity with contrast-enhanced MR angiography in the differentiation of malignant from benign lesions. 􀀭􀀡􀀴􀀥􀀲􀀩􀀡􀀬􀀳􀀀􀀡􀀮􀀤􀀀􀀭􀀥􀀴􀀨􀀯􀀤􀀳􀀎

Contrast-enhanced 3D MR angiograms of the breasts of 102 patients with unilateral and histopathologically confirmed breast lesions were evaluated retrospectively. All images were evaluated for both ipsilateral increased vascularity and adjacent vessel sign, and the values of these signs in the diagnosis of malignancy were assessed. 􀀲􀀥􀀳􀀵􀀬􀀴􀀳􀀎

Histopathologic analysis of 102 patients revealed 50 malignant and 52 benign results. In 31 of the 50 patients with breast cancer and in 11 of the 52 patients with benign lesions, ipsilateral breast vascularity was increased. The resulting sensitivity and specificity of ipsilateral increased vascularity were 62% and 79%. The adjacent vessel sign was present in 37 of the 50 patients with breast cancer and six of the 50 patients with benign lesions. The resulting sensitivity and specificity of the adjacent vessel sign were 74% and 89%. The overall accuracies of ipsilateral increased vascularity and the adjacent vessel sign were 71% and 81%. 􀀣􀀯􀀮􀀣􀀬􀀵􀀳􀀩􀀯􀀮􀀎

Both ipsilateral increased vascularity and the adjacent vessel sign were found to be associated with breast cancer in a significant percentage of patients. The adjacent vessel sign is more practical and generally applicable. There is a borderline significance in favor of the higher accuracy of the adjacent vessel sign in comparison with ipsilateral increased vascularity (p = 0.043).

ARE YOU LIVING IN FEAR OF BREAST OR OTHER CANCER?

Fear is beneficial (as far as I'm concerned) in acute life-threatening situations; tigers (outside the bars), mad dogs, men with weapons etc. Fear of the unknown or fear of possibility is the worst -- as it is the ongoing stress hormones that are secreted by this type of fear that can cause or accelerate disease.

I personally believe that we create our problems and diseases with our thoughts. Unfortunately those thoughts (negative) create the very thing we fear or do not want. We become what we focus on --- if you focus on illness then wellness isn’t the outcome.

The body is an incredible work of art. It is SO complex. But everything in the body begins with chemistry. You don’t lift a finger or a foot to run unless the chemistry directs the action. Very complicated and immediate discharges of cellular transmitters start all activities (that’s where the hormones of fear come into play ....) If you truly have a fear of cancer – then the chemistry is probably in action. Getting structural tests such as mammography show the changes long after the chemistry has been in play. I encourage you to save your pennies and get a Cancer Profile study from American Metabolic Laboratory. Specifically request or include the addition of thymidine kinase levels in the test.

This is taken from Wiki’s information on TK1 Clinical chemistry[edit]Thymidine kinase is a salvage enzyme that is only present in anticipation of cell division. The enzyme is not set free from cells undergoing normal division where the cells have a special mechanism to degrade the proteins no longer needed after the cell division.[10] In normal subjects, the amount of thymidine kinase in serum or plasma is therefore very low. Tumour cells release enzyme to the circulation, probably in connection with the disruption of dead or dying tumour cells. The thymidine kinase level in serum therefore serves as a measure of malignant proliferation, indirectly as a measure of the aggressivity of the tumour.

If the fear of cancer drives you --- then this is the way to go. Your practitioner probably doesn’t know about this test – and won’t recommend anything that isn’t in the “Betty Crocker recipe book for finding and treating cancer”. They only follow algorithms. If A then B – If B then........ . They can’t practice any other way – or they get some type of oversight...

This is what I suggest – but if you’re of the mind to wait and see.............

Caveat emptor - Radiology is NOT Thermography and Thermography is NOT Structural

What Do Thermal Indicators Mean?

Infrared thermal imaging determines if abnormal or asymmetric thermal patterns, consistent with abnormal physiology, are detectable in the breast tissue. This procedure is used as an adjunctive diagnostic procedure in addition to structural tests, not in place of those tests. Thermal imaging is an ideal marker to indicate your level of RISK for breast cancer and also can assist as an indicator of “activity” if a cancer is present. The higher the tissue temperature -- the greater the cellular activity.

Not all ‘cancers’ emit a thermal signal. “DCIS, LCIS and Atypia” are considered cancerous or precancerous on mammography and MAY NOT demonstrate a thermal signal at this time. Additionally – thermal signals can be present within one or both breasts – but may not be located adjacent to a cancer; blood supply is called to a tumor and is not initiated at the tumor. Mammography may locate a cancer in the opposite breast. This is a physiological signal NOT a structural test. A normal TH factor does not rule out the possibility of cancer detectable by mammogram.

Thermal Indicator: TH-1 Symmetric Bilateral – Non-Vascular (normal) TH-2 Symmetric Bilateral – Vascular (normal) TH-3 Equivocal – One Thermal Factor Present (equivocal) TH-4 Abnormal – Two Factor Present (abnormal) TH-5 Suspicious - Three Factors Present (suspicious for malignancy) ,

Your recall period is based on your Thermal Risk indicators. Tumor doubling time averages 150 days. A 3-month recall will determine if your TH Factors are stable or require additional investigation by structural study. Follow-up studies of 6 – 12 months are considered Standard. Recall procedure is important to monitor breast health and to follow any demonstrated changes in either the Risk Index or Thermal Indicator Scale. Statistics have demonstrated that abnormal serial scans demonstrate a greater potential (higher RISK) for conversion than other RISK markers.

DAMNED IF YOU DO ---- NOW DAMNED IF YOU DON"T HYPERPLASIA LEADING TO LUMPECTOMY

New data contradict current recommendations for management of breast biopsy abnormalities

This study challenges current understanding that atypical ductal hyperplasia (ADH), a type of breast tissue abnormality, leads to breast cancer in the same breast while atypical lobular hyperplasia (ALH), another type of breast tissue abnormality, may not be a direct precursor of breast cancer, but may indicate equal risk of breast cancer across both breasts.

