#8: Breast Cancer on the increase

Simply Hormones Podcast

Get the real story behind Mammograms and my preferred route of Thermal Imaging. Listen to Prof Gordon Wishart on why this disease is on the increase.

Here’s the full transcript of the podcast interview:

Hello it's Kathryn Colas here of http://www.simplyhormones.com and I'm here today to talk to Professor Gordon Wishart about the early detection of breast cancer and how thermal imaging fits into this profile.

Before I speak to Professor Wishart, let me tell you something about him. He's a consultant breast and endocrine surgeon at Addenbrooke's Hospital, Cambridge. He is distinguished for his pioneering work in the treatment of breast cancer, where he has introduced innovative and sometimes controversial techniques, which have subsequently seen wide acceptance and adoption. (If you want to find out more about Professor Wishart I've put all the details at the end of this transcript.)

KC: Hello, Professor Wishart, and welcome…

GW; Good morning.

KC: I'd like to start if I may by discussing the current breast screening program. There's currently a very good NHS screening program in place that calls forward women aged 50+ every 3 years, until the age of 70 for a mammogram. But it seems to me that evidence is becoming more widely available in the public domain about an alternative, less invasive method, and perhaps more effective method that can detect tumours at a much earlier stage, and that is thermal imaging. The use of a heat seeking camera. Professor Wishart, can you explain to our audience in layman's terms how thermal imaging works?

GW: Yes well, thermal imaging has been around for approximately 50 years, but the reason it's come back to the fore is because there have been great advances in the digital camera technology, mainly because these are now being used by the military. And in addition to that we now have the ability to interpret these scans, which are lots of different colours, and we can interpret those with computer algorithms much more easily. So because of that we now have a system where we can take digital temperature pictures of the breast while it has been cooled and what we are looking for are areas of the breast that have abnormal blood patterns, or areas of the breast that don't cool down during this period of cooling, and the reason that the cancers and tumours don't cool down is that they encourage their own blood supply to go around them to feed the tumour, and these are abnormal blood vessels that don't contract when they meet cold air, so they retain their heat, so those are the things that we're looking for on an infrared scan.

KC: It seems to be working quite effectively doesn't it?

GW: Well the recent research study that we publish said that it was very effective in detecting breast cancer especially in younger women, and that's the great challenge for us. Most of the delays in diagnosis in breast cancer occur in women under 50 and it's in that age group where the breasts are more dense, the mammograms are less sensitive and it's just much harder to actually detect breast cancer in those women.

KC: But it also seems to me that no-one is paying any attention to looking at ways of reducing the incidence of breast cancer. In my view I wouldn't want to be faced with such a diagnosis and be subjected to disfiguring surgery and a lifetime of dependency on drugs, but instead it's become the norm, if you like, where both the NHS and cancer charities channel the research and thus our understanding of the process towards looking at a truncated life after diagnosis and how they would provide a reasonable quality of life through drugs. What would you say to this?

GW: Well I think the prevention of breast cancer is probably going to be something that we are going to talk more about. Up until now the two main risk factors for breast cancer are being female, and having a family history, of course neither of which you can do anything about. I think some of the things that have increased the risk in recent times are essentially reproductive factors.

A lot of women are now having their first pregnancy at quite a late age; they're not breast feeding because they're anxious to get back to work and in general having less children than they had before. All of these things increase your risk of breast cancer, by small amounts, but they all add up at the end of the day and so I think when you look at the incidence of breast cancer in western countries compared to say rural Africa or Asia, they have a much higher incidence because they have multiple pregnancies; they start as teenagers and they breast feed, and so I think that this is something for public health to tackle there.

But I think there are two other risk factors that have now really been much more recognised and those are alcohol and obesity and we know it this country that we do have a teenage and a young adult alcohol problem and there's much more binge drinking and much greater alcohol drunk by women. If we look at the generation of my mother or my grandmother, women didn't really indulge in alcohol, but that's changed dramatically, and we do have quite a lot of young girls now who are both drinking heavily and are overweight, and we already know that incidence of breast cancer are going to increase to about 1 in 7 by the year 2024 But with alcohol and obesity moving forward at the rate they are, it could actually be higher than that.

KC: And that's in younger women you think?

GW: Yes it is, the risk factors are occurring in younger women, we don't know how long that will take to feed through to increase the incidence, but it's something we need to monitor.

