Cancer Medicine Popular culture

A tourist finds breast cancer after a thermal scan at Camera Obscura. That doesn’t mean thermography works.

Bal Gill saw a hot spot on her breast on a thermal image she had taken at Camera Obscura in Edinburgh. This led her to see her doctor, who diagnosed breast cancer. Although a happy coincidence, this incident does not mean that thermography is an effective modality to detect occult breast cancer.

It occurs to me that I haven’t written about thermography in a while; indeed, I don’t think I’ve devoted a whole post to it since 2010, when Dr. Christiane Northrup published a hype-filled article touting thermography for breast cancer detection. Thermography is an imaging technique that produces an image based on the heat signature of the object being imaged. It’s an imaging technique that has many uses, but one of them is definitely not as a screening for breast cancer. Of course, October is Breast Cancer Awareness Month, and the month is almost over, which makes it strange that news or a study about breast cancer that caught my interest has’t shown up on my blog topic radar and piqued my interest enough to write about it. There’s another story out there that I might also want to write about, but it will take a lot more in depth analysis, which is why I’ll probably save it for next week, which, fortunately, will still be October. In the meantime, I’m sure you’ve probably seen this story. It started out as a local story in Scotland a few days ago and found its way to international news, with USA TODAY publishing an article about it just yesterday by N’dea Yancey-Bragg entitled A trip to a popular tourist attraction led this woman to discover she has breast cancer A trip to a popular tourist attraction led this woman to discover she has breast cancer. The attraction was Camera Obscura & World of Illusions in Edinburgh. Here’s the spin:

A family photo snapped at a Scottish tourist attraction led a woman to discover she has breast cancer. When Bal Gill, 41, snapped a photo in the thermal camera at the Camera Obscura and World of Illusions in Edinburgh, she noticed something unusual: a red heat patch over her left breast. It wasn’t until a few days later, when she was going through vacation pictures, that she decided to Google what the image might mean. Gill found several articles about breast cancer and thermal imaging cameras and made an appointment with her doctor, where she learned she had an early-stage breast cancer. She’s since had two surgeries and has to have another to prevent the cancer from spreading. “I just wanted to say thank you: without that camera, I would never have known,” she said in a statement published on the Camera Obscura’s website. “I know it’s not the intention of the camera but for me, it really was a life-changing visit.”

I can see it right now. Naturopaths and other alternative medicine mavens will likely tout this as evidence that thermography “works.”

But is it? Given my specialty as a breast cancer surgeon, you know I can’t resist unpacking this story and taking a closer look. So let’s start out with the post on the Camera Obscura Facebook page on Tuesday:

And, just yesterday:

This post references a blog post on the Camera Obscura website:

Andrew Johnson, General Manager of Camera Obscura & World of Illusions said:

“We did not realise that our Thermal Camera had the potential to detect life-changing symptoms in this way. We were really moved when Bal contacted us to share her story as breast cancer is very close to home for me and a number of our team. It’s amazing that Bal noticed the difference in the image and crucially acted on it promptly. We wish her all the best with her recovery and hope to meet her and her family in the future.” Thermography, also called thermal imaging, is a tool used by breast cancer specialists and uses a special camera to measure the temperature of the skin on the breast’s surface. It is a non-invasive test that involves no radiation. Thermography is based on two ideas; because cancer cells are growing and multiplying very fast, blood flow and metabolism are higher in a cancer tumour; as blood flow and metabolism increase, skin temperature goes up.

Looking at the image above and the image posted to the Camera Obscura website, I must admit to some confusion. The only “red heat patch” I see anywhere near Ms. Gill’s left breast is obviously the face of what I assume to be one of her children, who can easily be identified as a person because he or she is waving at the camera and I can see the outline of the person’s hand. No, seriously. Look at the image. (If I’m off-base on this, let me know.) There is a bit of a yellow patch over Ms. Gill’s right breast, but it’s singularly unimpressive. I suppose it’s possible that the sides are reversed and that yellow patch is really over Ms. Gill’s left breast, but that doesn’t seem too likely either. I suppose it’s also likely that there are other thermal images from Ms. Bal’s trip to Camera Obscura, but if there are why did she choose this one to share with the media? Presumably it’s the one that tipped her off to go to her doctor.