“Most have considered ADH a direct precursor to breast cancer, arguing that it requires complete surgical excision while others have maintained that ALH serves as an indicator of heightened and equal risk of breast cancer across both breasts and does not need complete surgical removal,” explained Hartmann. “Moreover, some experts have argued that women with atypia develop ‘better risk’ breast cancers, meaning low-grade cancers with a good prognosis.”

IT IS NOW RECOMMENDED THAT WOMEN HAVE LUMPECTOMIES WITH ADH - or ATYPICAL DUCTAL HYPERPLASIA. Isn't this comparable to having a hysterectomy if you have an abnormal PAP?

Its challenging enough that DCIS has been advanced to "cancer" when it was considered a watch and wait for many years. Now atypia will lead to lumpectomy just as DCIS. This seems as if they aren't making enought money with the current population -- that now they want to advance the surgical intervention in hyperplasia. I don't know what you think ---- but I think this is really pushing the limits.......

ADH, cytologically, architecturally and on a molecular basis, is a low-grade ductal carcinoma in situ (DCIS);[1] however, it has a limited extent, i.e. is present in a very small amount (< 2 mm). ADH is not considered breast cancer,[2] but recognized as a risk for breast cancer. The usual treatment is lumpectomy to exclude the presence of breast cancer

I'd rather have a simple blood test to see if there is a elevation of enzymes present with active cancer -- before I submit to lumpectomy for atypia...

Look for Cancer Profile - American Metabolic Laboratory -- and determine your actual risk.

DAMNED IF YOU DO --- NOW DAMNED IF YOU DON'T : Breast ATYPIA will lead to Lumpectomy

New data contradict current recommendations for management of breast biopsy abnormalities

This study challenges current understanding that atypical ductal hyperplasia (ADH), a type of breast tissue abnormality, leads to breast cancer in the same breast while atypical lobular hyperplasia (ALH), another type of breast tissue abnormality, may not be a direct precursor of breast cancer, but may indicate equal risk of breast cancer across both breasts.

“Most have considered ADH a direct precursor to breast cancer, arguing that it requires complete surgical excision while others have maintained that ALH serves as an indicator of heightened and equal risk of breast cancer across both breasts and does not need complete surgical removal,” explained Hartmann. “Moreover, some experts have argued that women with atypia develop ‘better risk’ breast cancers, meaning low-grade cancers with a good prognosis.” IT IS NOW RECOMMENDED THAT WOMEN HAVE LUMPECTOMIES WITH ADH - or ATYPICAL DUCTAL HYPERPLASIA. Isn't this comparable to having a hysterectomy if you have an abnormal PAP? Its challenging enough that DCIS has been advanced to "cancer" when it was considered a watch and wait for many years. Now atypia will lead to lumpectomy just as DCIS. This seems as if they aren't making enought money with the current population -- that now they want to advance the surgical intervention in hyperplasia. I don't know what you think ---- but I think this is really pushing the limits of malpractice.

How Accurate Is Thermography?

The challenge today is that women want to monitor breast health without mammography. They believe that choosing thermography will provide them with a non-contact, non-invasive way to detect early changes and not need mammography at all. I'm sorry -- but that is not the truth, regardless of how hard we want to believe that thermography is the answer, it is only one way to look at the breast changes over time. Thermography is physiology and physiology is ever-changing. Mammography is structure - and once the structure changes - its visible by x-ray, which is the energy level that mammography measures. The 'efficacy of detection with thermography is 87-92%' based on the current meta-analysis. Mammography is 75% - 95% accurate based on the meta-analysis of studies. But BEWARE - they are NOT comparable tests.

Recently I've had a few clients, who regularly participate in thermography and mammography, come back with diagnoses of cancer in what we reported as a stable or negative thermogram. They are told that "thermography is wrong and dangerous” that only mammography will find early cancer." This statement can be true and false. False in that thermography is wrong and dangerous. The body does not lie. If there is a thermal abnormality there is something happening. Thermography finds changes that are related to the physiological stimulus of blood flow in the region. Many things besides cancer can stimulate changes in blood flow - including hormones and medications. Mammography detects the dead cells - or castings of cells that are left. This can be DCIS - in the duct, spiculations in the tissue, or changes in the tissue density. Often they will report you as having "cancer" with DCIS - as the common practice in medicine is to remove DCIS because it CAN be transformed into invasive cancer and they don't know if or when. Thermally - DCIS is most often not chemically active. It will not exhibit a thermal signal. Additionally - we often find the opposite breast is demonstrating signals of suspicious change and the mammogram finds nothing in the stimulated breast, but suspicious changes in the opposite breast. Why is this? We are one body. Chemistry is not isolated. The breasts operate together. There is a commone blood supply and connecting blood and lymph. Also, DCIS is frequently found in multiple sites and has a high probability of being in both breasts. Years ago they usually did a mirror biopsy in the contra lateral breast of DCIS or invasive breast cancer - because the statistics of that cancer being in the opposite breast are higher than not. That is not done as often today. Standard medical practitioners believe that mammography is sensitive enough to see the contra lateral change. But why the thermal signal in the contra lateral breast? Because radiologist won't use thermography to monitor change - we don't have recent comparative studies to say the signal came and went prior to the structural change. We do know that enzymes in the tissue contribute to the conversion of normal to invasive cells and that that is early in the process of cancerous change -- and it is postulated that thermography is catching the chemical reaction that is taking place prior to the structural change. Without comparative studies we will not get that answer. What we do know from studies conducted - and those studies include large population of thousands of patients - is that thermography is the best indicator of RISK. Serial (or changes over time) thermograms demonstrate a higher RISK than the presence of Family History of breast cancer, and other statistical factors. Watching non-invasively can help make shifts in lifestyle (cancer causes are known to be 85% lifestyle) and help postpone or avoid future changes to cancer. But your medical doctor will not have the time, or the desire to help you do this. Changing lifestyle is an individual responsibility. So is thermography wrong and mammography right? This depends on what you intend. Do you want to monitor yourself JUST for breast cancer? Then mammography is your test. It will not detect the chemistry, or the hormone shifts, or the changing blood flow of disease. Mammography usually detects a cancer that is already growing. PERIOD.

