Episode Transcript
Dr. Christina Tello-Skjerseth:
I think some people just feel better with getting some kind of exam that is pain-free and doesn’t have radiation. And that’s fine for some people, but you need to know that it’s not actually detecting cancer. And just because you get a negative thermogram does not mean you don’t have cancer. And you really should be using modality like mammography, which has all the data behind it and that’s federally regulated so that things are done consistently and accurately.
Courtney Collen (host):
This is “One in Eight,” a podcast series by Sanford Health. I’m your host, Courtney Collen, with Sanford Health News. One in eight women will be diagnosed with breast cancer during her lifetime, so we want these conversations to shed light on awareness, featuring expertise from our Sanford Health providers that could save your life or the life of someone you love. We’re so glad you’re here.
This conversation breaks down the difference between mammograms and thermograms. To help us do that, I want to welcome Dr. Christina Tello-Skjerseth. She is the chief of radiology at Sanford Health in Bismarck, North Dakota, and chief of staff at the medical center, and specializes in diagnostic imaging as a radiologist. Dr. Tello, welcome.
Dr. Christina Tello-Skjerseth (guest):
Thank you so much for having me again. I’m looking forward to this talk.
Courtney Collen:
Me too. So happy to have you here. I’m not familiar with thermography in this space, especially when it comes to screening for breast cancer. Can we start by having you break down the differences between mammography and thermography?
Dr. Christina Tello-Skjerseth:
Sure. So mammography is essentially obtaining a specialized X-ray of the breast where you can see the different kinds of tissues in the breast. And the purpose of that is to find breast cancers when they’re smaller and, you know, earlier and better to treat.
Thermography is a different type of exam. It’s actually like a heat sensing camera that can take the temperature of the skin surface and then make like a different pictorial representation of that. So it doesn’t actually show anything inside the breast. It doesn’t really show you any detailed anatomy, and it’s FDA approved because of its safety profile. It’s a safe technology, but it’s not approved because of its efficacy.
So we actually don’t use thermography to detect breast cancer. It’s really just sensing temperature on your skin. And, you know, the theory behind that is that breast cancers are hypermetabolic, meaning they essentially take up more blood flow because the cancer is making more vessels, and it essentially eats more, if you want to think of it that way. So the thought process is that more vessels, more metabolism, makes that area hotter. It gives off more heat, and then you can see that on your skin surface.
Now, the research behind thermography, most of the data out there is from the ‘70s and ‘80s. There’s really no recent information about it showing that it can actually detect breast cancer. And the FDA actually will put out warnings to facilities that that advertise thermography as a breast cancer detection tool. That’s really not what it’s used for. It’s approved to be used in addition to another type of screening or a diagnostic test, not a stand-alone tool.
Mammography is extremely regulated by the government, by the FDA and MQSA, which is Mammography Quality and Standards Act, since 1992. So there are a lot of guidelines, rules, and certifications we have to stick with and follow every three years to make sure that our equipment is appropriate. Our technologists are up to date, and the radiologists, and how we interpret exams, even the language we use in the reports, it’s all standardized and very regulated. So everyone across the U.S. should be doing it the same if they’re certified in mammography. Thermography really has nothing like that.
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Photo by: Sanford Health
Courtney Collen:
What kind of misinformation are you hearing or reading about specifically when it comes to thermography as some might compare it to mammography? Can you help clear the air there?
Dr. Christina Tello-Skjerseth:
Let me start with the main benefit of mammography. It’s the only tool we have, the only screening tool we have that has shown – from decades and decades and decades of research – to decrease mortality from breast cancer, meaning your chance of dying from breast cancer. And studies have shown that there’s a 40% reduction in breast cancer mortality using screening mammography.
Some of the harms of mammography, and I say “harms” in quotes, the main one is radiation. So yes, we’re taking X-rays of the breast and that makes radiation. So your body is getting radiation from the machine. And most of our data regarding the harms of radiation in general come from atomic bomb survivors in the ‘40s and other different atomic disasters we’ve had. And it’s all extrapolated data showing what the potential risks are for having certain doses of radiation.
Now, mammography has a very, very low dose of radiation. It’s about equivalent to maybe getting three to five chest X-rays. And to us living here on Earth, we get cosmic radiation every day that comes down from the sun, space, everything outside the Earth. And so there’s a certain dosage that we get every year. And getting a mammogram is about equivalent to just living on Earth for two months. It’s about that same dose of radiation. So it’s a very low dose.
Our equipment is very technologically advanced. It’s very modernized. So we’re able to calibrate very well and get the dose as low as reasonably possible. It’s very safe, and there’s been no data out there showing that mammography causes cancer. And that’s really the main I’ll say advertisement that people use for thermography is that there’s no radiation. There’s not an increased chance of getting cancer from that tool.
Thermography is also reported as painless because there’s not any compression of the breast. That’s another one of the, I’ll say, harms or downsides of getting mammography is that you are in a compression paddle. So some people are really sensitive to that and it can hurt for the most part, you know, having them myself, I would just say it’s just uncomfortable, but it’s just for a couple of seconds. There’s no long-term damage for that.
So I guess to kind of summarize that the main issues with mammography are the radiation, the pain.
Another one is the callback rate, meaning if you have a screening mammogram and then we find something and bring you back for more imaging, people get very anxious and concerned about that. But what people need to realize is that there’s really only a 10% callback rate. So for every thousand mammograms that we read, we’re only really calling back 10 people, I’m sorry, a hundred people to get further imaging. And the vast majority of those people will just get sent back to screening or have like a short term follow-up. The biopsy rate is quite small. The actual rate of cancer is quite small. It’s about five to eight people per a thousand mammograms will actually get diagnosed with cancer. So it does cause a lot of anxiety.
