SciCheck Digest
The U.S. Food and Drug Administration considers mammograms “the most effective primary breast cancer screening test” and says there is no evidence to indicate that thermography can replace mammograms. But an article shared on Facebook tells people to “stop getting mammograms” and try thermography instead.
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Each year, according to the Centers for Disease Control and Prevention, about 264,000 women and 2,400 men in the U.S. are diagnosed with breast cancer, and roughly 42,000 women and 500 men die from the disease.
In most cases, early detection is key to surviving the disease, health experts say. And mammograms, although not flawless, are the most effective method of detecting breast cancer early, when it is most treatable, says the FDA, the federal agency that regulates medical devices used for breast cancer screening.
“It is the only test shown to reduce breast cancer deaths,” says the American College of Radiology.
The ACR also notes that mammography, which became more widespread in the 1980s, has contributed to a nearly 40% reduction in breast cancer mortality in the U.S. since the early 1990s, according to data from the National Cancer Institute.
But a since-updated July 11 Facebook post told the public: “Stop Getting Mammograms Immediately As They Are Outdated And Dangerous! There Is A Safer Way to Test for Breast Cancer!”
In the comments section below his post, David Wolfe, a social media personality who promotes alternative health products, provided a link to an article on the Green Living Tribe website with that same cautionary message about mammograms as its headline.
“For years, mammograms have been hailed as the gold standard for breast cancer screening, with women being encouraged to undergo regular screenings to detect potential signs of the disease,” the article says. “However, recent research has shed light on the potential risks and limitations associated with mammograms, urging women to reconsider their approach to breast cancer detection.”
The article goes on to raise concerns about X-ray-based mammograms, such as radiation exposure and an “alarmingly high false positive rate.” Then the article pushes thermography — which uses a heat-sensing camera to check the breast for elevated temperatures that could indicate a tumor — as “a safer alternative that can effectively test for breast cancer.”
However, the FDA and organizations such as the Society of Breast Imaging have previously explained that thermography is not a replacement for mammography.
“The SBI does not support thermography as a standalone tool for breast cancer screening or evaluation of breast problems,” Dr. Mary Newell, a radiologist and president of the Society of Breast Imaging, said in an email to FactCheck.org.
“We definitely welcome all technological progress that will allow earlier detection of breast cancer but want to see findings that are broadly confirmed with scientific data, as seen with mammography, before we embrace a new technology. We urge women to continue screening using mammography given its wide scientific validation,” she said.
Wolfe later changed his Facebook post and comment after PolitiFact gave it a “false” rating on July 17. It now reads: “Here Are Other Options Beyond Mammograms To Check For Breast Cancer,” and “Correction: This post contains false information.”
Thermography Isn’t a Substitute
Thermography, also known as digital infrared thermal imaging or infrared imaging, uses a special camera to measure variations in temperature along the surface of the breast. A malignant tumor with growing cancer cells tends to have a higher metabolic rate and increased blood flow, which may result in a greater amount of heat under the skin of the breast. In theory, that change in temperature can be detected by the imaging device.
Thermography is noninvasive, doesn’t use radiation and is considered to be relatively inexpensive.
But the technology has only been approved by the FDA for use alongside or in conjunction with another screening or diagnostic test like mammography.
Since at least 2011, the FDA has sent “warning” letters to several businesses or facilities it said promoted thermography devices for unapproved uses. And as recently as January 2021, the agency published a consumer update reminding the public that thermograms are “no substitute” for mammograms.
“The FDA has received reports from health care providers and patients that some health centers are providing information that can mislead patients into believing thermography, a type of test that shows patterns of heat on or near the surface of the body, is a proven alternative to mammography. But the FDA is not aware of any scientific evidence to support these claims,” the notice said.
It added: “Thermography has not been shown to be effective as a standalone test for either breast cancer screening or diagnosis in detecting early stage breast cancer. Mammography is still the most effective primary screening method for detecting breast cancer in its early, most treatable stages.”
An FDA spokesperson, in an email to us, said that is still the agency’s position.
In its 2021 advisory, the FDA also said it was unaware of supporting evidence for claims that “thermography can find breast cancer years before it would be detected through other methods,” a claim made in the Green Living Tribe article.
Furthermore, even one of the papers the GLT article cited came to the same conclusion about thermal imaging as the FDA and other breast cancer experts.