If you want to do any preventative action – then monitoring hormone changes and risk with thermography will improve your outcome. So it’s a big decision. If you don’t want to initiate lifestyle changes – maintaining appropriate body mass index for your size, and age, monitoring for influence of endocrine imbalance, and other physiological changes, then a mammogram every two years should be done. Don’t waste your time and money with thermography. But you must also realize that thermography – just like mammography, will not detect EVERY cancer. Thermography will not detect DCIS. So educate yourself on how you want to deal with a breast cancer IF you were to receive that diagnosis. Understanding the choices you have BEFORE is very important. Otherwise you’ll be making very difficult choices in a VERY SHORT TIME. Medical doctors will want you to have a biopsy and surgery within days of a questionable mammogram. The faster they get you to the table the less time you have to think about it and back out. So better to understand options before you’re under the knife. Many women regret getting pushed into surgeries and treatment without having prior understanding of outcome and possibly damaging results they can’t UNDO after the fact. Don’t be intimidated. Do not be rushed. Understand the choices you have and the potential of the outcome EITHER WAY.

Thermography is a non-invasive way to monitor physiologic changes and change over time. Mammogram examines the structure. Apples and oranges -- these two tests CAN NOT BE COMPARED.

I make a point to educate every woman who comes for thermography about the risk and benefits of both tests. I provide information and education. So basically it becomes a choice of how much do you want to know, when do you want to know it, and how will you make choices IF or WHEN you receive a diagnosis of breast cancer – whether its DCIS (which historically was NOT a true cancer - only hyperplasia) or another more challenging aspect of the disease.

CONFIRMATION OF ABNORMAL SERIAL SCANS

Often women who have a consistently abnormal thermal scan are resistant to getting a mammogram when a structural test is needed. For whatever reason - be it the physician, the radiologist or the insurance company - getting an Ultrasound as the next step it usually difficult or impossible. Ideally an Ultrasound could be performed on the breast or the area of concern noted by the infrared exam. When the technician switches the imaging mode to Doppler - in order to analyze the blood flow during the exam - it helps to identify the suspicious blood flow detected by the thermogram. Doppler can determine if the circulation is consistent with normal blood vessels (by directional flow or the pulse due to heart beat) or if the flow is chaotic and abnormal, indicating a potential change in normal circulation.

The thermogram identifies changes in metabolism and the resulting change in circulation. A structural test is needed to determine if an abnormal growth is already present - or if thermography is detecting a metabolic change in advance of the structural tissue change. This is one reason that thermography and mammography act together to increase the efficacy of early detection. A serial positive thermogram with a negative mammogram warrants close observation. MRI with and without contrast is currently the ideal test to identify the neoangiogenesis associated with breast cancers. But again, the roadblock is in place to prohibit MRI unless a significant family history is present or the patient has a history of multiple biopsies and abnormal mammograms with negative biopsies. Cost of this test is one reason that insurance companies usually withhold precertification when it is requested. Even if a patient wanted to self-pay for the test it is withheld.

For these reasons – I’ve been encouraging women with repeatedly abnormal thermal scans to consider another option for early detection. This option is not medical imaging, but the detection of very significant protein markers found in the Cancer Profile exam (blood and urine analysis) conducted by American Metabolic Laboratory of Hollywood Florida. This very sensitive test can identify multiple markers – that when elevated indicate the presence of cancer in the body. Having consistently abnormal thermal scans and abnormal cancer markers help the women determine how aggressive she must be in seeking medical intervention. Additionally – with negative cancer markers – the abnormal thermogram can be followed and diet and lifestyle can be altered to change hormone influence on the breasts (although this is usually the first step following abnormal thermal scans.)

Dr. Emil Schandl, Ph.D. of AML has developed and structured this analysis (Cancer Profile Plus) to find the human growth hormones associated with early cancer and other proteins and enzymes, including serum thymidine kinase – which aid in the replication of cancer cells and the metastasis of the cells to distance sites. This test is highly accurate and detects cancer in the earliest stages – usually before structural imaging detects the multiplication of abnormal cells into a tumor. Mammograms detect cancer when the cells have sufficient doubling to measure at least 200 cells. The Cancer Profile needs only 4-6 doublings (about 12-16 cells) for cells to emit enough metabolic enzymes (MMPs) for detection.

For anyone facing cancer concern via thermography or not the Cancer Profile Plus is your next step. www.americanmetaboliclaboratories.net

This article was in my Oncology Newsletter today.  This is VERY IMPORTANT INFORMATION for anyone interested in Infrared Imaging for breast health monitoring. Please read this article and keep in mind that IR detects this fine vascular network that provides the opportunity for breast cancer to metastasize.

