New breast cancer screening guidelines released

New breast cancer screening guidelines released

Canadian Task Force on Preventive Health Care issues updated guidelines

New breast cancer screening guidelines for women at average risk of breast cancer, published in CMAJ(Canadian Medical Association Journal), recommend no routine mammography screening for women aged 40–49 and extend the screening interval from every 2 years, which is current
clinical practice, to every 2 to 3 years for women aged 50–74. The guidelines also recommend against routine clinical breast exam and breast self-examination in asymptomatic women.

The guidelines, aimed at physicians and policy-makers, provide recommendations for mammography, magnetic resonance imaging (MRI), breast self-exams and clinical breast exams by clinicians. They target average-risk women in three age groups (40–49, 50–69 and 70–74 years) who have not had breast cancer and do not have a family history of breast cancer in a mother, sister or daughter.

“As the Guideline on Breast Cancer Screening was last updated in 2001 and breast cancer screening has since become a subject for discussion amongst doctors and patients, the revitalized Canadian Task Force selected breast cancer screening as the topic for its first guideline,” said Dr. Marcello Tonelli, Chair of the Task Force on Preventive Health Care and Associate Professor at the University of Alberta, Department of Medicine, in Edmonton, Alberta. "We intend that this Guideline, which
reflects the latest scientific evidence in breast cancer screening, be used to guide physicians and their patients regarding the optimum use of mammograms and breast examination.”

According to the guideline, outcomes of breast cancer screening such as tumor detection and mortality must be put into context of the harms and costs of false–positive tests, over-diagnosis and over-treatment. False–positive results can have a significant impact on the emotional well-being of patients and families. They can cause lifestyle disruptions and result in costs to both patients and the health care system.

“Providing Canadians with guidelines that reflect the most current scientific evidence is our priority," said Dr. Tonelli. “We encourage every woman to discuss the risks and benefits of screening with their doctor before deciding on the best approach for them.”

Key recommendations:

No routine mammography for women aged 40-49 because the risk of cancer is low in this group   while the risk of false–positive results and over-diagnosis and over-treatment is higher
Routine screening with mammography every two to three years for women aged 50-69
Routine screening with mammography every two to three years for women aged 70-74
No screening of average-risk women using MRI
No routine clinical breast exams or breast self-exam to screen for breast cancer.

“There was no evidence that screening with mammography reduces the risk of all-cause mortality,” state the authors. “Although screening might permit surgery for breast cancer at an earlier stage than diagnosis of clinically evident cancer (thus permitting the use of less invasive procedures for some women), available trial data suggest that the overall risk of mastectomy is significantly increased among recipients of screening compared with women who have not undergone screening.”

In addition to the full guidelines, one-page information pieces are available for both physicians and patients on the task force website: www.canadiantaskforce.ca

The Canadian Task Force on Preventive Health Care is an independent body of 14 primary care and prevention experts. The task force has been established by the Public Health Agency of Canada to develop clinical practice guidelines that support primary care providers in delivering preventive health care.

In a related commentary, Dr. Peter Gøtzsche, Nordic Cochrane Centre, Copenhagen, Denmark, writes, “these guidelines are more balanced and more in accordance with the evidence than any previous recommendations.”

He states that evidence does not support mammography screening and argues that screening is ineffective and even harmful because diagnosis of cancers that would otherwise be undetected lead to life-shortening treatments and mastectomies.

“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening,” writes Dr. Gøtzsche.

“The best method we have to reduce the risk of breast cancer is to stop the screening program,” he concludes. “This could reduce the risk by one-third in the screened age group, as the level of overdiagnosis in countries with organized screening programs is about 50%.”

MEDIA NOTE: Please use the following public links after the embargo lift:
Research http://www.cmaj.ca/lookup/doi/10.1503/cmaj.110334
Commentary http://www.cmaj.ca/lookup/doi/10.1503/cmaj.111721
Media contact for guidelines:
David Rodier
Hill & Knowlton
(613) 786 9945
david.rodier@hillandknowlton.ca

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Medical Infrared Imaging of the Breast: An Analysis of 100 Successive Cases of Breast Cancer

Medical Infrared Imaging of the Breast:

An Analysis of 100 Successive Cases of Breast Cancer

William C. Amalu, DC, DABCT, FIACT

PCRC Infrared Imaging Lab – Redwood City, California

March 18, 2015

     The following data presents the findings in 100 successive cases of breast cancer using medical infrared imaging (MIR). Thermovascular markers were detected using a specialized high-resolution computerized medical infrared imaging system capable of detecting minute variations in the regional vascular perfusion of the microdermal circulation. The imaging system used is composed of a highly sensitive infrared camera coupled to a central processing unit capable of multitasking capabilities including post-image processing and accurate temperature measurements (Spectron IR 640 Medical Infrared Imaging System). All pre-imaging patient preparation protocols and laboratory requirements were strictly adhered to as per established MIR standards and guidelines.

