GARVEY SCOTT
This print of a thermographic image taken of an elephant was displayed by Kansas City Zoo veterinarian Kirk Suedmeyer.

The veterinarian at the Kansas City Zoo uses the toy — er, diagnostic tool — nearly every day. It’s a machine that produces thermograms of an animal’s body, showing temperature differentials in bright digital color.

You would expect an elephant’s ears to show up in blue because there’s less blood there to create heat. And you would expect the skull and abdomen to glow orange or red because that’s where the organs are.

But what if there is something strange? The thermogram can provide clues to tell zoo officials to take a closer look at something that may mean a health problem for the animal.

“We’ve been able to find things with the thermography unit that we didn’t even know were there,” Suedmeyer said. “And the animal may otherwise be acting fine.”

For example, the vet and zookeepers were aware that one of the elephants had a relatively small wound on the bottom of one of her feet. The vet staff was keeping it clean and free of infection.

But a thermogram of the elephant revealed that the inflammation extended several inches up her foot. That alerted the staff to monitor a potential problem and to watch to see if the condition was healing or getting worse.

Unusual warm spots may indicate infection or disease. A cold spot may indicate a cardiovascular problem such as poor circulation.

“We try to do as much preventative care as we can,” Suedmeyer said. “If we can catch something early on, it’s a lot easier to treat it.”

The thermography machine and a large wall monitor for the veterinary operating room at the zoo were a $15,000 gift from the Deramus Family Foundation. It was a luxury the zoo just could not afford to purchase.

Now the vet staff has an additional tool, along with traditional X-rays, blood tests and physical exams, to help keep the hundreds of exotic animals in its care healthy.

Suedmeyer already is creating a bank of images of zoo animals to keep on file. He recently e-mailed thermal images of an emu to the Milwaukee County Zoo in Wisconsin in advance of that animal being shipped there from Kansas City.

The thermography machine has been at the zoo just a couple of months, and Suedmeyer continues to explore its possibilities.

For example, what does it mean when one kangaroo’s nose registers cool while another’s shows up as warm? Thermograms may provide the answer, Suedmeyer said.

“If I do 100 kangaroos and 99 of them are one way, then maybe there’s a problem with the other one.”

To reach Matt Campbell, call 816-234-7745 or send e-mail to mcampbell@kcstar.com.

Posted on Mon, Jan. 17, 2011 10:56 PM

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The two techniques look at different things. Thermography looks at abnormal blood vessel formation, which is an early event in the life of a cancer. Mammography looks at masses (1 centimeter or larger) and calcification patterns, which are later developments.

Each has reliability in the recent literature of around 88 percent to 96 percent. Each misses tumors picked up by the other (perhaps as many as 10 percent). Mammography cannot visualize tiny tumors with new vessels, which show up on thermography. Conversely, tumors large enough to show up on mammography don’t always have thermographically abnormal vessels.

So, each technique is weak where the other is strong. The techniques are complementary. It is not a case of either one or the other.

One of the reasons for moving the starting age to 50 for mammograms was the vast number of negative breast biopsies for calcifications. I suspect, in my personal experience, I did 20 benign biopsies for calcification for every cancer we picked up. That is way too many, but abnormal calcifications are pretty common — and frequently benign.

Personally, I think the most prudent course for a woman to take is to get a baseline mammogram somewhere between the age of 40 and 50 (unless she has a high-risk family history, in which case earlier is better) to be reasonably sure larger lumps are not seen, and get a baseline thermography to look for early blood-vessel formation.

If both are negative, then follow with annual thermography looking for new vessel formation, with mammography every few years to look for solid lumps. Less frequent mammography means less radiation and mechanical pressure.

That regimen allows a woman to take advantage of the strengths of each technique without undue risks from radiation or unnecessary biopsy and, it seems to me, to maximize cost-benefit considerations.

— Robin A. Bernhoft, M.D., practices medical toxicology in Ojai.

The Record

Alternative to mammograms

In view of the recent U.S. Preventive Services Task Force recommendations concerning new guidelines for having mammograms, some vital information for women needs to be presented. The new guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations.

It has always been known that mammograms carry a significant risk of causing and spreading breast cancer, although this has largely been ignored by mainstream medicine. They can cause breast cancer through repeated irradiation of the breasts and spread cancer by the fracturing of the fibrous capsule surrounding the tumor through compression of the breasts.