June 17, 2013

How dormant breast cancer tumor cells become metastatic

The long-standing mystery about what activates dormant disseminated breast cancer tumor cells after years and even decades of latency may have been solved. Dormant cancer cells have been found to reside in the microenvironment surrounding microvasculature, which are the small blood vessels that transport blood within tissues. When these blood vessels begin to sprout, the new tips produce molecules that transform dormant cancer cells into metastatic tumors.
In a small but significant number of breast cancer patients, cancerous cells can move through the bloodstream from breast tissue to secondary sites in other parts of the body. There, they may remain in a dormant state that is clinically undetected for an extended period of time before they suddenly become metastatic. It has been difficult if not impossible to predict if and when metastases will occur.
“Our study reveals that a stable microvasculature constitutes a dormant niche, whereas a sprouting neovasculature sparks micrometastatic outgrowth,” said cell biologist and lead investigator Mina Bissell, PhD, of Lawrence Berkeley National Laboratory in California. “Sprouting is meant to coincide with tissue growth, but if a tumor cell happens to be in the wrong place at the wrong time, then it comes under the influence of the factors deposited by tip cells and it starts growing.”
“Some patients may experience metastatic relapse within months, other patients may go several years or even decades without distant recurrence,” Bissell says. “The recent discovery of tumor-promoting milieus, referred to as metastatic niches, that are established at distant sites prior to or upon the arrival of disseminated tumor cells could explain cancer cells that relapse early, but in late relapsing populations, what tumor cells do from the time of dissemination to the time they become clinically detectable has been a big question.”
The research team discovered that the protein thrombospondin-1, which is prevalent in stable microvasculature, creates a dormant niche by suppressing the growth of breast cancer cells. When the tips of blood cells begin to sprout, the thrombospondin-1 proteins give way to tumor necrosis factor-beta 1 and periostin proteins in the neovasculature. This turns it into a metastatic niche that both permits and accelerates the growth of breast cancer cells.
The identification of dormant niches in basement membrane microvasculature and how those niches become metastatic in the neovasculature holds important implications for future breast cancer therapies. These research findings, published in Nature Cell Biology (2013; doi:10.1038/ncb2767), will support future models that will allow therapies to be screened that impact tumor dormancy and metastasis.

From news release at ChemotherapyAdvisor.com [info@email.chemotherapyadvisor.com]

Six-Month Intervals for Post-Lumpectomy Mammography Do Not Improve Detection Rates for Breast Cancer Recurrence

(ChemotherapyAdvisor) – Scheduling follow-up mammography every 6 months after breast-conserving treatment (BCT) offers little benefit over a schedule of annual follow-up mammography for breast cancer survivors, according to a retrospective single-institution study published in the Journal of Surgical Oncology.
“Mammography yield of cancer in the study population was not greater than the general population,” and there was “no difference” in tumor recurrence detection rates among patients complying with 6-month follow-up recommendations, reported senior author David McNaul, MD, of the University of Missouri's Department of Radiology in Columbia, MO, and coauthors.
The authors studied medical records of 399 patients who underwent BCT lumpectomies between 1997 and 2009, and who were followed for 2 years after surgery. Cancer yields from follow-up unilateral mammography were compiled and two comparisons were made: First, BCT patients' mammography-detected tumor recurrence was compared to mammography cancer yields in the general screening population. Second, yields were compared between BCT patients who were compliant or noncompliant with instructions to undergo follow-up mammography every 6 months for 2 years.
Yields were similar in both the BCT follow-up population and the general screening population and the study found “no difference between the compliant and noncompliant groups regarding tumor recurrence,” the authors reported. In the group of 67 noncompliant patients, no local tumor recurrences were identified.
Among the 399 patients instructed to undergo follow-up mammography every 6 months instead of annually after BCT, the authors noted, “the extra interval unilateral mammograms (at 6 and 18 months) only detected one local recurrence. Based on the 6-month surveillance mammography schedule, a large number of additional mammograms were performed without obvious benefit.”
“Mammography yield was 0.94 and 2.87 per 1,000 (95% CI: 0.0-0.0028) for the first and second years, respectively, following surgery,” they noted.
The study's findings are consistent with ASCO's guidelines, which recommend annual mammography after BCT, rather than the every-6-months follow-up mammography recommendations observed at some cancer centers like their own, the authors concluded.
Abstract

Breast Cancer and the Environment

I just received this newsletter and this is an excellent article. No link - so this is a direct copy

Breast Cancer and the Environment and Environmental Health Policy

by Susan Luck, Educational Director, Earthrose Institute 

In today’s world, many people experience unexplained symptoms that eventually drive them to our office seeking a diagnosis and treatment. Common complaints presented include unexplained onset of allergies, chronic fatigue and fibromyalgia, mood and behavioral changes, hormonal disruption, and immune and autoimmune issues.

Although environmental factors contribute to up to 80% of those seeking medical services, many practitioners do not have the information or tools to include an environmental assessment as part of their work up and therefore may be missing key information into the environmental triggers and what may be needed for an effective prevention strategy and treatment protocol.

It is estimated that currently there are 100,000 synthetic chemicals registered for commercial use in the world today with several thousand new ones being formulated every year. Few have been tested for human safety and while many are known to be potentially toxic and carcinogenic, new research is just beginning to show how low dose exposures over time impacts our health. We swallow, inhale, ingest, and absorb through our skin, plastics, pesticides, fire retardants, exhaust fumes, fragrances, and much more every day. They are ubiquitous and are in our homes, automobiles, cleaning products, cosmetics, clothing, children’s toys, and contribute to our continual exposure to many that have been classified  as endocrine disruptor chemicals or EDCs.

A growing pandemic of endocrine-related disorders, including ADHD, Parkinsons, Alzheimers, diabetes, obesity, early puberty, infertility and other reproductive disorders, and childhood and adult cancers, is seriously undermining the health and wealth of our nation. Recent data from the National Institute of Environmental Health Sciences (NIEHS) shows that all of these diseases can be caused by developmental exposure to EDCs in animal models.

Epidemiological evidence increasingly suggests that environmental exposures during critical windows of development including in utero, play a role in susceptibility to disease later in life, including breast and testicular cancers, and can be passed on through subsequent generations. Epigenetic modifications provide a link between the environment and alterations in gene expression that might lead to disease phenotypes.

Last month, the Center for Disease Control (CDC) issued their Fourth National Report on Human Exposure to Environmental Chemicals and concluded that Americans of all ages carry a body burden of at least 148 chemicals, some of them banned for decades. This  is the most comprehensive assessment to date on the exposure of the U.S. population to chemicals in our environment. The CDC measured 212 chemicals in people's blood or urine-75 of which have never before been measured in the U.S. population. The new chemicals tested include acrylamide, arsenic, environmental phenols, including bisphenol A and triclosan, and perchlorate.

