Women's Bodies, Women's Wisdom (76 page)

“But it’s required,” she said. “It’s part of the procedure. Then, after we place the clips in your breast, we’ll take you for another mammogram.”
And how painful will that be?
I couldn’t help thinking. “We have to make sure the clips are in the right place. This is the best way to track what we’ve done so you don’t have to have any unnecessary biopsies.”
Like the ones I’m having now?

I told her again that I didn’t want or need any tracking devices—I’m not an endangered animal in the wild. And because she’d obviously lost sight of the fact, I calmly told her that it
was
my body, so it really should be my choice. She told me they couldn’t do the biopsies unless I agreed to the clips. I told the poor woman, who was just following the protocol, that I was happy to leave without having the biopsies.

We agreed to have the doctor come in. And he made a good point: If the tissue being biopsied turns out to be cancer, having the clip will help the breast surgeon zero in on cancerous tissue, which makes the recovery process easier after a lumpectomy.

I looked into his eyes using the mildest version of my mommy stare. He had a tray full of needles and other sharp objects that he was going to use shortly. One was a needle full of local anesthesia, and I wanted that! I explained that I didn’t want the clip and was prepared to leave. (Even though the clip made logical sense, it just felt wrong to me.) He said I was lucky I hadn’t scheduled the procedure a few days later (in 2009), when the clips would then be the new standard of care and he wouldn’t feel comfortable doing the biopsy without one. He also told me he would “let me slide” because he was pretty sure that my lumps were nothing to worry about. We went ahead with the biopsies.
Darn,
I thought after he was done,
that felt good, having you use my breast for
a dartboard!

Of course, I thanked the radiologist for his work when I left. He was very kind, and I was sure he did a good job. I knew my ob-gyn would be happy I had complied. I put up with pain and extensive bruising for about a week. Everything turned out normal.

THE THERMOGRAM

About eight months later, I scheduled a thermogram because I wanted to experience an approach to my breasts that Dr. Northrup told me was far more proactive. I entered a cozy center near Baltimore called the Cometa Wellness Center, which felt more like a home than a medical office. My thermographer (the thermography technician) met me and took me to a comfortable room. I could tell right away that she was caring and professional, and this helped me relax a little.

Given my history of fibrocystic breasts, a lumpectomy at age seventeen, and multiple biopsies, I was curious to see if there would be heat where these masses were or had been. I, like most women, also have some spots in my breasts that hurt from time to time, and I wondered if those spots would be warmer than the normal tissue.

The thermographer told me I would be having a thermogram of my entire upper body.
What a nice surprise!
I thought. Then a thermologist (an M.D. trained in the science of reading thermograms) would read the digital images taken by the thermographer. The doctor would look at a number of areas, including my sinuses, jaw, and gums; my thyroid and the lymph glands in the neck and armpits; the muscles in my back and neck; and my entire digestive system, including my gallbladder, liver, kidneys, colon, and stomach. Oh—and my breasts!

The thermographer gave me very comprehensive medical history forms. In addition to indicating my previous breast or other surgeries or biopsies, she also had me indicate any area of pain or concern on a chart. There were also extensive questions about the health of my upper body. The information would help the thermologist better interpret the results.
What?
I thought.
No one incites panic in this model? Can this be
real medicine?

Certain things interfere with the test results. I was told not to bathe, shave, or use deodorants within four hours of the imaging, so I showered, etc., the night before. I was also asked not to use creams or makeup on the day of the test and not to have bodywork, such as massage or chiropractic manipulation, within a certain number of days before the exam.

I was taken to a dark room where I slipped into a gown, leaving my clothes on from the waist down. When the thermographer returned to the room, she took the images of my head, neck, chest, and back first, while I remained clothed from the breasts down. I stood a few feet from a machine that reminded me of an old-fashioned camera on a tripod. When the thermographer took a picture, the thermal image came up immediately on a computer, with different colors indicating the intensity of the heat. The thermographer told me not to be concerned by what I saw or to try to make sense of it. Still, it did kind of make sense—and it was fascinating.

Next, I dropped my gown for five images of the breast and lymph nodes in the chest and armpits. Because it was dark in the room and she never touched my breasts, I felt that my privacy was being respected. One of the images required my putting one hand behind my head, elbow out. “I feel like a pinup girl, but in a good way,” I joked. I was proud and happy to have breasts, not terrified that they were unhealthy.

Finally, she did the abdomen. She didn’t like the results at first and asked me to stand with my arms away from my body so I could adjust to the temperature of the room. She explained that it only takes about a minute for that to happen. She stepped out of the room briefly, and this was the only awkward moment for me. I felt a little silly holding my arms up and away from my body, because I was standing there half naked. While waiting, I noticed that the room was the perfect temperature and nothing like the radiology group’s setting, which can only be likened to a meat locker. The thermographer said that they intentionally pick a temperature that’s comfortable. The entire exam took about fifteen minutes.

A few weeks later, Ariane Cometa, M.D., a practicing internist and the founder of the Cometa Wellness Center, called me to go over the results from the thermologist who read my scan. Normally she just sends a letter outlining the findings; however, I had arranged for a consultation. We talked a little about my thyroid. I had had it tested recently, and it was a little low. Dr. Cometa told me that she saw dysfunction and asked me if I had a history of thyroid disease. I had been taking medication for a while but stopped when it made me jittery. She recommended a different medication and told me something very interesting: Thermography often gives her better information on how the thyroid is functioning than blood work does. So if her patient’s blood work for the thyroid is normal but her patient is experiencing symptoms that would indicate thyroid dysfunction, she’ll advise a thermogram. Dr. Cometa said that follow-up thermograms of the thyroid taken after the patient has been on thyroid medication for a few months often show positive changes that don’t get picked up by blood work. I was so impressed with her knowledge and caring, as well as with the practical, health-promoting solutions she offered. Again, I felt like a unique individual rather than a random widget on a huge medical assembly line, unable to move forward without “their” stamp of approval. The thermogram provided insight into
my
health issues.

