Question: What are your thoughts on the use of thermography in conjunction with mammograms to detect abnormal cysts in women’s breasts?

Dr. Hibberd's Answer:

Thermography, an imaging technique that detects changes in blood supply, often provides too many false results. It does not appear to be very reliable for evaluating breast disease, breast cysts, or malignancy.

Ultrasound is the best choice for diagnosing cystic breast disorders, with treatment usually consisting of simple aspiration and/or modification of factors that trigger breast cysts such as caffeine, estrogen supplementation, etc.

Although mammography, a form of specialized x-ray, is currently the imaging method of choice for non-palpable malignancy surveillance in those over 40 years of age, not all breast cancers are detected by mammography. Dense breast tissue in patients under 40 years of age will often obscure malignant tissue, making mammogram use in young women a case of unnecessary x-ray exposure. The usual reason for mammography under the age of 40 is to establish a baseline pattern for malignancy surveillance in later years. It should generally not be used for malignancy surveillance in patients under the age of 36. MRI has proven very useful for imaging breast disorders. Although expensive, it does not involve radiation and is certainly a safer method for serial imaging.

No imaging technique replaces tissue evaluation when malignancy is suspected, and needle biopsy should be preferred over excisional biopsy in most lesions. Surgical removal of the cyst should be reserved for high risk or enlarging lesions or for those that prefer excision for other reasons.