Although the full impact of exposures to endocrine disruptors is still to come, there can be no denying that we are witnessing a spike in breast cancer, testicular, and prostate cancers along with a huge increase in infertility in both men and women.
Children, particularly vulnerable, continue to have rising rates of autism, childhood cancers, chemical sensitivities, allergies, asthma, and ADHD. Scientists and advocacy groups are leading the way to informing the public, urging health policy actions, and confronting industry on this urgent issue.

Banned in Europe, and defended in the US by the chemical industry, Bisphenol A is an example of a known endocrine disruptor originally developed to replace DES. Today, it permeates our products and our bodies and is commonly found in umbilical cord blood. For the first time, research indicates that early exposure to PBA is a predictor for breast cancer later in life.

Today, women in the United State face a greater lifetime risk of breast cancer than any previous generation, having tripled during the past 40 years, with estimates of one in six women having a diagnosis in their lifetime. Only about 5 percent of women diagnosed with breast cancer have a link to the “breast cancer gene”. This means that the vast majority of women never know what “caused” their diagnosis.

Currently, 216 estrogen disruptor chemicals have been identified. Global research estimates that women’s cumulative exposures to estrogenic compounds, both exogenous and endogenous, may be responsible for up to 50% percent of all breast cancers today.
Known environmental factors that contribute to the increase breast cancer risk include: exposure to radiation from chest x-rays in childhood, hormone replacement therapy, alcohol, tobacco and second hand smoke. Breast cancer rates are higher in women who are obese, and women who gain excess weight during adulthood. In a surprising reversal, at the annual meeting of the Radiological Society of North America this past month, a study was presented associating low-dose radiation from annual mammography screening  with an increase in breast cancer risk in women with genetic or familial predisposition to breast cancer.

The degree of alarm within the scientific community concerning the dangers of radiation and hormone disrupting environmental pollutants is also apparent in a report recently released by the Health and Environment Alliance (HEAL), a European umbrella group of non-governmental research organizations. This report directly questions the growing tendency to label breast cancer a lifestyle and genetic disease and states, "We will not be able to reduce the risk of breast cancer without addressing preventable causes, particularly exposure to chemicals."

To compound the problem of our toxic environment, we have refined away much of the nutritional value of our food supply, and replaced it with imitation foods lacking essential elements and protective phyonutrients. Our modern poor quality diet, combined with agricultural pesticides and animals being raised on antibiotics, chemical feed, and growth hormones, may have predisposed many of us to experience a toxic body burden, stressing our body’s ability to detoxify and eliminate these substances.

The good news is that cancer can be reduced by avoiding or lowering exposures to environmental toxicants as well as by optimizing our immune surveillance systems and cellular energy metabolism with nutritional intervention strategies.

As part of an integrative wellness assessment, and to be more effective in our outcomes, asking our patients about possible environmental exposures in the workplace, home, community, diet, and personal care products, can assist us in addressing how cumulative toxic exposures can impact our health, immune system, and genes and guide our intervention strategies.

There has been no public health policy campaign to address these environmental issues until last month, when the Endocrine Disruption Prevention Act, legislation introduced by Congressman Jim Moran of Northern Virginia and Senator John Kerry of Massachusetts, (HB 4190) and (S2828) proposed a bill to explore links between hormone disrupting chemicals in the environment and everyday products. This legislation also emphasizes the dramatic increase of autism, hyperactivity, diabetes, obesity, breast cancer, prostate cancer and other hormone related disorders.

As citizens and as practitioners, we now have a tremendous opportunity to impact environmental health policy by contacting our U.S. Senators and Representatives and asking them to cosponsor this bill. We need to share this with our colleagues, patients, and community to take action for changing current environmental health policy.

Participate in Susan Luck's discussion about conducting environmental assesments and environmental healthcare policy.
For more information, including sign on letters, click here.

Additional Websites
www.ewg.org
www.earthroseinstitute.org
www.breastcancerfund.org
www.safecosmetics.org
http://www.cdc.gov/exposurereport/ 

First Breast Ultrasound Imaging System Approved

This is good news for those who require Ultrasound for dense breast tissue.

The FDA approved U-Systems Inc.'s somo-v Automated Breast Ultrasound System (ABUS), the first ultrasound device for use in combination with a standard mammography in women with dense breast tissue who have a negative mammogram and no symptoms of breast cancer. Dense breast tissue may obscure smaller tumors, which could delay detection of breast cancer.
http://www.chemotherapyadvisor.com/first-breast-ultrasound-imaging-system-approved/article/259776/?DCMP=EMC-CTA_Front&Visitor_ID=&cpn=cta_sutinl&spMailingID=4912796&spUserID=MTI0ODg0NTY1NTIS1&spJobID=55116620&spReportId=NTUxMTY2MjAS1

Thermography and DCIS

With use of mammography as the 'gold standard' imaging - more and more women are being diagnosed with DCIS   "Ductal Carcinoma In Situ".

This is, however, a double-edge sword.

Early diagnosis of breast cancer is the ONLY reason that women are willing to submit to mammography.  But along with early detection – are we truly identifying those who have a ‘true breast  cancer’ or  are we willing to sacrifice women with a general diagnosis of DCIS and commit them to surgery, radiation and possibly chemotherapy – in the chance they will – in the future –convert to invasive breast cancer?

The diagnosis of DCIS – is rarely discussed in terms of ‘not yet a breast cancer’.

Following the call-back after a diagnostic mammogram – the patient is usually in a state of shock – and presents with a ‘deer in the headlights’ condition.  Is this really the best time for a discussion to take place?  However – whether it is the ‘optimal’ time or not --- the only words women appear to hear is ‘breast cancer’.   There is no IN SITU explanation what-so-ever.

When all patients with ductal carcinoma in situ are considered, the overall

mortality from breast cancer is extremely low, only about 1–2%. When conservative treatment fails, approximately 50% of all local recurrences are invasive breast cancer. In spite of this, the mortality rate following invasive local recurrence is relatively low, about 12% with eight years of actuarial follow-up.