A 1999 meta-analysis, “Is Screening for Breast Cancer with Mammography Justifiable?,” was published in The Lancet, the United Kingdom’s premier medical journal, in 2000. It said, “Screening for breast cancer with mammography is unjustified.” This study showed that “for every 1,000 females having mammograms over a 12-year period, the life of one was saved, while the total number of deaths increased by six.” The United States continued to screen with mammography until the new recommendations appeared in the Nov. 17 issue of the Annals of Internal Medicine.

Many women are asking themselves, “What should I do now?” The answer is simple: thermography, or digital infrared thermal imaging. This is a true “screening” test that is absolutely 100 percent safe, since it does not require contact with the breasts or use ionizing radiation. It has been approved by the FDA for breast cancer screening since 1982.

Thermography employs an infrared camera that measures the physiology of the breast, not the structures within the breast, as does mammography. The physiology is function rather than structure, more specifically inflammation. Inflammation at any tissue depth will be recorded by the sympathetic fibers in the neurological supply of nerves to that area. This neural information will then be processed through the central nervous system, which will then cause a sympathetic (automatic) response in the area of the skin corresponding to the affected site. Thermographically, the area of hyperthermia seen at the surface of the skin is due to a decrease of sympathetic motor tone (reduced sympathetic function) allowing increased blood flow through the postganglionic gates serving that area. And, all this happens before the presence of a tumor.

In addition, thermography can pick up breast disease eight to 10 years earlier than mammography can pick up a tumor. This happens long before tumor formation, whereas a tumor of a rather large size must be present for mammography to be effective. The bottom line is thermography is preventive, and mammography is no more than “early detection” of an already present tumor.

If any further studies are required for diagnosis, breast ultrasound and breast MRI are the tests of choice, since they are completely safe and do not employ radiation.

Women 21 or older should screen for cancer by doing breast self-examination, clinical breast examination annually and at each doctor’s visit, and thermography.

Alan L. Woods. 

Wyckoff, Nov. 17

The writer, a physician, is director of natural health education for the Institute of Natural Health and Wellness in Wyckoff.

Readers Comments:

Welcome attack on ‘holy grail’

Speaking from the vantage point of a senior citizen, I am thrilled that the U.S. Preventive Task Services Force has issued new guidelines for mammogram screenings.

In the past, whenever I tried to have a conversation with my doctors about the risks of mammography, my questions were answered with anger and belligerence as if I were violating a sacred holy grail.

Now, women can feel free to ask such questions as: Will repeated radiation exposures to the breast pose a cancer risk for premenapausal women under 50?

What about so-called indolent cancers that will never spread and tiny cancers that might go away by themselves? Is it possible that I could be subjected to unnecessary surgery, radiation and chemotherapy and really be healthy?

Once upon a time, thermography was a secret weapon. Its
heat-sensing ability helped the military flush out adversaries
hiding by night and led missiles to their targets. People
trapped in burning buildings, lost at sea or in snowdrifts,
could be rescued because their body temperature showed up
as thermal images. So far, so dramatic, but when the
technology was released into the public domain, 1960s
physicians leapt on thermography’s potential as an equally
potent life-saver in the medical sphere: cancerous tissues
emit more infra-red heat than healthy tissue, so here, it
seemed, was a surefire way of detecting tumours.

Zeal, unfortunately, ran ahead of clinical trials, which at the
time were carried out using ex-military and industrial
equipment. Thermography fell out of favour for many years
but good ideas find their own right time: in the past decade
thermography scanning has been re-introduced and refined
in tune with greater understanding of physiology and
advances in computer technology. It is now routinely used in
many areas of mainstream medicine (including
rheumatology, neurology, pain clinics and vascular-related
dysfunction). But so far it’s been most enthusiastically
embraced by the holistic health world, where its value as an
extra diagnostic tool for breast disease is seen as groundbreaking:

“It seems to spot active pre-cancerous breast signs
some six to eight years before any palpable lump appears.”

