mammograms, MRIs, thermography, ultra sound?

impositive

I am just curious about what tool everyone prefers for screenings.  I recently had a thermography and  the findings were "equivocal", "between normal and abnormal".  They recommend I have a mammogram which I am very much against and I dont like the idea of the dye being injected into my veins for MRI but I need to follow up on this. Can anyone weigh in?

Member_of_the_Club

No one test works completely (says the woman whose breast cancer was missed by both a mammogram and an ultrasound).  Mammograms have gotten better since they've gone digital, and use less radiation as well.  MRIs work the best, and have no radiation, but have a higher false positive rate.  I do a mammogram and an MRI once a year, spacing them 6 months apart.  I think thats the gold standard and its what i recommend.  I've never had thermography.

althea

I had my first thermography in November.  My letter also had language to the effect that thermography is not to be considered a substitute for mammogram.  I suspect the reason for that language is to keep the FDA from jumping all over them for making claims they're not allowed to make.  I haven't had a mammo since 08.  I have more confidence in a therm. 

SJW1

My "prevent" doctor who is a D.O. says mammograms and thermograms are equally good. She has thermograms once a year and mammograms every two years. She told me that I probably should have a mammogram every year though since as a DCIS patient, I am at higher risk.



I have a RODEO MRI every year, since they have less than a 1 percent false negative rate (and about a 30 percent false positive rate which is better than mammograms or ultrasounds). In addition to that I have a thermogram every year. I really am undecided about a mammogram, because they always want to biopsy me and the 80 percent of the time these are unnecessary biopsies.



You need to feel comfortable with whatever you decide to do for your own personal breast surveillance.



Sandie

impositive

Althea, I prefer a thermography, of course, but I just dont quite understand the results.  When I called to discuss them, I was told I would be charged for a consult. I was outraged and told them I payed for a thermography, I shouldn't have to pay more to have it interpreted. I haven't yet pursued that but intend to.  I too thought that they were advising a mammogram to protect themselves from the FDA but the more I go over the findings, I'm more concerned. 

Do yours usually say you are within normal ranges (TH1) or normal vascular range (TH2)?

Mine say both breasts are equivocal (TH3)

Here is what mine says under summary: " As an initial thermogram, your images are considered to be questionable (between normal and abnormal) with respect to the right breast and mildly questionable with respect to the left breast....Your images also show blood vessel patterns in both breasts. A blood vessel pattern such as this may be a thermal sign that suggests in some patients, the effects of hormones on the breasts.  However, this must be investigated by your doctor with further tests before this can be confirmed.....I recommend that you see your doctor to get a follow up mammogram....I also recommend you return for a repeat thermogram in 6 months to see if the thermal activity in your breasts is either increasing, decreasing or stable. 

It also says "A thermographic signal is noted suggesting a possible viscerocutaneous feedback reflex from your thyroid.  This may be an indicator of thyroid disfunction."

I guess I wanted a definite answer like "there's a suspicious spot" or "everything looks clear".  It's just not so clear cut.

  

impositive

Does anyone else worry about the radiation from mammograms or the dye from the MRI? 

Hindsfeet

Impositive...Actually, I'm not that worried about having a mammo once a year. We all are constantly radiated...especially when we fly. The new mammo's are supposedly safer than they were a few years ago. It caught all my cancers.



After my last MRI experience, I'm not as keen on them. After researching more on the contrast dye, I've decided I would do a mri only if necessary. But...admit it did find this small invasive cancer.

My surgeon said the other day, I think it was the American Cancer Society said that the mri's mri's will no longer be used for bc followup unless you have a Brac genetic link to cancer. And for this reason insurance companies will no longer be paying for annual mri bc followup.



Ultra Sound: Not as effective, but again it found the lump in my breast this time. I had a mri and then it was followed up by a ultra sound because there was too much movement in the mri.



There is another test that is supposed to be 95% accurate...my doctor mentioned it. It is not the contrast dye...it's another dye. Not sure of side effects.



Like so many have said, you have to weigh in all the factors. I thought since I' chose the watchful waiting that I had better get the best possible screening so if it did happen again that I would find it early.

impositive

barry, that's kind of what worries me, we are subjected to radiation most everywhere nowadays so do we submit to more?  Having said that, I agree that we need the best possible screening so it's a dilemma....use what "they" have determined is the best tool... and submit our known cancer prone tissue to more of something that has been proven to cause cancer.    

Except for worrying about the radiation or the pressure of the mammogram possibly bursting a tumor, I would much rather undergo the mammogram...I hate MRIs!  I think I may be in the minority there though.