The management of ductal carcinoma in situ of the breast: Endocrine-Related Cancer (2001) 8 33–45 K A Skinner and M J Silverstein

92% of all newly diagnosed patients had nonpalpable lesions, most of which were detected mammographically [4]. High-quality mammography is capable of finding a range of nonpalpable, asymptomatic, noninvasive lesions, many smaller, of lower nuclear grade, and with subtler mammographic findings than had been seen in the past. The concept of DCIS as a single disease entity is clearly not valid. DCIS is a heterogeneous group of lesions with diverse malignant potential.

Ductal Carcinoma In Situ of the Breast: Controversial Issues. Melvin J. Silverstein. 1998  The Oncologist.

Until recently --- there is usually an opportunity for the woman to receive an MRI with and without contrast.  The MRI conducted in this manner would help to identify if the IN SITU identified by mammography was, in fact, the only area of potential abnormal cells or if there are other areas of ‘DCIS’ in the same or potentially both breasts that mammography did not detect.

I say until recently --- because a recent study sends the message that the MRI may not be needed.  “ Pre-op MRI ineffective in preventing further breast cancer surgery”     September 19, 2012 | By Susan D. Hall

But – the question that I pose is “not necessary” according to whom?

MRI with contrast not only identifies those areas of suspicious cells – but aids in the detection of neoangiogenic support.  According to most if not all medical literature – cancer is unable to grow without the expression of angiogenesis.  Mammography is UNABLE   to detect the presence and or the absence of neoangiogenesis for any mammographic abnormality.  The utilization of Doppler Ultrasound usually follows a questionable mammogram to identify blood flow associated with the questionable area.  If we are denied the Ultrasound and now denied the MRI prior to biopsy or surgery --- how is the extent of the cancer determined prior to the “first cut”?

The primary issue regarding the diagnosis of DCIS – is this: DCIS MUST BE IDENTIFIED BY THE CELL TYPE AND THE STAGE... Without this information and the education related to these facts the woman is making a treatment decision based on fear alone.  The radiologist or the surgeon that does not educate the patient with regard to the current cell status and the true potential for future invasive cancer is being deceptive.  They are treating DCIS as an invasive cancer when it very well may not have the propensity for conversion.

Prior to mammographic detection of DCIS – pre 1990’s almost all DCIS was treated by mastectomy.  The true reason for this is most women who presented with what was diagnosed as DCIS already displayed palpable lesions.  Most of the “DCIS” was growing and more than likely was already an invasive disease.  But with mammographic detection of non-palpable lesions, the only true way to discern the potential threat is by Grade and cell type. The biopsy will provide this information.  Ask about the Grade and the 'comedo subtype'.

“Danish studies estimated that about 25% of all women will develop in situ carcinomas, predominantly in the form of DCIS.  Only a fraction of these lesions will evolve into a clinical manifest form”

WOMEN – educate yourself about DCIS prior to getting a mammogram.  Statistically -- one in four women will be given this diagnosis.  Be prepared and ask questions – don’t be driven by fear.

Thermography is currently the only non-invasive way to detect the pattern of neoangiogenesis in an abnormal thermogram.  DCIS with no neoangiogenesis present has a higher probability of being Low Grade or benign. MRI with contrast will help identify the presence and extent of neoangiogenesis in the breast. 

Thermography as a monitoring tool can aide in identifying early changes that are potentially breast cancers.  MRI is currently the only definitive test for localization of neoangiogenesis within the structure of the breast. 

Next Blog: Detection of DCIS by Thermograpy: True or False?

Don't Be Fooled

I've recently received a publication that included this article on health insurance (Understanding Medical Loss Ratio by Leon Kircik, MD).  I'm not a fan of insurance -- as it's legalized gambling;  but DIYD-DIYD (darned it you do and darned if you don't) participate. I frequently hear disparaging comments about the Affordable Care Act - "Obama Care"  -- as if this is some horrible 'Government Controlled' imposition.  But often I believe most people are only listening to propaganda created by insurance companies to over-rule or dismantle the potential of this Act. We, the people, are losing ground in our ability to fight against corporations who are only concerned with profit and not in the business for the general good. Government was created for the purpose of aiding 'the people'.  We are all - 'the people'.
Do you know that insurance companies are 'businesses"? Everything businesses do is designed to create profit -- and to the greatest extent.  Therefore -- whatever they (insurance companies) pay out for your health-related costs -- is money they have lost.  The difference between what we as consumers pay for premiums and what the insurance companies pay to cover our care is classified as 'medical loss ratio' . There is great incentive to NOT PAY. What they don't pay for our care - becomes a profit.
The Affordable Care Act has set limits to the percent of money insurance companies can hold back from paying. This law states insurance companies need to pay out 90% of our premiums toward our care.  If this Act is impaired, or worse yet - dismantled, then you and I will receive less and less for the premiums we pay and insurance companies will profit more and more.  With no restrictions or regulation on the amount of profit from dollars we pay, individuals will have little ability to demand changes in this profit structure. Is this what you really want? Profit is the only incentive for any business operation. But reasonable profits, not exploitation. Is "Government intervention" in exploitation really evil? I think if you're an insurance company or own stock in these firms it is -- but if you're looking for financial assistance to cover huge medical costs -- perhaps it's not. Remember, everything we evaluate is based on our perspective.  Why not look at the Affordable Care Act from many angles before you criticize what "Obama Care" might mean for all.

AMA Speaking Out Against Thermography (again)

We left off with the last post To Be or Not To Be (Rebuilt) Is That the Question?