Thermography’s key asset is that it seems to spot active
pre-cancerous breast signs some six to eight years before
any palpable lump appears. This may well be in time for
wise patients to alter their lifestyle and so modify their
health, reversing the earliest changes. Speedy (the whole
procedure is over in 15 minutes), safe (there’s no exposure
to radiation) thermography is also non-invasive (so there’s
no unpleasant compression and the patient sits in a small
cosy room several feet from the scanner). So could
thermography be the new secret weapon in the battle
against breast cancer? Could it help women avoid
unnecessary mammograms and reduce exposure to harmful
radiation? Could it lead the way beyond screening
mammography which, on its own, only detects breast
disease that is already well developed enough to be seen
with x-ray? We already know that thermography works for
young women where mammography is contra-indicated
because their breast tissue is too dense to “read”. Given the
sharp rise in breast cases among younger women, this
simple screening system would be hot news indeed.

The picture – for young women especially – looks good, and
women would naturally wish thermography to take over
from mammography because it is so simple, painless and
radiation free. But Dr Peter Leando, founder and Managing
Director of Meditherm, the US firm producing high specificity
medical thermal scanners cautions against seeing
thermography as a stand-alone diagnostic miracle:
“Thermography is very much an extra, not an alternative
breast screening tool” he explains, “and I stress that we are
not in competition with mammography or taking on the
same job. Thermography works best in clinical evaluation as
an adjunct to mammography and ultrasound: a study at the
Ville Marie Institute in Canada found thermography to have
an 83 per cent detection rate as opposed to mammography’s
84 per cent. When combined, however the two services
reached 95 per cent accuracy.”

“The real purpose is to establish a base line – a thermal fingerprint.”

A thermal scan can provide additional information about the
body, but it does a different job from mammogram or
ultrasound which test structure and anatomy. Thermography
is a test, instead, of function and physiology and its
overriding purpose in specialist breast screening, says Peter
“is to monitor breast physiology and track changes over
time. A first study is not really designed to identify any
suspicious findings (though of course any patient would
immediately be referred to her physician for further clinical
investigation if worrying signs did emerge). The real purpose
is to establish a base line – a thermal fingerprint, if you like,
of the breast physiology that is normal for that particular
patient. Everyone has a vascular structure and anatomy
that’s particular to them, so what we are trying to establish
in every case is whether this thermal fingerprint is stable, so
we re-scan after the first three months to monitor for
changes that might give concern. Thereafter women are
followed up annually.”

All thermologists – the medical doctors trained to “read”
thermal scans just as radiologists read the x-ray pictures
radiographers have taken – are highly trained to look for
patterns particular to various breast conditions. These may
present as asymmetry – where the colour pattern differs in
one breast from the other – though repeat monitoring could
also evaluate this as normal for that particular woman.
“Comparing right side to left, and different areas of the
breast,” says Peter “we are looking for temperature
differentials and particularly patterns that may be
suspicious. But even if they do change over time, these
differences could also relate to fibrocystic changes, and
thermal ‘hotspots’ could simply reflect nerve irritation.”

Thermography, Peter points out, is not the appropriate firstline
service for any woman with known breast cancer:
“Mammography is more accurate for later stage cancer or
for anyone with a palpable lump, although the thermal
image can help pinpoint where the cancer is most active,
and therefore act as a useful guide for more targeted
mammography. Thermography only enables us to look at
the activity of that lump and see if it’s very vascular,
indicating angiogenesis or an active blood supply “feeding”
the tumour.

“Thermal scanning can’t give the information a mammogram provides in terms of size, density and order of the lump.”

Thermal scanning can’t give the information a mammogram
provides in terms of size, density and order of the lump. It
doesn’t provide what pathology can; it’s purely a test of
physiology. It can’t assess whether a lump is attached to the
surrounding tissue, if it’s rough or smooth, filled with fluid or
a denser, more solid mass. So much is involved in a
diagnosis of cancer. But when thermography does produce
positive findings, it justifies the more invasive tests and it
does give mammography something to look for and so aids
detection.

Thermography really comes into its own as preventative
screening before a woman ever has a scare or is called for
routine NHS mammography at 50. Although the thermal
scan colour images produced look very straightforward,
most women wanting the bottom line about breast health
would not immediately grasp what they are seeing: “What
the thermal image reflects” Peter explains, “is skin blood
flow. We don’t see any organs, any depth into the body or
any conducted heat from deeper structures or underlying
inflammation. Any thermal patterns we do see reflect the
body’s surface temperature as a neural response to
whatever is going on beneath, which could be inflammation,
lymph congestion or angiogenesis. Thermography works
because the skin, as an organ, is totally under the control of
sympathetic nerve function and thermography provides a
snapshot of the body’s response on the skin surface to any
disease or injury.” For young women who are wisely healthconscious
or, at the other end of the spectrum, concerned
about the effects of lifestyle habits like smoking or drinking,
thermography clearly fills a gap in the standard diagnostic
screening process.