I did find one story that shows the same image, with a circle over the yellow warm patch over the right breast, suggesting that that was the “hot spot” that alerted Ms. Gill to see her doctor. Whatever the case, that is a singularly unimpressive hot spot. It could be due to any number of things that could make that area of her skin or clothing slightly warmer.

I must admit that I was pleasantly surprised that most of the articles reporting this story that I read correctly noted that thermography is not recommended for breast cancer screening. For instance, USA TODAY:

Thermal imaging cameras like the ones used at Camera Obscura have been used in medicine, but experts don’t recommend it for breast cancer screening. Thermography is a noninvasive tool that uses an infrared camera to capture images of heat and blood flood on the surface of the body. Although thermography has been successful at using heat signatures to assess repetitive motion injuries, it “just doesn’t work very well” for breast cancer screenings, according to Robert Smith, Senior Vice President of cancer screening at the American Cancer Society. “The problem with thermography though is that not all breast cancers, especially very little ones, produce a heat signature and other benign conditions in the breast can also produce heat signatures,” Smith said

This is, of course, basically accurate, as is this assessment in a CNN article:

Caroline Rubin, vice president for clinical radiology at The Royal College of Radiologists, said there is no scientific evidence to suggest they are effective tools in screening for breast cancer or other medical conditions. “The principle behind using thermography is that infrared heat cameras can be used to map patterns of heat and blood flow close to the surface of the body,” said Rubin in a statement, who explained that cancer tumors generate heat as they tend to have a good blood supply but they vary hugely in size and position. “Thermography devices are not sensitive or specific enough to be a trusted method to detect breast cancer — in Ms Gill’s case the discovery was serendipitous.”

“Serendipitous”? That’s putting it mildly. I’d say it was more of a happy freak accident based on what was likely a misinterpretation. Consider how thermography works. The idea is simple. As its name implies, thermography measures differences in temperature. Most thermography systems use infrared imaging to achieve these measurements, and there’s nothing magical about it; the technology has been in use for various applications for several decades. The rationale for applying thermography to the detection of breast cancer is that breast cancers (like other cancers) tend to induce angiogenesis, which is nothing more than the ingrowth of new blood vessels into the tumor to supply its nutrient and oxygen needs. A tumor that can’t induce angiogenesis can’t grow beyond the diffusion limit in aqueous solution, which is less than 1 mm in diameter. These blood vessels result in additional blood flow, which results in additional heat. In addition, the metabolism of breast cancer cells tends to be faster than the surrounding tissue, and cancer is often associated with inflammation, two more reasons why the temperature of breast cancers might be higher than the surrounding normal breast tissue and therefore potentially imageable using infrared thermography.

There are many problems, however. For one thing, thermography tends to measure surface temperature; it’s not clear that a tumor deep in the breast would produce enough additional heat to show up on the surface. Another issue is that there aren’t any widely agreed-upon standards for the performance and interpretation of breast thermography. Not only have these standards not been developed, largely thanks to its adoption as a “breast cancer screening tool” that’s “better and safer than mammography” by some physicians, chiropractors, and naturopaths. Still another issue is that it’s a crap study to find breast cancer in an asymptomatic patient. I hadn’t reviewed thermography in several years; so I did a few Pubmed searches.

One study, in particular, was quite damning. Published in Academic Radiology in 2018 by a group at my medical alma mater, the University of Michigan, this retrospective study asked a very simple question: What percentage of women who presented to U. of M.’s breast center with a “positive thermogram” actually turned out to have breast cancer? True, it was a small study, with only 38 patients, but the results are telling:

Ninety-five percent (36 of 38) of patients did not have breast cancer. The two patients diagnosed with breast cancer had suspicious clinical symptoms including palpable mass and erythema. No asymptomatic woman had breast cancer. Negative predictive value was 100%. Of 38 patients, 79% (30 of 38) had Breast Imaging Reporting and Data System (BI-RADS) 1 or 2 assessments; 5% (2 of 38) had BI-RADS 3; and 16% (6 of 38) had BI-RADS 4 (n = 5) or BI-RADS 5 (n = 1) assessments. Two of six patients with biopsy recommendations were diagnosed with breast cancer (Positive predictive value 2 = 33.3%). All findings recommended for biopsy were ipsilateral to the reported thermography abnormality.

