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