Five Years Plus











{August 22, 2010}   Re-imagining Imaging

As my regular readers know in recent blog posts I have been exploring breast imaging issues. I had my first thermography appointment this week and I have to admit, it was a bit anti-climatic after all this build-up. After changing into a lavender colored gown on my top, the appointment started with a health history review and time for questions, after which I sat on a swiveling stool in front of an infrared camera while my practitioner took six pictures from different angles. I was in and out within half and hour. The best part was seeing the colorful images of my breasts displayed on the laptop monitor looking kind of like a topographical map. Although the images are produced instantaneously, they need to be interpreted by a qualified doctor, so I had to wait for my results.

All my research indicates that thermography can indicate the earliest signs of breast cancer, is radiation-free, pain-free and poses no health risks whatsoever. It actually detects the activity of abnormal cells and has the ability to accurately assess younger women with dense breast tissue for whom mammography is notoriously unreliable. Oh by the way, it is also the least expensive screening technology available. So why isn’t it the dominant breast cancer screening modality? Why isn’t it even recommended by most physicians?

Thermography, also known as digital infrared imaging, is based upon the principle that chemical and blood vessel activity in both precancerous and the area surrounding a developing breast cancer is almost always higher than in normal tissues. This activity frequently results in an increase in regional surface temperature of the breast. Thermography uses ultra-sensitive infrared cameras and sophisticated computer software to detect, analyze, and produce high-resolution images of these temperature variations, which may be the earliest signs of breast cancer.

In the race for better imaging spearheaded in the 1970’s thermography showed promise, but was sidelined by the conventional medical establishment by the 1980s. I found several different explanations for this.

  1. Early Mistakes – In Beyond Mammography, Len Saputo recalls that breast thermography became available in the 1960s, before clinical trials of its effectiveness were completed and before there was a clear understanding of how to interpret the images. A relatively high rate of unnecessary surgeries resulted, leading the technology to be “sidelined by mainstream medical practice for several decades”.
  2. Technology improvements – When I asked the technician who performed my thermogram the reason that thermography was not used more often, she replied that the medical infrared imaging cameras and computer technology had improved greatly over the past decade making it much more suitable now for widespread use.
  3. Inappropriate Comparison – According to the American College of Clinical Thermology, when thermography was first explored for breast imaging during the 1970s, it was tested and evaluated as a competitive strategy to mammography. In 1974 a major project on breast screening called the Carolina Breast Cancer Detection Project that included thermography concluded that mammography should become the primary imaging modality. In fact, the two tests are complementary and both have a place in the detection of breast cancer. Mammography is a structural test that looks at the anatomy of the breasts, density changes and lumps, masses and calcifications. Thermography, on the other hand, measures the activity of the tissue by how much heat is generated. Clinical studies show that in women under age 50, thermography alone is more sensitive (better at detecting suspicious tissue) than mammography, finding 90% of cancers vs. only 70% for mammography alone. However the two modalities combined offer 97% sensitive detection of breast cancer!
  4. Insurance Coverage Revoked – Also according to the American College of Clinical Thermology, while thermography’s role in breast imaging was being explored, it was also being used in other diagnostic roles. It became popular to use in court as a visual proof of pain in accident and injury lawsuits. In response, the insurance industry lobby succeeded in removing insurance coverage for thermography in the United States.
  5. Economic/Political Issues – Thermography is inexpensive and because it is inherently safe and doesn’t involve any radiation, requires no regulation or an expensive clinical environment to administer. Screening mammography and the associated follow-up tests (e.g. ultrasound, biopsies) represent an $8 billion industry which might be threatened if thermography was more prominent.
  6. Too Early Detection – Thermograms can pick up changes that precede cancer. When it was first tested on younger women, abnormalities were detected that mammograms couldn’t find. At the time, these were considered “false positives” and led to a mistrust of thermography. It turned out that a large percentage of the women who had these so-called “false positives” developed breast cancer years later. “Thermography’s only ‘error’ was that it was too accurate too early and the results couldn’t be corroborated at the time.” Thermography can provide an early warning signal before tissue actually becomes cancerous. However, if a woman has an abnormal thermogram that no other test can corroborate, the conventional medical establishment still will likely discard it as a “false positive”. Currently there is no protocol (other than surgical removal) in the conventional standard of care for what to do about something that is not cancerous but might become cancer in the future.

What Next?