The BI-RADS reporting system is a system used to grade how suspicious for breast cancer that patient’s imaging (mammography, ultrasound, MRI). BI-RADS 1 or 2 means normal or benign findings; BI-RADS 3, probably benign findings (chance of cancer ~1-2%); BIRADS 4 and 5, suspicious findings and very suspicious findings, respectively). So, from the above, you can see that the vast majority of women with “positive” thermography had negative mammograms (BI-RADS 1 or 2) and only a minority had suspicious findings (BI-RADS 4 or 5).

These findings led the researchers to conclude:

No cancer was diagnosed among asymptomatic women. The 5% of patients diagnosed with cancer had co-existing suspicious clinical findings. Mammogram and/or ultrasound were useful in accurately characterizing patients with abnormal thermography.

Of course, the very purpose of a screening test is to detect occult disease in an asymptomatic patient. Clearly, this study, at least, shows thermography failing miserably at that task. The only women with “positive thermography” who actually turned out to have disease weren’t asymptomatic!

A 2019 review on thermography notes that thermograms are quite sensitive to many conditions, including the temperature of the room and that current thermography suffers from high false positive and false negative rates. The author argues that these problems can be “effectively reduced by suitable combinations of segmentation, feature extraction and classification techniques” and that specific “outputs from numerical simulation can also act as input to artificial neural networks, thereby integrating thermography and numerical simulation.” In other words, artificial intelligence will be the answer! I’m not so sure. I’m open to potentially using thermography to complement mammography, potentially reducing its false positive and negative rates when the two imaging modalities are used together, as this review article argues to be a promising strategy. Heck, years ago at my previous job I even participated in a clinical trial whose goal was to add a thermography-like machine to mammography. It’s just that thermography by itself is pretty much useless as a screening tool for breast cancer.

I’m actually happy to have seen this story, because there was another story a while back that, for whatever reason, I never wrote about. Looking at the date, I think I know why; it happened right around the time my pain from my cervical radiculopathy was at its worst and I was on track for my first appointment with major surgery in adulthood. Basically it was an FDA warning on February 25, FDA Warns Thermography Should Not Be Used in Place of Mammography to Detect, Diagnose, or Screen for Breast Cancer: FDA Safety Communication. A tourist at Camera Obscura in Edinburgh saw a hotspot on her breast and was diagnosed with breast cancer. Does this validate thermography? In this safety communication, the FDA reiterates that thermography alone is not reliable for breast cancer detection and that only mammography is the only method validated to decrease breast cancer-specific mortality and mentions that it had sent several warning letters to those selling thermography machines and services:

On February 22, 2019, the FDA issued a Warning Letter to Total Thermal Imaging, Inc., in La Mesa, California, for marketing and promoting thermography devices for uses that have not received marketing clearance or approval. The FDA has also issued Warning Letters to the following facilities:

Looking at the letters above, depressingly I see the same sorts of claims, such as that thermography can produce “early detection of the diagnosis of many disorders including breast cancer, inflammatory breast cancer, pre-stroke, heart disease, deep vein thrombosis, reflex sympathetic dystrophy/complex regional pain syndrome, back, leg or headache, and even unexplained pain, TMJ, and other disease” and thus save your life and that it is “an alternative to mammography that doesn’t involve any patient contact (no pain), will not cause cancer (no radiation), and is far more efficient at detecting cancer.” One claimed that breast thermography “has: 99% Sensitivity, 90% Specificity, 90% Accuracy” and is “far more sensitive than mammography,” recommending that all “women 25 and older should get annual Thermography screenings.”

