Is No Touch BreastScan useful for breast
cancer screening?
K.S. PARTHASARATHY
T. VIJAYA KUMARTime-tested:
Mammography, an x-ray imaging method, continues to be the recommended one to diagnose
the disease. — photo: T. VIJAYA KUMAR
TOPICS
In
2011, the Indian Council of Medical Research reported that breast cancer in
India is doubling every 24 years. One in 11 and one in 8 women in Delhi are at
risk of developing breast cancer by the time they are of age 64 years and 74
years respectively. The data for other cities are similar.
Early
detection of cancer is important for effective treatment. Mammography, an x-ray
imaging method continues to be the recommended one to diagnose the disease. On
September 18, this year, the U.S. Food and Drug Administration approved the
first ultrasound device for use in combination with standard mammography in
women with dense breast tissue who have a negative mammogram and no symptoms of
breast cancer. No one can ignore the arrival of ‘No Touch BreastScan’ (NTBS)
imaging device, based on thermography, which looks for temperature hot spots at
the surface of breast. Increased metabolism in cancer cells leads to increase
in temperature.
NTBS
may not have sufficient clinical backing but commercial considerations prevail.
AGGRESSIVE PROMOTION
Promoters
of NTBS aggressively highlight the deficiencies of mammography. Squeezing
breasts to get a mammogram is painful; it involves radiation exposure; cancer
in dense breast tissue is difficult to diagnose etc. The promoters lament over
the shortage of radiologists in India but ignore the lack of experienced
thermographers to use NTBS. They seldom reveal the drawbacks of NTBS as a
stand-alone tool (http://www.notouchbreastscan.com/pdfs/HEAL%20India.pdf).
In the
May 10, 2010 issue of the European
Journal of Surgical Oncology, Dr Wishart and co-workers
from Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge, U.K. reported
that No Touch BreastScan (NTBS) and mammography in women under 50 gave
encouraging results suggesting a potential way forward for a dual imaging
approach in this younger age group.
At the
American Society of Breast Surgeons’ annual meeting in Phoenix on May 4, 2012,
Dr. C.M. Guilfoyle, a researcher at Bryn Mawr Hospital in Pennsylvania
concluded that in a study of about 180 women who had biopsy proven breast
cancer, NTBS unit missed about 50 per cent of cancers! It delivered too many
false positives. False positives may lead to trauma.
Drs
Anita Fitzgerald and Jessica Berentson-Shaw, Research Services, New Zealand
Guidelines Group, Wellington concluded that currently there is insufficient
evidence to support the use of thermography in breast cancer screening, nor is
there sufficient evidence to show that thermography provides benefit to
patients as an adjunctive tool to mammography or to suspicious clinical
findings in diagnosing breast cancer (The New Zealand Medical Journal,
09 March 2012). They reviewed papers from 1984 to the end of April 2011.
“Despite
widely publicized claims to the contrary, thermography should not be used in
place of mammography for breast cancer screening or diagnosis,” the US Food and
Drug Administration (USFDA) cautioned in an update on November 7, 2012.
According to FDA, mammography is still the most effective way of detecting
breast cancer in its earliest, most treatable stages.
The FDA
has no evidence to support the claim that thermography is a replacement for
mammography and that thermography can find breast cancer years before it would
be detected by mammography.
American
Cancer Society and National cancer Institute have similar views on the limitations
of thermography.
In
spite of well known deficiencies, a few private hospitals in India have
purchased the imaging units.
“To
make it comfortable for women to undergo check-up of breasts for detection of
cancer, the Brihanmumbai Municipal Corporation (BMC) plans
to buy ‘no-touch’ scan machines,” a section of the press reported on November
8, 2012.
The
health committee chairman of BMC announced the civic body’s plans to buy the
machines so that women “do not have to experience awkwardness while going
through physical examination of breasts or pain while scanning through a
mammography machine,” the report added.
Those
associated with the proposal to buy NTBS seem to be carried away by the
vendor’s words!
The No
Touch BreastScan machine, developed in the USA by UE
LifeSciences and
installed at private facilities in Thane, Pune and Ahmedabad, may cost the BMC
up to Rs75-80 lakh.
CRITICAL REVIEW NEEDED
There
is a need for critical appraisal of such expensive tools before they are
purchased. Such reviews must include the experience in using the device
internationally.
It is
inappropriate and unethical to spend scarce resources on fancy equipment where
its benefit to users has not yet been proved.
(ksparth@yahoo.co.uk)
Keywords: Indian Council of Medical Research, breast cancer
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