The authors of the 2008 study, which was published in the American Journal of Surgery and concerned the accuracy of thermal imaging in detecting malignancies, said that, due to the technology’s limitations, thermography should be used with – not in place of – another test such as a mammogram.
Digital infrared thermal imaging “is limited by the fact that thermal recordings are only a physiologic measure and therefore must be used as an adjunct to another test such as mammography or ultrasound,” the researchers wrote.
They said that an infection or inflammation within the breast could also affect temperature recordings and produce false-positive results, and that “morbidly obese women” and breasts larger than size DD could hinder accurate temperature readings as well.
Mammograms Aren’t Perfect
While there is some disagreement as to when women should begin screening for breast cancer and how often, many organizations recommend that they do so with mammograms.
For example, for those who are at average risk for the disease, the American Cancer Society says women ages 45 to 54 should get mammograms every year, and women 55 and older can get them every year or every two years.
Women at high risk, meaning they have a personal or family history of the disease or a gene mutation, among other factors, should start annual screenings earlier, typically at age 30, the ACS says.
But in May, the U.S. Preventive Services Task Force, an independent volunteer panel of field experts, issued new draft recommendations calling for biennial mammograms for all women ages 40 to 74 years. The group had previously recommended mammograms every other year starting at age 50.
Mammograms have their own limitations, and they also come with some risks.
For one, mammograms don’t detect all breast cancers. They miss about 1 in 8, according to the American Cancer Society.
The organization says that women with dense breasts, who tend to be younger, have a greater chance of getting a false-negative result, which indicates they don’t have cancer when they really do.
The flip side of that is when abnormal results suggest that women have cancer when they don’t. False-positive results, in addition to causing stress and anxiety, can lead to patients getting additional tests or procedures, such as biopsies, that they don’t need.
“About half of the women getting annual mammograms over a 10-year period will have a false-positive finding at some point,” the ACS says.
Along those lines, mammograms can identify cancers that are not life-threatening, which is referred to as overdiagnosis. This also can lead to women being overtreated for tumors that would have caused them no actual harm.
The problem, according to the National Cancer Institute, is that physicians cannot always distinguish which cancers found during a mammogram need to be treated or not.
Mammograms also are low-dose X-rays of breast tissue, but they do expose patients to more radiation than a regular chest X-ray. However, “the risk of harm from this radiation exposure is low,” the National Cancer Institute says.
So those deciding when and how often to get a mammogram should discuss it with their doctors.
“All medical tests have some risks associated with them,” Newell, the SBI president and Emory University School of Medicine professor, told us. She said the potential harms should be weighed against the benefit of fewer breast cancer deaths in women who undergo screening.
“With mammography, the benefits far outweigh the risks,” Newell said.
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Sources
U.S. Food and Drug Administration. “Breast Cancer Screening: Thermogram No Substitute for Mammogram.” 13 Jan 2021.
U.S. Food and Drug Administration. “FDA Warns Thermography Should Not Be Used in Place of Mammography to Detect, Diagnose, or Screen for Breast Cancer: FDA Safety Communication.” 25 Feb 2019.
American College of Radiology. “Continue Mammography Care in 2022.” Accessed 17 Jul 2023.
Dr. Mary Newell, president of the Society of Breast Imaging and Emory University School of Medicine professor. Email Sent to FactCheck.org. 15 Jul 2023.
Mashekova, Aigerim, et al. “Early detection of the breast cancer using infrared technology – A comprehensive review.” Thermal Science and Engineering Progress. 1 Jan 2022.
Simmons, Rache, et al. “Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer.” American Journal of Surgery. 15 Jun 2008.
American Cancer Society. “American Cancer Society Guidelines for the Early Detection of Cancer.” 24 Feb 2023, accessed 17 July 2023.
U.S. Preventive Services Task Force. “Understanding Task Force Draft Recommendations.” 9 May 2023.
American Cancer Society. Limitations of Mammograms. 14 Jan 2022, accessed 17 Jul 2023.
Mayo Clinic. “Dense breast tissue: What it means to have dense breasts.” 25 Feb 2023, accessed 17 Jul 2023.
National Cancer Institute. Mammograms. 21 Feb 2023, accessed 18 Jul 2023.
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Czopek, Madison. “Experts, medical groups still recommend mammograms as a screening test for breast cancer.” PolitiFact. 17 Jul 2023.