What’s my reason for blogging about new advances in breast reconstruction if the procedure isn’t readily available?  You need information -- because most women are not exposed to changes in technology taking place in any phase of research related to breast cancer, diagnosis, treatment or the devastating effects that the disease and treatment create. Women are blindly following the advice of their physician at a time of intense fear – immediately following the discovery of breast cancer.  Fear and ignorance (different than stupidity – ignorance is a lack of information) drive women to “get it out” within days of a positive biopsy (sorry girls it’s been there growing for quite a while, a few days added to your planning process before surgery or treatment won’t stop metastasis.)  Physicians are still in ‘business’ ladies and they often want you to use them for your surgery and treatment. They know that the sooner they get you into the process --- you’ll be more likely to use their services instead of “shopping around”.  They don’t like women who ask questions. It takes too much time (remember your insurance company and the doctors practice-builder won’t let them spend more than 10-15 minutes with you or the visit isn’t generating the maximum revenue.)  They need you in and out and on the table, then off to the oncologist to determine if you’ll get radiation or chemo (there is a specific treatment recipe for your cancer type – and only that recipe will be approved by your insurance company. Don’t your dare try to cut steps or improvise or you won’t have coverage!)

Most women can’t “shop” for the ideal surgeon, or treatment center due to physical (geographical) and insurance restrictions.  But it always amazes me how fear causes so many to make rash, uneducated choices.  Women are starting to talk to plastic surgeons prior to lumpectomy and mastectomy to determine how they will rebuild their breasts post surgery. Unfortunately the current procedures (flap rebuilding, or implants) don’t give you your original shape back. You will not look like your do pre surgery. Also astounding is that women are opting for double mastectomy (taking the good breast with the bad) and re-building both as a breast cancer preventative. Fifty-six percent of double mastectomies believe this will prevent future cancer – even though studies find no survival advantage in removing the healthy breast.

Love it or hate it --- the practice of medicine still controls most.  The disease model (wait until disease happens – panic and try to save your life in the face of a dysfunctional body, assaulted by both disease and treatment) is ‘socially accepted’.  The general population walks around with the belief that their body only carries their head to and from a destination. Their body is responsible for itself and what we eat, what we do with it have nothing to do with getting sick – let alone cancer.  Good luck with that idea! 

Have you had an "interesting" situation with reconstruction or post diagnosis decision making? If so please share your experience.

We left off with the last post TO Be or Not To Be (Rebuilt) Is That the Question?

What’s my reason for blogging about new advances in breast reconstruction if the procedure isn’t readily available?  You need information -- because most women are not exposed to changes in technology taking place in any phase of research related to breast cancer, diagnosis, treatment or the devastating effects that the disease and treatment create. Women are blindly following the advice of their physician at a time of intense fear – immediately following the discovery of breast cancer.  Fear and ignorance (different than stupidity – ignorance is a lack of information) drive women to “get it out” within days of a positive biopsy (sorry girls it’s been there growing for quite a while, a few days added to your planning process before surgery or treatment won’t stop metastasis.)  Physicians are still in ‘business’ ladies and they often want you to use them for your surgery and treatment. They know that the sooner they get you into the process --- you’ll be more likely to use their services instead of “shopping around”.  They don’t like women who ask questions. It takes too much time (remember your insurance company and the doctors practice-builder won’t let them spend more than 10-15 minutes with you or the visit isn’t generating the maximum revenue.)  They need you in and out and on the table, then off to the oncologist to determine if you’ll get radiation or chemo (there is a specific treatment recipe for your cancer type – and only that recipe will be approved by your insurance company. Don’t your dare try to cut steps or improvise or you won’t have coverage!)

Most women can’t “shop” for the ideal surgeon, or treatment center due to physical (geographical) and insurance restrictions.  But it always amazes me how fear causes so many to make rash, uneducated choices.  Women are starting to talk to plastic surgeons prior to lumpectomy and mastectomy to determine how they will rebuild their breasts post surgery. Unfortunately the current procedures (flap rebuilding, or implants) don’t give you your original shape back. You will not look like your do pre surgery. Also astounding is that women are opting for double mastectomy (taking the good breast with the bad) and re-building both as a breast cancer preventative. Fifty-six percent of double mastectomies believe this will prevent future cancer – even though studies find no survival advantage in removing the healthy breast.

Love it or hate it --- the practice of medicine still controls most of you.  The disease model (wait until disease happens – panic and try to save your life in the face of a dysfunctional body, assaulted by both disease and treatment) is ‘socially accepted’.  The general population walks around with the belief that their body only carries their head to and from a destination. Their body is responsible for itself and what we eat, what we do with it have nothing to do with getting sick – let alone cancer.  Good luck with that idea! Have you had in "interesting" situation with an insurance company; if so please share your experience.

To Be or Not to Be (rebuilt) Is This The Question?

I love  Wired Magazine. It’s informative, edgy and helps me stay connected with current technology, trends and details about incredibly diverse markets.  I keep my copies and read and re-read them, because an article or information in Wired this month will show up in another publication next – and remind me I should look at the data again.

The cover story of Wired – November 2010 was about engineered tissue. Breasts were the focus of the article.  “New and improved. How tissue engineering can help the body rebuild itself." This article was researched and written by Sharon Begley.

The long and short of it --- use our own fat tissue injected back into the body to rebuild surgically damaged breasts.  Cytori Therapeutics has developed technology to use the stem cells of our fat tissue to rebuild or remodel the breast following lumpectomy or other surgical procedures that alter (deform) our shape.  As in all newer medical applications, Cytori is still working to get FDA approval to begin clinical trials in the United States.

Cytori was able to work with Japanese research physicians to begin human trials in early to mid-2000. Next was a clinical trial in Europe using a second generation process for women who had partial mastectomies. The number of participants in each trial was very small. Approximately 20 women are followed in each clinical trail.