At the moment there is a resurgence of interest in thermography due to the accumulation of clinical research, improvements in infrared imaging technology and the growing realization that mammography is not an effective option for pre-menopausal women. Thermography could play an important role in the development of a real breast cancer prevention strategy, acting as an early warning system by detecting tissue changes that reflect the early cancerous process. Studies on thermography have demonstrated its ability to warn that this process is underway 8-10 years before any other test can detect it – even before the cells become cancerous. At this early stage, preventive measures such as nutritional supplements, increased exercise and a lifestyle that reduces cellular inflammation and acidification would have time to take effect before cancer ever formed. In addition, thermographic baseline studies are appropriate for women as young as age 20 or 25 whereas harm from the mammogram’s ionizing radiation is cumulative and much worse for younger women.

Robert Kane, a lecturer and thermal imaging interpreter, suggests that the popularization of thermography will have to occur at the grassroots level due to the current political, funding and insurance issues. For my part, I can whole heartedly endorse my first experience of thermography. Three days after my test I received a call from the owner of Advanced Thermal Imaging offering an overview of my results (they had also been mailed to me in a report that morning). I did not realize the undercurrent of stress I had been holding until I heard the words “nothing suspicious”. I was informed that there is “an irregular heat pattern on the left side of my left breast” that although not of concern at this time, should be monitored given my previous history. The fact that there is a way to assess and follow the health of my breast tissue and the lymphatic area on the side where my breast tissue was removed feels very reassuring.

You can find the articles I used to reference this post embedded in the text. I recommend you check them out if you are considering thermography for yourself. A list of approved thermography clinics can be found here. The photo is from the Advanced Thermal Imaging website.

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{August 14, 2010}   The D-bate

Prior to my first thermography appointment (in less than a week) I have done a lot of research on imaging and early detection. While learning some fascinating facts on cancer screening and diagnosis, I have begun to question whether the emphasis on detection and diagnosis might completely miss the point. What about preventing cancer in the first place?

I despair at attempting a comprehensive answer which would include proper nutrition, suitable physical exercise, stress and inflammation reduction, avoidance of toxins (e.g. industrial chemicals, pollutants, pesticides, drugs, tobacco smoke, alcohol, and ionizing radiation), a healthy mental attitude, nourishing family and social relationships and beliefs (religious or spiritual) that connect us to something larger than ourselves. The prospect of trying to comprehend and apply all of this is almost enough to send me scampering back to the straightforward recommendations of my doctors and the seeming certainty of the Standard of Care.

This week I want to focus attention on the debate on vitamin D. There is promising evidence that it has a role in the prevention and treatment of breast cancer and other diseases, but the American Cancer Society and the National Cancer Institute do not currently recommend vitamin D supplements. Beyond a basic multivitamin, many people do not regularly take supplements. There is a common belief that “if we eat properly we will get everything we need” and the conventional medical system has downplayed the importance of supplements. So what is the evidence for and against taking vitamin D supplements?

The case for vitamin D supplementation

Vitamin D is a pro-hormone that influences many genes. Proper levels of vitamin D have been linked to improved muscle strength, proper immune function, reduced inflammation and absorption of calcium and phosphate required for bone health. Our skin produces Vitamin D when exposed to sunlight. Today about half the adults in developed countries have deficient levels of vitamin D probably due to lower exposure to unscreened sunlight. The role of Vitamin D in cancer prevention first became apparent in the 1990s through geographic correlation studies showing that individuals living in southern latitudes have lower incidence and death rates from cancer. In the laboratory Vitamin D slows the growth and increases the differentiation and death of cancer cells. In a four year randomized clinical trial of 1200 healthy post-menopausal women found that women taking calcium (1400-1500 mg) and Vitamin D (1100IU) together had a 60 percent lower incidence of cancer overall than the women taking a placebo. A 2009 article published in the Annals of Epidemiology concluded that if the population at large raised levels of Vitamin D to optimum levels, 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer could be prevented annually and ¾ of all deaths from these two diseases could be avoided. Grassroots Heath (a organization of scientists promoting public health) published a Vitamin D call to action statement and posted a video calling for increased research and stating that delays in encouraging daily supplementation of Vitamin D3 of 2000 IU per day is leading to a great deal of unnecessary loss of life.

