The incidence of breast cancer has increased substantially over the past 20 years. While advances in medicine have increased a women’s chance for survival, little has been done to reduce–or prevent–the cancer from occurring. 

Thermography uses a digital infrared thermal imaging to detect and record the infrared heat radiating from the surface of the body.  Clusters of abnormal cells that can develop into a cancer often have an increased blood supply that leads to an elevation in the temperature of the skin over the area.  Breast thermography has the ability to warn women years before any other procedure that inflammation is present that could later become cancer. This is the best prevention: Find inflammation that can be addressed at the earliest stages. Even though thermography was approved by the FDA as an adjunctive screening procedure for breast disease in 1982, few women are aware of this useful technology.

More than 800 peer-reviewed studies exist, involving more than 250,000 study participants describing its usefulness. The number of women in the studies range from 37,000 to 118,000, and some women were followed for up to 12 years. The studies revealed that breast thermography has an average sensitivity and specificity of 90% for detecting early changes in the breast that can possibly lead to cancer. 

Studies have shown that:
• An abnormal infrared image is an important marker of high risk for problems in the tissues. The marker is said (by some) to be 8 times more significant as a marker for disease than a family history of the cancer.
• A person with a persistently abnormal thermogram has a 10 times greater risk of developing breast cancer in the future.
• A positive infrared scan does not mean you have cancer. The increased heat  may be suggestive of presence of many different breast abnormalities such as mastitis, benign tumors, fibrocystic breast disease, and cancer.
• In a study from 1998, 100 new cases of ductal carcinoma in situ were diagnosed pre-operatively using a clinical breast exam, mammography, and infrared imaging.  The number of tumors diagnosed with mammography alone was 85%. The number of tumors diagnosed when a breast exam and a breast thermography were added increased to 95%.

Breast thermography can detect abnormalities six to seven years before the changes can be detected on a mammogram.

COMMENT: Every woman between the age of 20 and 40 needs to have a thermogram and so, if needed, they can start a breast health program years before breast cancer has a chance to set in. Every woman between the age of 40 and 65 needs to have a thermogram in conjunction with their mammogram.

Whether for contraception, menopause symptoms or to control heavy bleeding, women have been given artificial hormones for many years now. What is the price we have paid?

First it was the Pill then the Coil, the Implants and then HRT as women were exposed to increasing numbers of artificial hormones and although in the beginning we were not aware of the risks, the same cannot be said today.

In the 1960’s young women rejoiced to find a safe, effective form on birth control that gave the power to regulate our own fertility.

My generation was the first to be put on the Pill and their daughters happily followed as their mothers moved on to HRT.  But we didn‘t escape the risks of the Pill as we moved into menopause as apparently more than three quarters of a million women in the US are taking it for other reasons. Whether that is to control painful or heavy periods, acne or migraines it is a popular choice for symptoms that are hormone related but just how does taking it affect our hormone levels?.

Side effects of Progestins

I speak to many women who tell me they are on a progesterone contraceptive, but there is no such thing. The majority of contraceptive pills and the coil consist of a low dose of an estradiol derivative (ethinyl estradiol) and one of several synthetic progestins (synthetic progesterone), although there are some that do not contain estrogen but only a synthetic progestin.  Some of the most common progestins in these products include: medroxyprogesterone, norethindrone, levonorgestrel, norgestimate and drospirenone.

Risk factors on the Pill are mainly directed at women who smoke or are overweight. Common side effects include headaches, nausea, breast tenderness,slight weight gain and slight ’spotting’ between periods. Several of these ‘side effects’ are also symptoms of oestrogen dominance which is also related to the more serious consequences seen with the Pill such as  deep vein thrombosis (DVT) or clotting, heart attacks and strokes.

Why take the Pill?

The purpose of the Pill is to prevent the mid-cycle release of LH (Luteinising Hormone) and reduce FSH (Follicular Stimulating Hormone) levels and so inhibit ovulation. So clearly it is primarily used for contraception but I am saying an increasing number of women who are using it solely to reduce very heavy periods – which it will do – but again there are health consequences to be considered.

While the progestins in the Pill typically bind to progesterone receptors, they do not have the same action and it is not recommended to use bioidentical progesterone alongside them if you are trying to prevent pregnancy. Logical really as the role of progesterone is to promote fertility!

