Jody DeLand’s last mammogram several years ago resulted in a biopsy that was painful, expensive and did not reveal cancer. Instead, the spots on the mammogram were calcifications, which commonly show up on the images — usually as benign spots, although sometimes as signs of cancer.

DeLand, a massage therapist for more than a decade, feels like she got a “bad read” on her mammogram. Had she known then about a screening technique called thermography, she said she would have avoided the procedure.

She’s since become a thermographer. She purchased a digital infared thermal imaging camera and — within the past year — set up an office within Baker Family Naturopathic in Bend.

Thereamography, the use of nonradiation digital infrared thermal imaging to detect patterns of heat and blood flow near the surface of the body, is commonly used by providers who believe it aids in the early detection of breast cancer. The idea, according to DeLand and many of the technique’s proponents, is that thermography can detect breast cancer early by picking up on heat patterns generated by angiogenesis, the creation of new blood vessels in the development a tumor.

Thermography, DeLand said, can detect tissue changes that may indicate tumor development within its first year, whereas mammography wouldn’t pick it up for at least eight years. Only a biopsy can determine whether cancer exists.

“You get one every year, you’re going to see if something starts happening,” DeLand said of thermography. “You’re not going to get into hot water. You’re not going to all of a sudden have something really, really critical if you keep up with your annuals.”

From now on, DeLand said thermography will be her primary means of breast cancer screening. So long as her thermograms come back normal and her doctor says it’s OK, she will no long receive mammograms.

Despite the enthusiasm among thermography proponents, most of the medical community cautions women against forgoing regular mammograms in favor of thermograms, even if the technique does hold promise. The FDA issued a warning in 2011 reminding the public that scientific data has not found thermography to be an effective screening tool for any medical condition, including the early detection of breast cancer, and is not a substitute for or superior to mammography.

There aren’t many scientific studies that support the effectiveness of thermography, and the small ones that do say it may be useful in helping to detect cancer if used in conjunction with mammography. Most major medical organizations, including the American Cancer Society and the American College of Radiology, do not recommend the screening.

Dr. Ray Friedman, who worked as a radiologist for 50 years and taught at Oregon Health & Science University for the latter half of those years before retiring in April, said angiogenesis, which the proponents say happens in the early stages of tumor development, does not begin in ductal carcinoma in situ tumors until they’re between 4 and 6 millimeters large — still moderately early, but after the tumor has had time to develop, he said.

“It (thermography) can see cancer, no problem, as long as the cancer is big,” he said, “and by big, I mean, about the size of a golf ball. We want to find cancer that’s about the size of your fingernail, or small. Therein lies the problem.”

By the time a tumor is 2 centimeters or larger, the patient’s survival rate drops to less than 50 percent, Friedman said.

Likewise, Dr. Patricia Dawson, a breast surgeon at Swedish Hospital in Seattle and medical director of the Swedish Cancer Institute’s breast program and the True Family Women’s Cancer Center, said until more research supports thermography’s effectiveness, she would not recommend it to patients, even if used in addition to mammography.

“I think sometimes women are being oversold on thermography and I worry,” she said. “I’ve seen enough women come in with late cancers who’ve been followed by thermography.”

‘I don’t tell people what to do’

Candace Parmer, a massage therapist who lives in Portland, first learned about thermography earlier this year from DeLand, whom she has gone to for massages. It sounded interesting, so she did some research.

“I was so impressed by the way it works that I knew I needed to make this my primary means of detection for any problems or abnormalities,” said Parmer, 53.

So far, her breast thermograms have turned up normal. A full-body thermogram showed her knee pain was not joint related, as she had guessed, but the result of a tight muscle in one of her calves. She solved the problem by releasing the muscle tension.

“I was able to avoid X-rays,” she said.

From here on out, Parmer plans to travel to Bend to receive thermograms annually from DeLand. Like all new patients, she must first have two breast thermograms performed three months apart to establish a baseline reading. DeLand charges $195 for each breast thermogram visit. Full-body thermography costs $395.

If her thermograms show abnormalities, Parmer said she’ll monitor their growth using thermography while working to change her lifestyle or diet — “whatever I think might be the cause of it.”

DeLand said Parmer’s choice is a personal one, but that she thinks many people are doing the same.

“At that point, you can change things and your body can heal it,” she said. “Our bodies can heal cancer if we support them to heal cancer.”

DeLand said she encourages her patients to discuss thermography with their physicians, especially if the images show abnormalities, and undergo mammograms if necessary. She even sends results directly to patients’ primary care providers.

Ultimately, though, it’s up to the patient, she said.

Mainstream medicine is different from naturopathic medicine in that it relies on drugs, surgeries and its own imaging methods, DeLand said.

“It’s an enormous business, with the insurance, with the hospitals and with the doctors,” she said, “and people, in fear, just get swept into it, and they’re really not making their own decisions. … But some people believe strongly enough in their own health and the strength of their immune systems that they feel comfortable with it.”

DeLand said she was mentored in thermography through fellow thermographer Karmen Lawson, who travels to Bend a handful of times a year and provides thermography at two local clinics: the Westside Family Clinic and High Desert Chiropractic.

Evelyn Brust, the naturopathic physician who serves as medical director for the Westside Family Clinic, said she has patients who receive annual thermograms and do not receive mammograms.

“I don’t tell people what to do,” she said. “A lot of people feel better with thermography because their breasts are not squished. There is no pain. There is no radiation. They’re low-risk anyway, and if something abnormal shows up, they go straight to ultrasound.”

When reminded of the FDA’s warning against forgoing mammography in favor of thermography, Brust said Americans can discern what’s best for their health.

