Breast Thermal Imaging, the paradigm shift

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ANECDOTAL Vs SCIENTIFIC EVIDENCE

It is very important to differentiate scientific fact from anecdotal evidence. For purposes of this paper I define anecdotal to mean a myth or a fable not supported by fact, but accepted because of a common belief or usage.

Many physicians and investigative journalists use anecdotal data to support their point of view. An example of this is the often published article in a medical journal that uses 20-30 references by other authors who all have just rewritten an original thesis or premise in order to get published without contributing any new data.

Now the materia medica has a number of consistent articles or studies which appear to be powerful when used as an argument for or against a given procedure or point of view. In reality, anecdotal evidence is disastrous when not recognized.

Thermal imaging is pure science. While prone to misinterpretation by "untrained" clinicians, its diagnostic accuracy and yield are unparalleled. With respect to breast thermal imaging, a great number of studies by researchers in different parts of the world, utilizing different technology have still demonstrated the usefulness and clinical utility of the procedure. (when utilized appropriately).

In the United States, William Hobbins, MD(2) demonstrated in a sample of 37,050 patients, a yield of 56 cancers per 1,000 abnormal thermograms as compared to the 5.6 per 1,000 in the BCDDP studies utilizing mammography. In France, Gauthrie et al(3) utilizing thermography determined 73% correct diagnosis in 486 breast cancer patients.

In worldwide retrospective studies, thermograms were positive in a minimum of 71% to a maximum of 93% in patients with breast cancer as reported by Nyirjesy (4).

There are literally thousands of pages of discussion in print regarding the benefits of thermography as it relates to breast cancer. The interesting observation to this author is the wide variety of protocols and equipment utilized and yet a tremendously high statistical correlation of accuracy prevails. Think of what might happen if the technology and training were more standardized.

Comparing anatomic (mammography) to physiologic (thermography) is a great irony and source of confusion in medicine. Many radiologists I have spoken to fear that their investment in mammographic equipment will be wasted because they view thermography as competitive with mammography or that stereo-tactic biopsy is better than thermography.

This is a classic example of the lack of training and anecdotal arguments I have previously described. Mammography is anatomical. So are other beneficial procedures such as ultrasound, diaphenoscopy and CT scanning.

Thermography is a test of physiology (function), and not of anatomy. One can not compare apples to oranges. The procedures are most definitely correlative and complimentary and not competitive. The view that thermography is competitive is error, and one of the most significant detractors from its effective utilization today.

When used adjunctively with other laboratory and outcome assessment tools, the best possible evaluation of breast health is made.

Radiologists need to understand the tremendous potential of thermography to detect the physiologic manifestation of disease that so often predate the anatomical analysis of the condition. In my first paper on this subject (5) I point out the danger in "over reading" thermograms and state that we should utilize the data obtained from thermal imaging from a "screening" standpoint only, not from a diagnostic one. (1987)

This "complimentary" nature of thermal imaging is of unparalleled significance to this issue.

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