As it’s non-invasive, patients can self-refer, yet come away
with a report that then becomes part of their medical record.
If thermography shows cause for concern, then it’s helpful
for a young woman to have something tangible to show her
doctor, who might otherwise dismiss her as one of the
worried well. Peter Leando says his thermography service
regularly picks up patients where a slight change registers
during the three months between initial scan and follow up.
“Sometimes mammography is negative nonetheless, and it
can take up to another year before what we first identify
becomes dense enough for mammography to identify. It
also takes quite a long time before biopsy can verify the
finding because you have to have some physical calcification
or cell growth to get a needle into.”

“Most women in this waiting state would rather not sit back and do
nothing. ‘

Most women in this waiting state would rather not sit back
and do nothing. And those wishing to do all they can to help
themselves, find their way to holistic health practitioners like
Dr Shamim Daya in Harley Street. Shamim (who explains
that she left general practice because “there was too much
emphasis on symptomatic treatment and not enough on the
root cause of the disease process”) will see the situation as a
wake-up call for any such patient in her care:

“I ask a lot of questions about women’s lifestyle and
generally find that they urgently need to clean up their act -
to cut out toxic drinks, drink more water, improve their diet,
introduce an exercise programme. The aim is to minimise
the toxic load that is primarily affecting the liver and
creating lymph congestion. For slightly older women in the
perimenopause, hormone imbalances increase stress on the
body. It’s common to find that these women have a
mouthful of mercury fillings, which also increases the toxic
load. If the lymph congestion is pronounced, I would
prescribe some herbal/homeopathic ‘drainage’ remedies as
well as suggesting that she drank more water and took
exercise. I’d ask ‘Have you done a bowel cleanse with herbal
capsules recently?’ This multi-factorial approach is intended
to get toxic waste out of your system as quickly as possible -
that’s what the breasts are trying to tell me.”

Shamim regularly sees women in their twenties who are
already at risk from smoking and drinking habits that put a
strain on key organs including the liver. Her message to
them cuts straight to the chase: “Please don’t wait till your
thirties, when you have a family and a drastic diagnosis like
breast cancer is the last thing you need.” She is quietly
confident that indications of early breast damage can be
reversed, “although in my experience thermography doesn’t
pick up a problem that will go away on its own. That’s why
we monitor. The importance of follow-up scanning is to
check for the progress of disease or its reversal, provided
my recommendations are followed. If things aren’t
improving as we would hope, then it may be necessary to
take a more aggressive approach to reduce the toxic load,
adding in specialist infrared saunas, correcting any
underlying hormonal imbalances using bio-identical (natural)
hormones and carefully supervised removal of mercury
fillings together with liver-supporting remedies.

“We can only advise and leave the responsibility to them.”

“Obviously we can’t force women to change – we can only
advise and leave the responsibility to them. Thermography
is a great tool for giving women choices and for many it’s a
great motivator for change. My resident thermographer
suggested screening to her own daughter, who seemed
impervious to warnings about booze and fags. Motivated by
her aunt’s recent breast cancer diagnosis, this young woman
came along – and was shocked enough by what she saw on
screen to change her lifestyle almost overnight.”

Thus far the NHS shows no sign of embracing thermography
So, sadly, almost all thermographic breast screening is paid
for privately: “But it’s no more expensive than a takeaway
coffee a day” says Dr Daya “We charge £185 for the first
scan, including a three month follow up. An annual scan is
£150 thereafter.” Sherrill Sellman, (one of icon’s Icons and
author of Hormone Heresy) has described the thermal
scanner as “the most neglected piece of apparatus for
female wellbeing”. Cost wise, it is relatively modest – around
£20,000 would buy a local Health Authority the whole kit -
camera, scanner computer, all the relevant software plus
training for two technicians. You could say that
thermography also has the royal seal of approval, having
been used to scan the four elegant legs of the late Queen
Mother’s racehorses at Lambourn, Berks! Thermal imaging is
very good for pain assessment and for picking up nerve
damage and muscle atrophy.