The case against vitamin D supplementation

Much of the evidence sited above comes from observational studies (based on questionnaires) that are inherently inaccurate. The one randomized clinical trial sited above was focused on bone health, not cancer prevention, and did not test the effect of vitamin D without calcium. The National Cancer Institute’s summary of the direction of Vitamin D research in the last 20 years concludes that evidence for Vitamin D’s benefits is “limited and inconsistent”. Vitamin D for breast cancer prevention is not in the American Cancer Society summary of current and proposed research on breast cancer. The Vitamin D Council suggests that the lack of research may be because Vitamin D is simply too cheap. “Therefore, the idea that [vitamin D] could help breast cancer offered no financial incentive to drug companies or researchers hoping to discover a drug they could patent.”

So what do I think?

I have my doubts about any magic bullet for tricky diseases like cancer and the compelling figures given are undermined by the deficiencies of the current research. But given that there is no harm caused by testing vitamin D levels and supplementing at 2000 IU per day, it seems like a no-brainer to do it.

I have my vitamin D levels tested regularly via the 25 hydroxy vitamin D blood test and have taken vitamin D3 supplements since I was first diagnosed. My results have never been dangerously low, but they have regularly been below the recommended 40-80 ng/ml. When doubling my daily supplement didn’t significantly raise my blood serum levels of vitamin D, my nutritionist recommended that I use a form that includes isoflavones to help the absorption. She told me that some people are genetically predisposed to have lower vitamin D levels. It’s shocking to think that insufficient levels of vitamin D might be related to both my mother’s and my own breast cancer.

I believe that taking dietary supplements (vitamins, minerals, probiotics, enzymes, herbs and other compounds that detoxify and support the immune system and certain organs) is one of the easiest things we can do to improve our health and help prevent disease, yes, even cancer. I consult a nutritionist 3 to 4 times each year to help me refine my eating and modify my supplement and dosage schedule to suit my changing needs. Currently I take 16 different supplements every day. I think it’s very helpful to have professional help in deciding on what to take. Our local health food store Natur-tyme offers free mini-consultations that can help people start on a supplement program.

In the nearly six years I have regularly taken supplements I have rarely been sick, my moods have continued to stabilize and I have less muscular and joint pain in my body. My massage therapist noticed that over time my body tissue has become more pliable and hydrated. Granted, supplements are not the only healing modality I have used and thus I cannot say how much is one thing and how much another. As the D-bate goes on, I take the tiny pill each morning, test my blood levels each year, and gently expose my skin to the sun whenever our upstate New York weather allows.



{June 12, 2010}   Breast Cancer Blunders

Last week I received a couple of copies of a group email entitled “The Cutest T-shirt Ever”. Usually I simply strike the delete button on emails like this and forget about it. This time I decided to devote today’s blog to this and other breast cancer blunders – common faux pas which, in my opinion, are best avoided when dealing with someone (like me) who has survived the ordeal of losing a breast to cancer and has lost dear friends and family members to breast cancer.

I open the email, and as I scroll down the page I see a wide-eyed baby with a puckered mouth wearing a pink hat and T-shirt that reads: “Find a cure before I grow boobs”.  The baby is cute. The T-shirt is crass, tasteless and exploitative. Additional text and a photo with some sort of religious connotation implores me to keep the email circulating in memory of anyone I know who has been struck down by cancer.

Losing a breast, facing cancer and the fear of death are such deeply personal, challenging, frightening and painful processes. To me it feels simplistic and insensitive to plaster breast cancer messages in every conceivable corner, this time on a baby t-shirt. At first sight, I am offended and angry. I have to find out the source of this offense, so I ask Chuck to trace the image for me. It seems to originate with a woman, Mary Nolan, who designed the T-shirt to sell on her UK website. This and her “Cancer, you got the wrong chick” t-shirt for women are her best sellers. So is the “keep this email going in honor of…” message just a ploy to sell more T-shirts? I don’t know. There is definitely irony in the fact that Mary’s site also features many items audaciously promoting the abuse of alcohol, which ironically, is the one dietary factor that randomized research most clearly relates to the development of cancer.

By now I’m pretty worked up and every dumb-ass thing that I have seen or heard about cancer comes back to me. Like the roadside billboard that faced me one morning as I drove into Syracuse for breast cancer treatment proclaiming “Abortion causes breast cancer.” How insensitive, insulting, rude and downright upsetting to post such a blatantly manipulative piece of propaganda in an attempt to further the anti-abortion cause.