Fearless_One

Depends on tissue density.   I have grade 3 breast density, mammos are useless on me.   Thermography is notoriously unreliable (although I personally have not tried it).   Ultrasounds are good if you have a "starting point" or focal area of where to look (such as a palbable lump).   I feel MRI's are currently the best screening device available (with the exception of PEM scan which is not widely available and uses a lot of radiation, more more than MRI).

koshka1

Hi,

I have a yearly mammogram and a yearly Breast mri.  They alternate 6 months apart.

I am in Canada and the mammgram is recommended by the radiologist on a yearly basis. But, because I am paranoid and figure catching this "crap"earlier is better...I opt to get a Breast MRI once a year.  I pay for it.

However, not heard anything about the dye?  What are the issues with the dye they use in MRI's??  Let me know.

Hugs....Kosh

IrishInNC

Hi,

I just had my first thermogram last Thursday 1/13 and the MD sent me my report right away because the right breast...5 months after lumpectomy and MammoSite Radiation Therapy...was bright red and orange(HOT). The left breast was all blue and purple(COOL). Everything on his report stated on the right breast..."this IS significant" or "Abnormal findings"....no one let me know that all of this could be from the radiation therapy..I freaked out for the first time since my diagnosis last July and had a terrible week because I could not get any answers from anyone...Then finally on Tuesday of this week I heard from my Wellness Center that the report was nothing to worry about and then this Thursday the MD that sent the original report said the same thing.....Why did he not say that to begin with!!!!  I really feel I should NOT have had a thermogram at this point in my healing. But no one told me that and they did it and took my money (insurance doesn't pay for thermography). I feel taken advantage of.  I'm not looking forward to having my scheduled mammogram in three weeks due to some lymphatic swelling from the MammoSite Radiation Therapy...the last thing I want is to compress that poor little breast in that d--n machine. Not sure what I'll do from here...MRI is not recommended and I haven't asked about ultrasound...I'm so glad to hear that all of you have such different opinions and experiences and I thank you for allowing me to let off steam...Send some postive thoughts my way...Thanks

impositive

koshka1, The contrast used in MRIs in called gadolinium.  It's a chemical that can cause toxicity mainly in patients with prior kidney disease.  It can cause a potentially fatal disease called nephronic systemic fibrosis.  Please keep in mind that it has only been reported in patients with kidney disorders so I'm sure the risk is very low to none in patients with normal kidney function.  It's just another potentially toxic chemical that's administered directly into my veins that I would like to avoid (if at all possible).  

impositive

IrishinNC, I think I read something (I dont remember where) about radiation therapy - that you need to be at least a year out from treatments before having a thermography so that's something your doctor SHOULD have known.  I believe in thermographys, I just have a problem with the people who administered mine.  Apparently you have gone through the same issues. 

I am leaning toward having an ultra sound.  I understand I will probably have to "force" the issue with the doctors, as they typically only do US after a questionable mammogram.  Also, my report lists an area of concern so they know where they need to look, something I also understand is important with US.

In addition to what I listed from my report in the posts above, it says...

Thermal differentials are within normal values over the region of the finding in the left breast.

Thermal differentials across the nipples are within normal values.

Right 7 o'clock areolar/periareolar region hyperthermia.

This seems contradictory to me since they just said thermal differentials across the nipples are within normal values....anyway, that's the area that concerns me on the report.

nowords

I had a mammogram and an MRI about 18 months after right mastectomy. The local oncologist suggested both because of my history of 10 years of mammograms failing to detect a greater than 10 cm lobular cancer. She said that the mammogram detects other cancers better than the MRI, but the MRI is better at detecting lobular. I wanted the peace of mind of the MRI, as I am consulting to have the DIEP performed on the right side, want to keep the remaining breast, and wanted some reasonable assurance that it is currently cancer free.The Mayo Oncologist who saw me through chemo said that only the mammo is standard for them, and the MRI if something is found that needs a closer look. I had dense breasts, was 50 at diagnosis. Tamoxifen and chemopause have changed the breast density.

o2bhealthy

I had my first thermo in Sept 2010 since my onc would not order any scans to verify I was NED.  An US of my thyroid and Carotid was recommended due to abnormal findings (carotid's were hot, thyroid cool).  Luckily my Nurse Practitioner/Primary followed up and ordered the US's.  Carotid's were ok but my CRP blood test is still running a little high so I am taking an aspirin a day.  The thyroid US found a couple of nodules on the right lobe.  I had a biopsy of the nodules and it came back papillary cancer.  I found a very good Thyca surgeon and he was amazed that we found the nodules so early.   I had a partial thyroidectomy (right side only - the cancer was 5mm and clear margins, 0/1 node). I declined RAI as I was done with poisoning my body and I did not want to expose my family and friends to radiation. 