     Following MIR interpretation guidelines, each patient was referred back to their primary care provider with recommendations for follow-up imaging or testing. The final diagnosis in each case was made by biopsy.

     In the data presented is a special category of patients. In this group MIR was the first alarm that anything was wrong. If it were not for MIR all of these patients would not have known they had breast cancer.

     When analyzing each breast, 20 basic thermal attributes are used in the grading process. A computerized analysis of both thermovascular patterns and objective temperature values are compared to a normative database. This determines where each breast is graded into one of five thermobiological classifications:

TH1 – uniform non-vascular

TH2 – uniform vascular

TH3 – questionable

TH4 – abnormal

TH5 – very abnormal

The following is a summary of the MIR findings in 100 successive cases of breast cancer –

Thermobiological Grade 3 (TH3 – questionable):  22 cases

·         Of the 22 cases, 10 were “first alarm” thermograms.

·         Of the 22 cases, only 9 were true TH3s. The remaining 13 cases were TH3+ (TH3+ thermograms are almost TH4s)

·         Of the 22 cases, 2 cases had bilateral breast cancer graded TH3 in both breasts.

·         One case was only 28 years old. This was the youngest patient in all of the 100 cases.

·         Of the 22 cases, 10 cancers were in the right breast and 12 in the left breast.

Thermobiological Grade 4 (TH4 – abnormal):  43 cases

·         Of the 43 cases, 22 were “first alarm” thermograms.

·         Of the 43 cases, 1 case had bilateral breast cancer graded TH3 in one breast and TH4 in the other.

·         Of the 43 cases, 1 patient was pregnant.

·         Of the 43 cases, 1 patient had a 3 year lead-time thermogram warning.

·         Of the 43 cases, 14 cancers were in the right breast and 29 in the left breast.

Thermobiological Grade 5 (TH5 – very abnormal):  35 cases

·         Of the 35 cases, 18 were “first alarm” thermograms.

·         One case was only 36 years old.

·         Of the 35 cases: 3 were TH6s, 2 were TH7s, 2 were TH8s, and 1 case was a TH9

·         Of the 35 cases, 1 patient had a 4 year lead-time thermogram warning.

·         Of the 43 cases, 13 cancers were in the right breast and 22 in the left breast.

Summary –

     Of the 100 cases 22% were TH3 (questionable), 43% were TH4 (abnormal), and 35% were TH5 (very abnormal). As such, 78% of the cases were TH4 or TH5 abnormals. This closely approaches the published literature stating that approximately 85% of all breast cancers are found in the TH4-5 range. If we were to adjust the data to include only the true TH3 thermograms, 92% of the breast cancer cases in this group would have been found in the abnormal range.

     Of note, 37% of the breast cancers were found in the right breast while 63% of the cancers were discovered in the left breast. This agrees with the literature that the vast majority of breast cancers are found in the left breast.

     The 22% of all cases found in the TH3 range points out the importance of making sure that if recent structural imaging has not been done that all TH3 graded thermograms are followed up with structural imaging.

     Of greatest importance is the 50% of the women who had “first alarm” thermograms. All of these women would not have known they had breast cancer if it were not for MIR. Many of whom would have gone from a year to many years before having any other imaging done. How many of these women would have died if not for this technology? How many breasts were conserved due to MIR? What about the women in this group who were under 40 years of age? Cancers in this age group are usually more aggressive and have poorer survival rates.

     As an adjunctive imaging technology, MIR offers every woman the possibility of earlier detection. The unique capability of MIR may also play a significant role in prevention. Studies continue to demonstrate that the addition of MIR to every woman’s regular breast health care increases survival rates along with preserving the breast.

Foot evaluation by infrared imaging

Foot evaluation by infrared imaging.
DiBenedetto M, Yoshida M, Sharp M, Jones B.
Source University of Virginia, Department of Physical Medicine and Rehabilitation, 545 Ray C. Hunt Drive, Suite 240, Charlottesville, VA 22903-2981, USA.

Abstract
For better assessment of foot injury severity during basic military training, we evaluated a simple
noninvasive technique: thermography. With this infrared imaging method, we determined normal foot
parameters (from 30 soldiers before training), thermographic findings in different foot stress fractures (from 30 soldiers so diagnosed), and normal responses to abnormal stresses in 30 trainees who underwent the same training as the previous group but did not have musculoskeletal complaints. We found that normal foot thermograms show onion peel-like progressive cooling on the plantar surface, with a medially located warm center at the instep. Thermograms of injured feet show areas of increased heat, but excessive weightbearing pressures on feet, new shoes, or boots also cause increased infrared emission even without discomfort. Differentiation remains difficult; however, thermography can detect injury early. It does not reveal exact diagnoses, but its greatest benefit is easy follow-up to monitor severity and healing.