Or the bottle-drive advertisement on a placard that I passed numerous times last summer saying, “Bottles for Boobs”. Just why is it necessary to use a term like “Boobs” to advertise the drive? And just exactly where is that money going?

A second category of breast cancer blunders is the dumb things people say. For example, shortly before my mastectomy a well-meaning health care provider said to me “most women I talk to don’t even miss their lost breast”. While I’m sure she thought she was reassuring me, the comment hit me like an arrow through the heart. At the time I was dealing with a tremendous amount of fear and grief, grief that continued for quite some time after my surgery. It is true that now, five years later, I don’t miss the breast I lost so much. I have a new one that is different in shape, texture and sensation and I love her in her own right. However, the acceptance of my loss was gradual and is ongoing. Of course the number one blunder that I have received in this category is when a breast cancer specialist answered my concerns over the carcinogenic nature of tamoxifen by saying that if I did get uterine cancer from taking it, they would cure that with a “simple hysterectomy”.

The third category of blunder is when well-meaning friends and acquaintances offer overly simplistic cures for cancer. The goji berry miracle juice I was offered or the “asparagus cure” circulated again by email are examples. All tap into our wish that there was an easy answer to this seemingly uncontrollable disease. As hard as it is to swallow, if there was an easy answer, we would have found a cure already. There was a time that I misunderstood the complexity of cancer and have been guilty of the same misguided behavior I am now complaining about. My husband and I now regret that we once gave what turned out to be a completely misguided book to a beloved friend who was dying of breast cancer. In my own treatment I got quite an awakening when my original attempt to cure my cancer with minimal surgery, maximum alternatives and soul searching did not work.

Breast cancer blunders are not just matters of taste or “political correctness” as some will say. I think that most people who make these blunders mean well, but feel fearful or awkward and try to compensate with humor. Some think “raising awareness” is important while others are motivated by profit (e.g. selling T-shirts) or to cover the enormous costs of conventional cancer treatments. Unfortunately, with billions spent on developing these conventional treatments, the incidence of breast cancer is greater today than it was in 1975. As much as the cancer industry attempts to convince us that the right drug or other “silver bullet” treatment will be the answer, cancer is complex and it is unlikely there will be a single cure.

I believe that it is undoubtedly easier to prevent cancer than cure it. Unfortunately, current breast cancer prevention efforts are primarily directed at encouraging women to get mammograms. The irony is that we actually know what causes cancer. Cancer occurs when previously normal cells cease to function normally, and the body’s own defenses fail to destroy these cells. David Getoff states that cancer is caused by:

  1. The enormous load of toxic chemicals, radiation and hormone-like substances that we are exposed to daily that our bodies are not equipped to deal with;
  2. The poor quality nutrition we give the body based on packaged, processed and artificial “food”; and
  3. The unprecedented amount of sugar and substances that digest quickly to sugars that we consume.

It is going to take tremendous individual and societal commitment to address these causes.

So here are some simple do’s and don’ts that I hope will help us to support friends, loved ones and other people we know who are facing breast cancer.

Do’s

I. Do engage in heartfelt acts of support. I personally found friends and acquaintances who took the time to send cards, flowers, bring food or even help me at home, to be tremendously uplifting.

II. Do ask someone you know who has cancer if they want to talk, and if they do – LISTEN.  After you’ve listened, all you need to say is “Thank you” or “I appreciate you sharing with me.”

III. Do send a simple note of encouragement or affection.

IV. Do support fully whatever treatments or life-style changes the patient chooses.

Don’ts

A. Don’t pass on “cute” emails, images or cancer slogans. You never know who you’re going to offend, who’s profiting and whether it’s helping or hurting.

B. Don’t exploit cancer to make your political statement, whatever it is.

C. Don’t give treatment advice unless you’ve been asked for it! I have a fairly strong alternative perspective, and I have to constantly catch my own tendency to proselytize my beliefs and follow the advice I read somewhere long ago: When someone is making a treatment decision, go ahead and offer alternatives if they are open to it. However, once they have made their decision, fully support that, whatever it is.

D. Don’t be afraid to ask, “How are you?”  Frequently I run into someone I haven’t seen in awhile who knows I had breast cancer. They ask me, with a meaningful look, “How are you? Are you well?” I know what they really want to know is am I still cancer free? Even though it can be slightly awkward, I really appreciate these inquiries. I feel seen and cared about. I reply, “I’m healthy, happy and five years cancer free. Thanks for asking”.



et cetera