What I found interesting is my local onc never once contacted me regarding the Thermo findings and I know they were hand delivered to her (my thermographer is a BC survivor and a patient of the same onc, she actually found her BC with thermography 6 weeks after a normal mammo).    I heard from my onc's nurse three weeks AFTER the biopsy and a week prior to my surgery, she was just checking to see if I had received a referral to a surgeon!

I am allergic to gadolinium and have to take pre meds (Steroids & Benadryl) prior to an MRI (and Valium!).  I had one post bmx mammo and was told no more mammo's since I have less then 5% of tissue remaining, plus mammo's do not show the chest wall.  I prefer thermo and should it show abnormal findings I will follow up with whatever tests are recommended.  I prefer to avoid radiation and don't really like exposing myself to more toxins like the gadolinium but unfortunately there are not many safe options.

impositive

o2bhealthy, your post confirms how I feel about thermography.  My naturalpath is a NP so I'm going to speak with her about ordering an ultrasound to follow up. 

Did you receive your colored images and did the doctor go over them with you or did you just received a report in the mail? 

I asked for images at the time of my thermo and the tech gave me black and whites, they almost look like x-rays.  She said the doctor who reads them prefers them in black and white.  That seemed weird to me, as the only images of thermos I had ever seen were in color.  My images were sent out to a Dr. William Amalu in Redwood City, CA for interpretation and then I received the his report along with an explanation from the doctors office who administered the thermo. 

Is this basically how yours were done?

Did you have more than just your breasts "photographed" or scanned?  I did not but apparently the thyroid showed up as well.

I am just so ambivalent about the report because on one hand it says findings were within normal values and on the other it appears to indicate I have "right 7 o'clock areolar region hyperthermia and a TH3 value which is right in the middle of the scale.  Also, the administering doctor's office report says..."We hope that answers to the following FAQs, will help make things clearer....My images are graded as a TH3. What does this mean?....First of all, this is goods news! Thermograms at this level are considered questionable but not abnormal." 

But it then goes on and says,"With TH3 thermos there is a possibility that this is a signal that a cancer is in need of a blood supply....Keep in mind that the majority of TH3 thermos (95%) normalize in time or remain stable due to your own unique physiology.  The remaining 5% are a combination of current risk, future risk and false positives.

They are recommending a mammogram to establish a new baseline and to address the 5% risk.  I guess I also need to address the thyroid issue...wish I knew what "thermographic signal suggesting possible vescerocutaneous feedback reflex from the thyroid" means. 

o2bhealthy

impositive - I had a full body scan, my report included color images and an interpretation from a radiologist Jeanne Stryker MD from Physicians Insight Interpretation Group.   The report was not quite as extensive as your report but it did clearly note where there were some questionable areas of concern. 

I would f/u on the thyroid findings with US and labs.   Hopefully your thyroid is just trying to recover from chemo and it will be functioning back at normal levels soon.

I will admit being dx'd with a 2nd cancer in less than two years was daunting, however the thyca was a a walk in the park in comparison to BC. 

My f/u thermography for breasts (+thyroid) is scheduled for March and that will be used as a baseline for future scans. 

toni30

My mammogram did not catch my cancer - I felt the lump myself 6 months after a clean mammogram.  I have dense breasts and am struggling with this issue.  Ironically, the mammogram I had before my lumpectomy had two false positives and I don't want to keep dealing with biopsies.  So I may go with the mamm-MRI combination.  Trying to find places in Philadelphia to do that.

CameoBarbie

Hope it's okay I post here.  I went for my thermogram but I was bumped so I am just waiting for the results.  At least she said she's sure it's t2 and t3, not sure which is which.  And I went in hot.  I was put on an antibiotic for the last 5 weeks.  I had a biopsy done on the RB in '08 and within days if I had a shower, the water hitting my LB felt like someone put an electrical current right through me.  It would come and go.  Well, it started up and stayed to the point where the slightest movement would make it radiate. Then it moved into my arm.  Well, when I went, it was peaking. So thankfully, it's over but at least we got it. I had an ultrasound 4 days after and she said to remember to say both breasts for the June Mammo/ultrasound. No mention of what she saw.  Doctor says she'll call me if there is anything. They said to call her and book it. Said she doesn't recognize thermograms and what information do I expect to get from it?

