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