Stem-cell re-growth of tissue isn’t a new concept.  It still is wrought with technical and political backlash. This article provides a very good synopsis of the risks and benefits of fat stem cell use. The key problem is the need to stimulate the cells into growth and also staying in place where they are injected.  “The problem is that the reason adipose regenerative cells work – inducing the formation of blood vessels—is also the reason they might be dangerous, especially to cancer survivors. Such angiogenesis, after all, is what allows metastatic tumors to thrive.”  Begley goes on to outline how researchers are studying and dealing with these issues. (this is a critical part of a big problem and we'll discuss this one later too)

Not ready for prime time?  Breast remodeling with fat tissue in the general population is still a ways off.  It is difficult to say how long before it happens.  Other applications (plastic surgery) using re-injected fat cells are already being done. The time to determine what you’d do if you received the diagnosis of breast cancer is before you do- and hopefully you never will!  It’s time to become more informed about what is happening in all phases of the process. 

Human tissue re-engineering holds a lot of potential --- but it’s not your answer today.  Disease prevention is still the most effective and cost-effective way to deal with your health.  Just as another of my favorite authors says “acceptance is the key to all our problems”.  Do what you can to accept your responsibility for the shape you’re in.   This is something you can change.  Cutting off your hand for a hang nail will only ensure you won’t have a hang nail on that hand. You have two hands. The same can be said for breasts --  cutting them off and rebuilding may not be the answer to potential disease problems. "Fifty-six percent of double mastectomies believe this will prevent future cancer – even though studies find no survival advantage in removing the healthy breast."

 This discussion is to be continued ----- but let know what you think. To Be or Not to Be (rebuilt) Is it the Question?

Inflammation and Its Role in Cancer  (from 2010)

In a recent copy of The Journal of Supportive Oncology – an article by Dr. Neil MacDonald- Professor of Oncology and Director McGill Cancer Nutrition and Rehabilitation Programme, McGill University Montreal Quebec Canada, covers the role inflammation plays in cancer.  “Chronic inflammation often acts as a tumor promoter, resulting in aggressive cancerous growth and spread.  Many of the same inflammatory factors that promote tumor growth also are responsible for cancer cachexia/anorexia, pain, debilitation, and shortened survival.  A compelling case may be made for mounting an attack on inflammation with other anticancer measures at initial diagnosis, with the consequent probability of improving both patient quality of life and survival.”

This is a welcomed article, considering that an overwhelming number of physicians maintain and promote quite the opposite position.  A patient who came for a thermal scan to evaluate her physiology, commented that her surgeon was angry when she wanted to “build her immune system” before committing to surgery for recently diagnosed breast cancer.  This surgeon was adamant that she not wait and building her immune system would not benefit her.  Obviously she felt it would help her in the long run.  But new evidence shows us that we need to evaluate the level of inflammation to determine the best course of action.

Dr. MacDonald comments that there are two schools of thought concerning immunity.  He refers to this as “friend or foe?” “Immune response to invasive tumor growth is highly nuanced; certain immune-defense patterns limit tumor progression, even in advanced disease.  Nevertheless, immunoreactive cells around the tumor (primarily part of the innate immune reaction) more likely are acting in malevolent alliance with malignant cells than exerting a defensive posture.  We are not helped when suppression cures to control the innate response are ineffectual and the system remains in the “on” position.  Evidence that this is happening includes the following.

Tumor-associated macrophages produce angiogenic factors and tissue proteases that promote development of the tumor blood supply and infiltration.

Stromal factors surrounding a tumor commonly promote an M2 macrophage reaction’ ie, one that does not involve an attack on the tumor. Rather, it is associated with a decreased M1 macrophage response, which may interfere with antitumor immunity.”

Dr. MacDonald goes on to say “chronic inflammation often acts as a tumor promoter, resulting in aggressive cancerous growth and spread.  Many of the same inflammatory factors promoting tumors also are responsible for the devastating symptoms that bedevil patients and their families, reducing quality of life and limiting independent function.”

Seeing this article improved my level of confidence when promoting thermal imaging.  Although many physicians are still ‘playing old tapes’ when it comes to knowledge of thermal imaging – “old technology – nonspecific etc., etc.” they are not thinking of what the potential thermal patterns can provide them. 

No disease is diagnosed with thermography.  Similarly – no disease is truly diagnosed with an x-ray.  There is often suspicion of the ‘presence’ of disease, but biopsy is needed to confirm.   Sadly when physicians only rely on structural imaging – there can be consequences.  A practitioner I met recently told me about a patient – who following treatment exhibited no thermal signal.  The MRI, however, was detecting ‘something’.  They elected to proceed with removal of the breast based on the MRI.  When the breast tissue was x-rayed following removal (a common procedure) there was no cancer present. It becomes a difficult situation.  If physiology says there is no action – do you wait and follow or do you proceed with a ‘safe’ alternative?  This woman will now statistically become one of those “cured”.  But actually – had benefited from the therapy – and surgery at that point was excessive action.  Some would argue for “better safe than sorry” and claim that in time the cancer would return. Sad that they second guess their own therapy.

Infrared imaging can easily detect the presence of inflammation.  It then becomes the job of the practitioner to determine the location and level of response.  But if we totally ignore the inflammatory markers that thermal detection displays – are we not missing 

Resistance to Mammography

I often hear the comment - "I've been trying to locate a thermography center because I no longer want to have mammograms." This is a common misconception regarding a thermographic or infrared exam. Thermography does not replace mammography. Why? Thermography, or Infrared Imaging, is a test that provides information related to the blood flow in the breast tissue. Only some centers -- mostly research at this point -- are able to measure where in the breast the abnormal signal is located. Most thermal tests provide information related to the degree of abnormality present, if any. This can be determined by temperature measurements. It does not tell the difference between the heat from infection or the heat from potential cancer. The amount of heat - or cold- measured determines the severity, or level of RISK present during the time of the thermal test. Only structural tests can locate the actual tumor, if it exists. Thermal signals demonstrate the chemical or metabolic presence of abnormality. Mammography, ultrasound, MRI, or scintigraphy (which are all structural exams) will locate abnormal tissue. Thermography is the complement to these tests. It is the less expensive and non-invasive option for easy monitoring. If you would like additional information or to schedule testing email thermograms@comcast.net.We have pamphlets that cover this information, and much more regarding breast health.