Breast cancer detection: more than wishful thinking

As I mentioned at the outset of these three columns, I have a long personal and professional interest in the subject of breast cancer. I grieved my mother's breast cancer diagnosis and ultimately her death. I winced at its grim effect on my own prognosis: Her premenopausal diagnosis easily doubled my risk of breast cancer. A generous colleague informed me during my internship that breast cancer often comes earlier in successive generations — my grandmother's in her 50s, my mother's in her 40s, when would mine come? At that time I bristled and signed up for an early mammogram. From the vantage point of my early 60s, of course, I think of his pronouncement as a magical, though tiny, blessing of safety.

I detect a similar magical and tiny blessing in the recent recommendations for decreased mammograms and decreased instruction in self-breast exams. The recommendations do compel a response, but I believe the current public debate is missing the most important point for women's true wellbeing.

To first credit the new guidelines, they indicate that our immune systems are stronger than we thought. It seems that a significant number of cancers smolder and perhaps even regress without medical treatment. The news should be gigantic and on billboards: Despite an increasingly toxic environment (plastics, poisons, etc.), women are not such easy targets for breast cancers. We don't have to find them as early as we thought to have the same success rate in curing them. Cure can happen with a joint effort involving women's immune systems and medical science.

I also welcome the advice that as physicians we are asked to wield our instruments with greater care. Cautious medical practice avoids X-rays that are not thought to be of benefit to the patient. Premature and overly frequent screening mammograms fall into this category.

I was at first taken aback at the caveat to stop teaching self breast exams. What could be the harm? Of course, the exams themselves offer no harm. Women, it seems, are actually better at finding small tumors while bathing than when they follow the proscribed maneuvers. In this case, intuitive awareness is keener when it operates unfettered by instructions.

If the issue were as simple as how much money to spend to save one life — we could debate that. But what the research suggests is that mammograms do not provide the service we are asking of them. Wishing will not make it so.

We learned that mammograms miss breast cancers in a significant number of women studied, especially younger women. We learned that mammograms can overdiagnose cancer where it isn't dangerous, subjecting healthy women to repeat mammograms, biopsies, chemotherapy and radiation.

Any outcry should not be to hold on to our mammograms. Our justified outcry should be a demand for research into a better screening tool! Safe and effective. Fewer cancers missed, fewer healthy breasts deemed worrisome.

What about right now: Is there a better way? Perhaps. What do I personally recommend? Something that's not so easy to get, not covered by most insurance and needs more research, but is also completely safe, equally reliable for different ages and even for men, captures more of breast physiology than its architecture, and can identify suspicious areas before a lump forms.

Breast cancers don't manifest as spontaneous lumps spontaneously; they form from abnormal cells fed by new blood vessels. When the body creates blood vessels, it's called neo-angiogenesis, which is dangerous if it's allowing a cancer to grow. Some forms of cancer treatment are intended to block this process.

Thermal imaging is newer than X-rays, was primitive in the 1960s and has shown promising advances in the last decade. Mammograms, ultrasounds and MRIs rely primarily on finding a physical tumor. Thermal imaging is based on detecting the heat generated by increased circulation and metabolic changes associated with and even preceding a tumor's growth. Appropriate interventions can sometimes normalize worrisome trends in breast physiology. Thermography, like mammograms, requires three skilled specialists for an optimal exam: a technician, an interpreter and a personal physician to apply the findings to an individual patient's situation.

We want more than magic and wishful thinking. Based on what I know now, I'm going with first line prevention (see Thursday's column for details). Admitting that prevention is no guarantee, I am also interested in safe and effective diagnostic tools. Right now, I'm most impressed with thermography, using other diagnostic imaging for confirmation where needed.

Deborah Gordon, M.D., is fully trained in family practice and specializes in classic homeopathy and preventative medicine in Ashland, where she has lived for 23 years.

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