KC: Obviously, as women age their incidence increases, but now you're saying it's going to become a serious problem with women even younger?

GW: I suspect so yes.

KC: That leads us nicely to my next question to you. If we could move on to how information is made available to us. My own research has revealed that published information on early detection of breast cancer focuses on personal breast awareness, feeling for lumps that you haven't noticed before, but not much else really. What are your recommendations on personal breast awareness?

PW: I think that probably there are 3 main areas to focus on. One is knowing what to look for, one is knowing when is the best time in the month to actually examine yourself, and then the third element really is what is your risk? Is it average, is it lower than normal or is it higher than normal? I personally think that the breast cancer charities are giving a very mixed message to women during the last 10 to 15 years and I think that discouraged many women from carrying out self-examinations. I think when they introduced the breast awareness campaign I think what they were trying to stop was women examining themselves every day and becoming very anxious about everything they felt. But actually, given that women detect 90% of breast lumps themselves, unless they know what a normal breast feels like, I can't see how they're going to find a new lump easily, so I think examining yourself once a month is the right thing to do. I think the best time to do it is about day 10-14 of your cycle so that the normal lumpiness that can often come with a period has settled down by then, so then you have the best chance of spotting something new. So I think self-examination is a good idea; doing it mid-cycle is the right time, and then the other thing is that now we can actually give someone an idea of what their own personal risk is and at Breast Health UK we've been using a well-validated model, which looks at family history and lifestyle, called Tyrer Cuzick, and by filling in this questionnaire we can give someone a prediction of their lifetime risk and feel that if it's lower than normal that must be quite reassuring, although low risk doesn't mean no risk.

KC: Vigilance is key isn't it?

GW: That's right, but if someone's at higher risk, then there are a number of things you can do. They might want to start screening at a younger age, or have more intensive screening, I think those are the key things.

KC: And do you think that's where the thermal imaging could come in, because you could see more than a mammography would pick up?

GW: We've certainly got a number of younger women under the age of 50 who are now having a digital infrared breast scan, which is a type of thermogram, because they want to start something at a younger age and so it has become very popular with women who just can't get access to mammography.

KC: That's good, and also just to bring in the older woman, with women who are already post-menopausal, obviously they're not in a cycle any more, so would you probably just pick a date in the month, say the middle of the month for arguments sake, when they should check their breast?

GW: Absolutely and I know that these things are always difficult to remember and just one of the things that we are introducing as part of breast awareness month is an actual text reminder service through Breast Health UK, so that women who sign up for this will get a text at the right time of the month, so that they can remember to examine themselves and there's also a very good video showing women how to examine themselves so that's something that we hope, through the Breast Awareness Month, people can get access to this. To be quite honest I think the majority of women do not examine themselves and those that do are not very sure what they're looking for.

KC: It's certainly raising awareness isn't it, in a much better way because it's quite random at the moment, where women may find out how to examine their breasts properly?

GW: I think that's absolutely true.

KC: Moving on again, I recall listening to an interview you did recently on Radio 4 Woman's Hour with Professor Hilary Thomas from Breakthrough Breast Cancer. .I remember Professor Thomas expressing a view that thermal imaging was not an option, as the evidence in research was just not there. What would you say to this?

GW: Yes, I think any representative from charities would always give a very balanced view, and there's always a balance between early results and getting those new technologies out there and not really raising women's expectations too high. I think what she was trying to say is that we haven't done a screening, a research study of 10, 000 women and followed them for 10 years, and the reality is that whatever new technology comes along we're not going to be able to do that now. We're just not able to wait that length of time, we have shown in our research study that it can detect breast cancer and so the way that we have been using it recently is in addition to mammography, so we're not trying to take this up as an alternative to mammography. What we're trying to say is that mammography is not very good in younger women. Why not add this on so they have a better chance of detecting something if it's there? I wasn't surprised by that approach and you always get a very cautious approach with any new breakthrough.

KC: I think it's different with drugs though, because you have to do so many tests to make sure that it's safe, but with something like this new technology, it's like new computers with ipads for example, it's so fast isn't it? The technology is coming into our field of recognition in such volume and so quickly that we need to understand it more quickly don't we, ourselves?