Dr. Cometa also explained that asymmetry in the thermogram can be a sign of trouble and that my right armpit showed more heat than the left. Because my right breast had been biopsied less than a year before, this could be explained by the detoxification and restoration process that was still occurring in the lymph nodes in this area.

So what about my breasts? Well, they are perfectly normal. Yahoo! There’s no heat or indication of cellular anomalies at all where I have lumps or have had surgeries. In fact, Dr. Cometa told me that she is extremely happy when test results show breasts as healthy as mine. I was so grateful to have had a test that was perfect for a woman with fibro-cystic breasts and absolutely no family history of breast cancer. I would return for a follow-up thermogram in three months to check on the right armpit area, and then once every year or so after that. It was such an empowering experience.

RECONCILING THE RESULTS

Ah—but that means the biopsies I’d had in December were unnecessary. So were the mammograms I was told to have in my twenties and all the previous biopsies, with the exception of the lumpectomy I had as a teenager. Yikes. What an awful realization. In an effort to take the best care of me that they could, my doctors put me through a lot of unnecessary pain, expense, and worry. Plus, how can being poked and jabbed and squashed be good for breast tissue?

Then something happened that I never would have expected. I went from being happy that all of my breast tissue was normal to wondering if I could trust the thermogram completely. Maybe I felt like a fool for having put my body through all that. Maybe I was just programmed to think that my breasts weren’t healthy until my mammogram said they were.

So I talked to Dr. Cometa. She agreed that because our society places such importance on the mammogram, it might be hard for some women to trust the thermogram at first, even though the technology has been around since the 1950s and more than eight hundred studies have been published proving its efficacy.
³⁸
Dr. Cometa said that she recommends that these women use the thermogram in conjunction with their mammogram until they can feel completely comfortable. She is sure that once a woman sees the changes that the thermogram picks up from test to test, and how it is completely unique to her, she will be both thankful and trusting of thermography. That’s certainly the way I feel.

The DCIS Dilemma

Mammograms, particularly the new high-resolution scans, often pick up very early breast abnormalities that may not go on to become actual invasive cancer. These early changes are known as ductal carcinoma in situ (DCIS), or mammary dysplasia or atypia. DCIS refers to cancer cells that are still contained within the mi croscopic breast ducts and have not broken out or invaded the fatty or fibrous tissue of the breast and formed a lump. DCIS is considered stage 0 breast cancer, and many people consider DCIS a precancer. Nevertheless, DCIS is routinely tested to see if it’s positive for estrogen receptors (ER positive). And if it’s indeed determined to be ER positive, women are given tamoxifen, a drug that has been shown to decrease the recurrence of ER-positive tumors.

However, this is an oversimplification. The multistep progression to breast cancer is not linear. DCIS is an example of a precancer that, in many cases, can be arrestable or even reversible—which means that thousands of women are overtreated for this condition. The Norwegian study mentioned earlier, which suggested that some breast cancers regressed naturally, speaks to this. Nevertheless, some doc tors automatically assume that all such abnormalities are fast-growing and potentially lethal. Since these lesions usually occur in many areas of the breast, mastectomy is often recommended.

H. Gilbert Welch, M.D., a general internist and senior researcher at the Department of Veterans’ Affairs in White River Junction, Vermont, has researched the problems associated with the ability of technology to overdiag-nose diseases such as breast cancer. He cites a study showing that in the breasts of women who died of other causes, 40 percent had microscopic precancerous changes in their breasts. These same types of lesions commonly show up on mammograms, and no one knows which ones will remain dormant and which ones will actually become invasive cancer.
³⁹
In fact, it is now well documented that the majority of women diagnosed with ductal carcinoma in situ of the breast do
not
go on to develop invasive breast cancer.

A 1996 article in the
Journal of the American Medical Association
⁴⁰
and a 2005 article in the
Annals of Internal Medicine
⁴¹
summarized the current dilemma well. Both studies show that the incidence of DCIS has increased dramatically since 1983 due to the fact that mammography screening picks it up. At least 20 percent of breast malignancies detected by mammogram are DCIS. A 2005 study from the Fred Hutchinson Cancer Research Center published in the April 2005 issue of
Cancer Epidemiology, Biomarkers, and Prevention
found that the diagnosis of DCIS has increased sixfold since 1980, while the incidence of true invasive breast cancer has remained flat. The researchers also found a fourfold increase in a less-common condition called lobular carcinoma in situ (LCIS), which is also noninvasive.
⁴²
While early detection of invasive breast cancer is beneficial, the value of DCIS detection is currently unknown. I am very concerned about the large number of DCIS cases that are being diagnosed as a consequence of screening mammography, most of which are treated by some form of surgery. In addition, the proportion of cases treated by mastectomy is inappropriately high, particularly in some areas of the United States.

Current treatment options for DCIS and LCIS involve varying combinations of lumpectomy (although there is no lump per se), radiation, and ta-moxifen, and sometimes even mastectomy. While having a mastectomy for such an early-stage cancer seems extreme, more and more women are opting for this surgery because they’re scared to death. While it is very sad for a woman to sacrifice her breast unnecessarily, I can certainly understand why women feel driven to this alternative. It beats the constant worry that stems from the current approach to breast health, which I summarize like this: “We didn’t find anything this year. But keep coming back. Eventually we will!” Without being given tools like thermography, which would allow her make better decisions about her breast health, a woman may feel so powerless over the situation that it just feels like a relief to have her breasts removed and be done with the fear once and for all.