There are hormonal consequences to the action of these progestins. Because LH and FSH also stimulate estrogen and androgen production in the ovary, suppression of these pituitary hormones often results in a decrease in androgen production that can have a profound effect on symptoms such as acne.  Because the Pill does not address the underlying reasons for hormonal imbalance, many symptoms may return when you stop taking it.

This can be a problem for women who are put on these therapies in their teens to reduce their period pains or manage their acne.  When they are ready to start a family they often find that the same symptoms may return and that their normal ovulation cycle can take quite some time to return to normal.  Anovulatory cycles (with no ovulation) can occur for anything between 1-6 or more months or more after stopping the Pill.

Mid life heavy bleeding

Young women are not the only ones on the Pill. Many women are given it not for contraception but to help control heavy bleeding. Such bleeding is often associated with oestrogen dominance and although the Pill will help it does not address the basic problem that the body’s high levels of oestrogen are not being balanced with sufficient progesterone to avoid the consequences of excess oestrogen which has been linked to breast cancer and heart disease.

What happens to your normal progesterone levels?

Testing the hormone levels of a woman who is on birth control can be tricky. The primary source of progesterone is the corpus luteum, which is derived from the follicle after the egg is expelled. When ovulation is prohibited, there is no corpus luteum, and therefore no ovarian progesterone is produced.

That is why normal progesterone levels are found to be very low in women who are currently taking oral contraceptive pills. The normal blood tests do not measure progestins because they are molecularly different from progesterone and do not have the same action.

What will help?

It depends on why you are taking the Pill. If for contraception then looking at alternatives might be an option. 

However for those women who are on the Pill to cope with heavy bleeding it can be a good starting point to rebalance the hormones and get oestrogen dominance under control, establishing the root cause of estrogen is best done working with a qualified professional.

A must read. A UK doctor reveals she has been offered cash incentives for referring more breast cancer screenings.

A UK doctor reveals she’s been offered cash incentives for referring more breast cancer screenings: “We are offered support from #CancerResearchUK to make an action plan to improve rates of bowel, cervical, and breast cancer screening. We’re incentivised with payments for engaging in the process and for any increase in the proportion of our patients screened.” She concludes: “The fact that we’re being offered payment for this [breast cancer screening] makes me very uncomfortable”

 2019; 365 doi: https://doi.org/10.1136/bmj.l1409 (Published 03 April 2019)Cite this as: BMJ 2019;365:l1409

Our practice has recently been invited by the local clinical commissioning group to take part in a quality improvement scheme aimed at increasing the uptake of cancer screening. We are offered support from Cancer Research UK to make an action plan to improve rates of bowel, cervical, and breast cancer screening. We’re incentivised with payments for engaging in the process and for any increase in the proportion of our patients screened.

I wish I could say that my conversations about cancer screening all adhere to guidelines about how to share decisions with patients.1 In reality, most of our exchanges are a very brief aside in a consultation about something else. If we do have time for more, the conversations about bowel and cervical cancer screening are relatively straightforward—for me, at least. I explore any reservations the patient has and try to explain the process and the pros and cons. As the evidence of benefit is robust, I can advise my patients that any disadvantages of taking these tests are very likely to be outweighed by the advantages of treating minor changes and preventing cancer.

But I have a problem with breast cancer screening. The evidence for its benefit is very much less clear. There are well known problems with lead time bias, overdiagnosis, and toxic treatments of screen detected “cancers” that would never have been clinically relevant.2

Michael Baum, an architect of the UK screening programme, said in a letter to the Times last week that “screening seems to be a zero sum game in that for every breast cancer death avoided there is one death from overtreatment of pseudocancers.” He went on to say that it was time to de-implement screening. He is not alone in this. In 2017 the Swiss Medical Board reviewed the available evidence and concluded that no new systematic mammography programmes should be introduced in Switzerland.

A Cochrane review in 2013 concluded that, in every 2000 women invited for screening, one would avoid dying of breast cancer and 10 would have unnecessary treatment.3 However, the conclusions of the Independent UK Panel on Breast Cancer Screening report published the same year were entirely different: one breast cancer death prevented in every 235 patients screened.4

So, what do I tell my patients? When I share the ambiguity in the evidence, we will probably have a long conversation, because I sincerely don’t know the answer to the question, “Should I have my mammogram?”—even for myself.

If, after this initiative, breast cancer screening rates rise at our practice, can I be sure that all patients have made a fully informed, shared decision? Or is there a risk that they will just have been advised by a trusted doctor to be screened? The fact that we’re being offered a payment for this makes me very uncomfortable.