Thermography really doesn’t have any of that related to it, so to speak. But one thing I want to highlight is if you do get a thermogram and they find something “abnormal,” the next thing to do is to get a mammogram. So you’re really not preventing getting further imaging. And they’ll actually send you to your doctor and they’ll do a full workup of the breast. So it’s not like you’re completely cutting out mammography or radiation as a whole. But I think the bottom line is that the radiation profile of mammography is very safe and it has not been shown to cause cancer.
Courtney Collen:
And the mammogram is still the recommended tool in prevention and detecting breast cancer early. Correct?
Dr. Christina Tello-Skjerseth:
Absolutely. Yep.
Courtney Collen:
What question should I be asking my provider regarding a mammogram or a thermogram?
Dr. Christina Tello-Skjerseth:
Well, I think now in 2024 we’re really getting more towards a sense of individualized medicine, and having those conversations with your provider as far as your risk profile. There’s a lot of genetics that go into your risk for breast cancer, but there’s a lot of environmental things as well: the age at which you had a child, the age at which you started your menstruation, drinking, smoking, there’s all kinds of different environmental things out there that can increase your risk, if you had biopsies before, if you have certain medical conditions. So it’s important to have those conversations with your doctor early.
We actually recommend having some kind of risk assessment by the age of 25 just to see if you would fall into those average risk guidelines for mammography versus high-risk guidelines. And those do change. If you’re average risk, the recommendation from all of the major societies that we follow in this country are to start annual screening, mammograms at age 40, so you get those every year. If you’re higher risk, we may start you as early as 30. If you’ve had a relative – a first year relative, like your mother or sister had it in their 30s – maybe you’d start 10 years earlier. So even in your 20s. So we are actually screening some women in their 20s.
Additionally, you may add on a breast MRI if you’re high risk. So there’s really a lot of options we have. So again, it’s really important to have that risk conversation with your primary care provider to decide what schedule you should be on.
Courtney Collen:
What role, if any, does thermography play in breast cancer screening?
Dr. Christina Tello-Skjerseth:
You know, to be honest, it really doesn’t play a role in screening. I think some people just feel better with getting some kind of exam that is pain-free and doesn’t have radiation. And that’s fine for some people, but you need to know that it’s not actually detecting cancer. And just because you get a negative thermogram does not mean you don’t have cancer. And you really should be using modality like mammography, which has all the data behind it and that’s federally regulated so that things are done consistently and accurately.
I will also say that the FDA does a really good job at watching some of these facilities that offer thermography, and mostly they’re going to be like medical spas or naturopathic, homeopathic type places, chiropractic care, that offer thermography. The FDA watches these facilities pretty closely. And if they advertise thermography as a screening tool and advertising it as having the ability to detect breast cancer, the FDA will send those facilities a letter, essentially telling them to cease and desist and to not give out that misinformation to the community.
We have one here locally that advertises it, but they advertise it appropriately and saying that this tool does not detect breast cancer. It’s to be used as an adjunct tool. So they’re at least advertising it correctly. But again, thermography really doesn’t have any data behind it showing that it can detect breast cancer and that it’s a good stand-alone tool and it’s not approved to be a breast cancer screening modality on its own.
Courtney Collen:
Sure. And like you said, if they were to detect anything, then a mammogram in most cases is the next step.
Dr. Christina Tello-Skjerseth:
Exactly. And when you really think about it, again, it’s a camera that’s detecting the temperature of your skin. So anything that’s increasing your temperature in that area could cause a positive thermogram. I could touch my breast and just put a little pressure on it. That’ll increase the heat there. Being outside will increase the heat. I mean, there’s lots of things, any type of inflammation will increase that heat. So it’s not specific for cancer.
Courtney Collen:
- And to recap, schedule your first mammogram starting at age 40 every year. And then if you’re high risk, sometimes as early as 30, and some women are even screened in their 20s in some cases.
Dr. Christina Tello-Skjerseth:
Yep. And then adding on some kind of supplemental screening if you’re high risk such as a breast MRI. That’s really the number one tool that we use in addition to mammography.
Courtney Collen:
Such valuable information. Thank you so much, Dr. Tello. What else do you want us to take away from this conversation?
Dr. Christina Tello-Skjerseth:
I guess I would just say if you do have any questions, please talk to your provider. I’m hoping you know that a lot of people now have good information about thermography so that they can have those conversations with their patients. And if the providers ever have questions, they can always call the radiology department. There’ll be a breast imager there that can answer any of their questions before they talk to those patients.
But I think just as a whole, it’s good to have good information, ask questions out there, whether you’re a medical provider or a patient, just to kind of know what the options are and what’s appropriate. And again, please know that mammograms are completely safe and very federally regulated so that things are being done safely and effectively. And again, it’s the only modality we have that can decrease your chances of dying from breast cancer, and that’s from decades and decades of research.
Courtney Collen:
Dr. Tello, thank you so much for your time and for all that you do.
Dr. Christina Tello-Skjerseth:
Thanks for having me. I appreciate it.
Courtney Collen:
This was “One in Eight,” a podcast series by Sanford Health. Find more of these podcast conversations featuring our Sanford Health medical experts on Apple, Spotify, or news.sanfordhealth.org. For Sanford Health News, I’m Courtney Collen.
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Posted In Bismarck, Cancer, Cancer Screenings, Health Information, Imaging, Physicians and APPs, Women's