Although a t3 score is just questionable, I at least know I am not making things up, there is something not right.  That is a weird piece of mind.  And to have someone to address my issues, is also good.  She mentioned a new clinic- maybe I'll find a new Doctor to take things over.  I saw red splotches and white , not a speck of blue green.  Definitely went in hot. So I have my worst case scenerio.

impositive

CameoBarbie, I definitely think the thermos see things that mammos do not, I'm not sure why they as recognized as mammography.  I had a hot spot at 7 o'clock on the right breast (TH3), near nipple.  I have been palpating it and I can definitely feel something there but it's lumpy all around the nipple because that's where all the ducts lead to.  I had my NP feel it.  She seems to think it feels different than the rest of the ducts.  I asked about an ultra sound and she said they wont do one without first doing a mammo so I guess I'm going to have to concede to the mammo.

Goodluck with your results! 

CameoBarbie

I have to say that I went in hot and was so happy that when the LB finally(?) stopped just super tingling and really hurt, that we were there to measure it.  But she called me for another one 5 days later because I "froze" the computer, other scans downloaded but mine was lost.  So we had to redo it.  I read lately though that your not supposed to get one when you have a fever until about 36 hours after.  I left out details just to say I was there and just waiting for the results.

impositive

CameoBarbie, It would make sense that a fever could throw off the imaging.  Hope your second one turns out to be a TH1 or 2!

impositive

Well, my diagnostic mammo is scheduled.  I go tomorrow morning.  I feel I'm almost being forced into doing something that I am strongly against.  I wish medicine had something better to offer.  I dont understand why we cant look at it with a US first then move onto mammo if need be.  It should be a last resort.  My NP assumes it has to do with insurance.  Fingers crossed!

Hindsfeet

I wish there was something better.  I hope it is a clean mammo.

CameoBarbie

Thanks I hoped so too but she said that in the second scan.

CameoBarbie

impositive:

I've been reading my face off and I found this.  You were wondering about some wording about 'feedback."

"Abnormalities in a Thermo FOUND with benign and malignant conditions include

(1) periareolar heat

(2) local hot spot        (sounds like a bar)

(3) diffuse heat  and

(4) vascular discrepancy or unilateral vessel accentuation."

impositive

Well ladies, my mammo was clean!!!  Ultra sound shows normal glandular tissue where the "hot spot" was shown on thermography. 

CameoBarbie, number 1 on your list sounds like what my thermo showed and number 2....lol, that does sound like a bar.

I'm soooo relieved. 

I go for a blood test tomorrow to begin the search regarding my possible thyroid issues, as well as vitamin D levels, etc.  

Hindsfeet

Great to hear impositive. Hope you find out whats going on with your thyroid. Make sure they check your t3 and your t4. Too often they only check the TSH.

impositive

barry, she's checking T3 free, T3 reverse, T4 free, tpo and TSH.  Does that sound right?  I'm not up to speed on the thyroid issues. 

CameoBarbie

I have my report.  A t2 and a t3.  But I'm surprised because the RB is the T2. Give me a day to read it and catch up with life- whew- and need to read it.

CameoBarbie

Alright then, this thermograph was evaluated by A Mostovoy. Follow-up in 6 to 9 months.

RB  TH-2 Score 50

Curvilinear Thermovascular pattern - upper breast

Thermovascular network

Asymmetrical thermal pattern

(Within normal limits regarding thermal emission.)

LB TH-3 Score 75

Curvilinear thermovascular pattern - upper breast

Inverted "V" pattern

Asymmetrical thermal pattern

Regional hyperthermia   11 and 1 oclock

(Equivocal regarding thermal emission.)

"Dialated thermovascular networks are observed bilaterally with regional hyperthermia noted within the upper medial and outer aspects of the LB with additional asymmetrical development and inverted "V" pattern detected within the upper medial areolar region.   Images are suggestive of hormonal influence and support the fibrocystic activity reported."

In the information presented as my history, the "observer" included nipple retraction.

Oh, and the ultrasound letter came back as no abnormality found. I have the June tests coming up and they want both Mam/US for both.  So I guess I'll have a double double. (humor) sigh...

The nipple Delta before 0.60 Centigrade (C)  after 0.60C

The periareolar Delta  before 1.14C  after 0.89 C

The Observer said to monitor the LB and if it is still there (the condition, and/or my LB?) or bigger at follow up, they will recommend something be done about it.