However promising, the future of thermography in twolegged
health will take its time to unfold. “Medical
developments are always very, very slow” says Peter. “But
breast screening will hopefully progress to include more
physiological assessment and a combined approach using
the different techniques for optimum results and early
detection.” Of the 600 Meditherm scanners worldwide, about
half are used predominantly in breast screening – 200 of
them in the US. In the first year of thermal scanning, one in
30 women presents with positive findings across the age
range from 25-75. That’s one more woman who can seek
early help and thank thermography for providing an extra
weapon in the war against cancer.

Examples
One

This 57 year old patient had her first scan last year. The
result was worrying so we asked for an urgent report.
Further investigation found that she was in need of natural
hormone support; she had a mouthful of mercury fillings,
metal toxicity in her liver and a sluggish lymph system
round the breasts. There was no lump to feel; ultrasound
and mammograms were negative.Yet something was
brewing that in five years or more could have become a
lump. Here we had a star patient, who was very
responsive and embarked pro-actively on a six month
restorative health programme. A year on you can see a
classic recovery. She feels great – and relieved.

Two

This young woman in her twenties has relatively
healthy looking breasts.

Three

This young woman in her twenties shows lymph congestion
in both breasts which seemed more marked in her three
month follow up scans, prompting her to quit smoking and
drinking.

The images illustrating this feature were taken with a
Meditherm, Med2000 scanner.

Contact
Dr Peter Leando’s website address is:
www.meditherm.com.

Dr Shamim Daya BM DRCOG works
from the Wholistic Medical Centre, 57 Harley St, London,
W1G 8QS; Tel: 07000 388 388
Website:www.wholisticmedical.co.uk.

One day there may be a single method for the early detection of breast cancer. Until then, using a combination of methods will increase your chances of detecting cancer in an early stage.

These methods include :

• Annual breast thermography screening for women of all ages.
• Mammography, when considered appropriate for women who are aged 50 or older.
• A regular breast examination by a health professional.
• Monthly breast self-examination.
• Personal awareness for changes in the breasts.
• Readiness to discuss quickly any such changes with a doctor.

These guidelines should be considered along with your background and medical history.

There has been much controversy within the thermal imaging community, and much comment by outside observers concerning two factors related to the interpretation of thermal imaging of the human breast. In this regard, I have spent quite some time investigating alternative language and reporting methodology and I have determined to make changes to my interpretation reports as follows:

1) The Thermal Rating System is being dropped.

The thermal rating system has proven to be a hindrance to proper communication and understanding of actual findings with referring physicians and indeed, with patients. The rating system has not been updated nor revised since its initial inception and utilization in the mid 1980’s. There are two significant problems which routinely occur with the utilization of the reporting system; however there has not been a proposed change that makes good clinical sense until now. The two key problems with the thermal reporting or thermal rating system are:

A) Unresolved anxiety for both patient and physician when TH3 – TH5 class thermograms are not confirmed by so-called conventional methodologies such as Mammography, Ultrasound or MRI. We all know that a positive thermogram is often many years ahead of anatomical testing as confirmed by the scientific research, but this does not help us when we “label” a breast as suspicious and no other method can confirm or deny the thermal findings. This creates the medical impression of a false positive and the resulting loss of confidence by the referring clinician.

B) Inaccuracy of the Rating System itself. This rating system was designed decades ago to provide for a more accurate and quantifiable system of reporting risk, however it has inherent errors which I feel cause tremendous confusion for the primary care physician and indeed the patient. Many patients with cancer have only one rating factor, for example a marginal 1.1C delta at the nipple, and are as such, rated TH-3 Equivocal. Other patients may have three or more low level rating factors with a completely healthy breast and as such are rated TH5 Suspicious. Often these patients present in my practice for many years with absolutely no change in thermal patterning, In other words – no increase in vascular or heat signature. Very often these patients have anatomical testing which is clearly within the normal parameters (not equivocal).

In the world of diagnostic imaging, the premise of any system, be it mammography, ultrasound or thermography is simply to identify risk factors which may not be determined in any other way. As such, a heads up is given to the primary care doctor that there may be pathology requiring further investigation. That is all.