GW: Yes I think that's absolutely right, but I think it's all to do with being cautious and managing expectations. For instance you will remember that there was a story just a few months ago about a possible vaccination to stop women getting breast cancer. And that was very well exposed in all the media, but the reality from that is it's only been tested in animals. You would then have to do a study in humans where you took a group of women and you randomised half of them to the vaccine and half of them not to have a vaccine and then you'd have to follow them up for a very long period of time to see who got breast cancer and whether it was less in the vaccinated group; so I think that's an example of where expectations were raised far too high and there wasn't really a balanced reporting. I think it's always difficult to get it right

KC: Because people want these things to happen yesterday don't they? When they hear the news they want to start queuing up and getting it sorted.

GW: Yes they do and of course every time there is one of these large news stories, those of us in breast cancer clinics just see people coming in with bundles of papers that they publish from the internet, and they want to talk it through asking “why did I not have this” and it does create a lot of anxiety, so I think we have to just talk it through in the best way that we can.

KC: And finally I'd like to talk to you about improving the early detection of breast cancer must surely be a long term goal for the NHS, not least because it could save so much money and of course the disfiguring surgery along with chemo and radiotherapy, the psychological trauma for women, and the savings overall in all those things must surely run into millions of pounds, what's your view on this?

GW: Well, I think that there's no doubt that breast screening in this country has been successful at detecting smaller tumours that are less likely to have spread and as you say require much less treatment. So I hope that despite the economic crisis and the reductions in funding for the NHS that the breast screening program is here to stay. It does seem to me however that the people running that program are reluctant to change the way that it's organised, for instance it's the same screening program for everybody regardless of your age and regardless of your risk.

One of things we know for instance is that if you have more dense mammograms you have a higher risk of breast cancer. We've known that for many years now; it wouldn't be that difficult to look at the first mammogram that someone has at the age of 50, and if they were very dense they might go down one particular route that might involve more intense screening and if it's less dense they might need less screening. In addition to that there are genetic tests that you can do that modify that risk up or down now, and so it seems to me that a screening program that would stratified according to your risk might actually be more cost effective than just doing the same thing for everyone. But despite asking these questions I think that it's unlikely that it is going to change and it's unlikely that new things are going to be added in to it. I suspect that it's going to remain very much the way it is at present.

KC: So from a personal perspective, and I know many women agree with me on this, that mammograms can be very very painful and you also run the risk, I've heard women say, and I've said it myself, that I'm not going for another mammogram, they're just too painful. So I think they would probably embrace thermal imaging, but of course they'd have to do it on private basis wouldn't they?

GW: Well yes unfortunately that's correct. If we look at the uptake for the invitation to come for a breast screening, across the UK it's about 70-75% in the best areas. In some of the parts in inner London where there are large numbers of ethnic minorities, where maybe the message hasn't come across about the importance of it, the pick up rate can be as low as 30%, so there are clearly a large number of women who either don't want to come or choose not to come, so at least we now have an alternative that they may want to explore.

KC: Yes absolutely, well thank you so much for all that information Professor Wishart. I think it's been very helpful and I'm going to put all the information at the end of the transcript about the breast health program you're running, because of course it's breast health awareness month in October and I think there will be a lot of people that will be picking up on this. I've already spoken to some friends about thermal imaging and the things I've discovered, and they're saying oh yes, give me the details, so breast cancer I think is something that really hits home to women and they want to be aware and to do something about it. So thank you once again professor.

The FREE service launched by Breast Health UK to remind women when and how to check their breasts is detailed here http://www.breasthealthuk.com/index.php?option=com_content&view=article&id=290 and here is the reminder form: http://www.breasthealthscript.com/form.php

New breast screening technology offers breast cancer detection hope to women under 50

Research from Addenbrooke's Hospital in Cambridge in May 2010 revealed that using Digital Infrared BreastScan (DIB) to detect breast cancer in combination with mammograms, increases the sensitivity of detecting tumours to 89%. The study showed that dual imaging increases sensitivity by 11% compared with mammograms alone (78%). Read more … http://bit.ly/97egsa

Kathryn Colas: You'll find lots of information on menopause, including my own personal journey at http://www.simplyhormones.com and do watch ‘Menopause: The Movie' highlighting how relationships are affected at menopause; here's the link: http://www.simplyhormones.com/video.asp and do join me on my blog for my own views on what's going on in the world: http://simplyhormonespodcast.com and feel free to comment on my ramblings and podcasts. Last but not least, you can contact me: [e-mail] .

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