“The FDA has put drugs on the market that have killed people, caused cancer and done all kinds of nasties. … Don’t even get me started on the FDA,” she said.

FDA warnings

The FDA cleared the first thermography device that measured temperature variations without touching the skin in 1985, Sanaz Jansen, a reviewer and biomedical engineer in the FDA’s Center for Devices and Radiological Health, wrote in an email. All thermography devices are cleared as adjunct tools for measuring temperature variations on the body’s surface, meaning they can not be used as a stand-alone screening method for any condition, including breast cancer, Jansen said.

“FDA has a longstanding concern regarding the promotion of thermography devices for breast cancer screening and diagnosis, for which there is no demonstrated effectiveness,” Jansen said. “In women who opt for thermography instead of screening mammography, the diagnosis and treatment of breast cancer may be significantly delayed.”

The agency has since issued a number of warnings to companies whose advertising falls outside of those boundaries.

The FDA sent a warning letter in 2011 to a California-based thermographer asking that provider to stop making a number of claims that did not fall within the uses the device was approved for, including, “Detects breast tissue abnormalities 8 to 10 years before a mammogram can detect a mass.” This claim is similar to one that appeared on Imaging Alternative’s website: “Thermograms can detect tumor cells as much as 8-10 years before mammograms.” The claim was removed from Imaging Alternative’s website last week.

Jansen, of the FDA, wrote that that claim supports using thermography as a sole screening method, which the devices are not approved for.

In a 2011 warning letter to an Illinois-based thermographer, an FDA official wrote that the business’ website claimed thermography can detect conditions like bursitis, herniated discs, ligament or muscle tears, nerve problems, whiplash and risk of stroke, among others. The letter directed the provider to immediately cease making such claims or face regulatory action, as thermography devices such as the Meditherm Med2000 Thermographic camera are not approved to be used alone to diagnose and screen for those conditions.

Imaging Alternatives, which uses a camera called the Meditherm Iris 7.5 DITI, names all of those conditions on its website under “clinical applications” of thermography — a list that includes more than 70 health conditions.

In Oregon, a Medford thermography clinic closed in 2009 as part of a settlement agreement with then-Attorney General John Kroger. The clinic had claimed its thermography device could detect the presence of breast cancer seven to 10 years before other diagnostic procedures, including mammography. Kroger said the clinic also did not advise women who received thermography to also receive mammography.

“Putting the lives of women at risk is unconscionable,” Kroger wrote in a statement. “Given the lethal consequences of delaying detection of such a deadly cancer, I am giving medical imposters fair notice that these types of misrepresentations will not be tolerated.”

The clinic’s operators had also been engaging in fraudulent billing practices.

‘Just the image-taker’

DeLand received board certification from the American College of Clinical Thermology, which she said required 16 hours of classroom learning and about 50 hours of working closely with other thermologists that had completed additional training. She said the classroom training, held at the Meditherm headquarters in Florida, was “strictly” on how to operate the camera.

DeLand sends the thermal images she takes of patients to a third-party interpretation service called Electronic Medical Interpretation, where she said physicians “primarily on the East Coast” perform a thorough evaluation of the images and send DeLand their report usually by the end of the following day. If those physicians find something abnormal, they will indicate in the report that the patient should follow up with his or her primary care physician, DeLand said.

While she’s in the room with patients, however, DeLand said she cannot say anything about the images, although they’re right in front of her on the computer screen, even if there is an area that seems to show concentrated heat. DeLand said she encourages patients to look at the images during the visit, but cannot discuss them until she gets the results from Electronic Medical Interpretation.

“It’s not my job,” DeLand said. “I’m just the image-taker.”

Some research has been performed on thermography. One study examined the technique’s ability to detect tumors by performing the imaging on 92 patients who were already recommended to receive biopsies based on abnormal mammogram or ultrasound results. Biopsies found that 60 of the 92 patients had cancer, and the thermography detected 58 of those cancers, according to the study, published in 2008 in the American Journal of Surgery. The researchers concluded that thermography could serve as a “valuable adjunct” to mammography and ultrasound.

A 1998 study in The Breast Journal found that, when paired with mammography, thermography increased the sensitivity rate, the proportion of cases correctly identified, by 10 percent. On the flip side, thermography resulted in a 19 percent false-positive rate, meaning the test affirmed an abnormality that further testing found to be benign. That study also concluded thermography could be valuable if used in conjunction with mammography.

Mammography also has a high rate of false positives. Research has shown that someone who receives mammograms annually for a decade has between a 50 and 60 percent chance of receiving a false positive, according to Susan G. Koman, a foundation that raises money for breast cancer research.

The problem with the thermography studies that have been performed is that their subjects already had cancer, said Dawson, of Swedish Hospital in Seattle. They don’t reveal how many women have had normal thermograms and developed cancer, she said.

Recent research has cast doubt on the value of mammography. Earlier this year, a study in the British Medical Journal concluded annual mammography in women ages 40 to 59 does not reduce mortality from breast cancer beyond physical exams or usual care. The study also found one over-diagnosed breast cancer for every 424 subjects who received mammography.

Mammogram recommendations vary as well. The U.S. Preventative Services Task Force recommends mammograms every other year for woman ages 50 to 74. The American Cancer Society, by contrast, recommends them annually for women starting at age 40.

Mammography is not perfect, Dawson said, but that doesn’t mean women should use a method that’s not been scientifically proven.

“I don’t know any physician who wouldn’t love to have a more reliable way of diagnosing breast cancer,” she said. “But we want it to be well-proven.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com