The attempt of earlier thermographers to create a rating system which is more objective and meaningful has actually created confusion within and outside of the thermal imaging community, and as such, this system should be abandoned.

This does not mean however, that reporting should simply be a series of circles or squares drawn over areas of clinical concern. Some rating factors, especially those in the “primary factors” category, still require description as a methodology to alert the primary care physician to areas of higher concern. To label these patients as equivocal, abnormal, suspicious or for that matter, normal is an inappropriate reporting methodology and as such, is no longer to be utilized.

2. The use of the Thermal Cold Stress Challenge for Breast Evaluations is being dropped.

This protocol has never been scientifically proven to be reliable and may indeed; affect the clinical management of a patient in the wrong way, for the wrong reason.

There are several solid reasons for this decision and these factors are related to my 20 years of clinical practice in the realm of thermal imaging. I wish to share these factors with you as a practicum.

A) There is no reliable literature nor blinded study to validate the use of the procedure for breast thermal imaging studies, contradictory to many studies on Reflex Sympathetic Dystrophy (RSD) and Chronic Regional Pain Syndrome (CRPS) (CMPS) Many thermographers have inappropriately applied the cold stress challenge designed for neurological conditions to the female breast.

B) The use of the stress challenge does not, and should not be used as an indicator of “aggressiveness” or “staging” of breast cancer. Some interp clinicians actually utilize a (+) or (-) in their reporting methodology to indicate whether for example, a Suspicious breast (TH5) is more (+) or less (-) suspicious depending on whether or not the area cooled. This is not a verifiable protocol and it is to be discouraged. (TH5+ or TH5-) An abnormal breast factor is ratable as a factor and requires clinical correlation, period.

C) The degree of cooling, or lack thereof, has also not been scientifically established as an indicator and I feel this has been an anecdotal use of the procedure. As such the stress challenge can be very misleading to both physician and patient. Depending on dietary influences, hormonal levels of the particular day, and the amount of stress within the patient from a variety of sources, the stress challenge may be more or less effective. Some days, a patient will cool 0.2C in a given area, and six months later 1.0 and on the next visit, 1.5. Some patients will not cool on a particular visit even 0.1C and on a subsequent visit they may cool 1.2C. Of course there are many instances of patient’s temperature increasing on the stress challenge and then on subsequent visits the area cools or stays the same. These variances have cast great doubt on the reliability of the stress challenge.

D) Some anatomical factors which are benign can severely compromise the ability of the sympathetics to provoke vasoconstriction. This would include blood vessels which have been compromised by surgery, incisional biopsy, lumpectomy, local trauma and even thoracic spine instabilities. These factors can provide for permanently dilated vessels or capillary networks which fail to respond to sympathetic stimuli.

E) The patient’s own apprehension of the procedure may produce sympathetic fight or flight responses prior to the stress challenge, often seen when patients can view the monitor during exam for example. This provokes a cooling response and “sets” the sympathetic tone prior to the actual cold challenge thus producing potential failure reporting when the fight or flight response actually took place minutes or moments before. Other examples of this are fear of the exam, an event proximate to the exam that has upset the patient (phone call) (rude comment) (slip and fall) etc. Many of these variables simply can not be accounted for.

F) Finally, and most simply, the fight or flight sympathetic response has never changed the thermal rating nor denies the need for further testing and correlation. Some clinicians will make a decision on whether or not to order additional testing based on the Success or Failure of the stress challenge procedure. The very fact that we can not with thermography, determine the amount or aggressiveness of angiogenesis validates this fact. The question must be asked- At what point of existing cancer development does angio-neo-genesis override sympathetic input? It is a great concept in theory, but it is not practical in day to day practice.

These factors (the thermal rating system) and (the cold stress challenge) contribute greatly to an overall confusion of the basic purpose of breast thermography and are based largely in Dogma. The purpose of breast thermal imaging is to view with a complimentary technology, the human breast and to determine if there are areas of clinical interest that require further clarification that can not be seen by other methods.

Thermography is a screening procedure. To continue to follow dogma and unproven methods will further restrain and constrain the advancement of this noble science.

William Cockburn, DC, FIACT, FABFE
Fellow International Academy of Clinical Thermology
Fellow American Board of Forensic Examiners