Also found are frequent claims that thermography is “FDA-approved.” This is a deceptive claim in that, yes, in 1982 the FDA approved Class I telethermographic systems for the use of “adjunctive diagnostic screening for detection of breast cancer,” which means that thermography can be used only in conjunction with approved screening methods, not in place of them, to detect breast cancer. Companies and quacks marketing thermography, unfortunately, frequently get away with forgetting to mention that last part. Canada, meanwhile, also warns that thermography is nothing more than ” specialized thermometers” and shouldn’t be used to screen for breast cancer.

Predictably, in response to the stories about her cancer being detected by Camera Obscura (which it almost certainly wasn’t), the quacks are coming out of the woodwork. For instance, here we have someone telling her not to have surgery, which she’s already had, given that her visit was in May:

I’m only surprised there hasn’t been more of this. I’m also pleasantly surprised that most news articles reporting on this story point out that thermography on its own is a highly unreliable method to screen for breast cancer, even as I worry that publicity over this story during Breast Cancer Awareness Month might lead some women to conclude that thermography would be better for them. I’m also very happy for Bal Gill, although it is almost certain that her detection of her breast cancer was not because the Camera Obscura thermal image detected her cancer but because a happy accident that, for whatever reason, that patch of skin (or even her clothings) over her breast was a little hotter than the surrounding skin and clothing, which led her to wonder and to go to see her doctor. She’s a very lucky woman.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

15 replies on “A tourist finds breast cancer after a thermal scan at Camera Obscura. That doesn’t mean thermography works.”

When I saw this I assumed that the thermal image was a Camera Obscura stock photo and not an image of Gill. It certainly looks like models as opposed to a random family. Maybe Gill doesn’t care to have millions of people staring at her breast.

When I look at that image, I have a hard time getting past the pointy-headed guy with beard stubble, a big red mustache, narrow multicolored sunglasses and a beanie. The smaller character rather resembles and ewok.

I was diagnosed with breast cancer almost 4 years ago. There is a woman at my church who is a RN. She told me she doesn’t have mammograms, but uses thermography. She also gave me a book on treating cancer naturally. She wanted to refer me to her naturopath. I politely declined. I took the book and told her I’d look at it. I did. I looked at the cover and promptly threw it into recycling.

I had a lumpectomy and radiation and am on hormonal therapy. Thankfully my mammograms have been negative. I shudder to think about people she might have talked to who are less skeptical and think her RN gives her credibility.

Finally after years of research in our top secret underground labs we have finally developed the ultimate in consumer friendly medical diagnostic appliances. There is no need to lug around expensive laboratory grade analysis equipment. It even fits in your pocket. At any time you can whip out your phone and check your friends, family and coworkers for the disease we fear most. All you need to do is download our app to your smart phone at the low, low price of $19.99 and the phone’s camera becomes a disease detector.

And when we say the disease we fear most, yes, we mean the big ‘D’: death! Load the app and find out who among those around you has this deadly (ha ha) disease. Is your under-performing coworker dead or simply acting that way? If your spouse is unresponsive with this app you can tell whether they’re sleeping soundly, dead or simply ignoring you like they always do. Be the life of the party? Great for social media too. Share thermographs of yourself to see who in your community of acquaintances is dead or alive.

It also comes in handy for zombie apocalypses. No, we don’t mean preventing or fighting on but bringing it on. If you’re a zombie you need this product! They can’t see you but you can see them! You shamble along slowly enough as it is (and smell bad) so you need every advantage that modern technology can give you. Spot your quarry sooner and home in on them directly rather than giving the game away with all that randomly bumping into things and low moaning. With our thermography app you’ll feast like a zombie prince or princess.

Remember it’s only $19.99 and will run on any iPhone or Android phone. What, you’re still using Blackberry? You must already be dead — we can’t help you.

A few days ago I saw something about this in the morning news. Not really a big item, just mentioning it happened.

In some way it reminds me on stories by people who had a full bodyscan and of course, something was detected at an early stage. So ‘the bodyscan saved my life’ because the headline and people start asking why it isn’t covered by health-insurance.

Ugh, those full-body scan scams! I just told off a company advertising one on Twitter. They tried to claim that they could tell from the scan what was cancerous and what wasn’t.
Thankfully several people were able to call BS on that.

The problem with body scans is that they can pick up what are called “incidentalomas”. These are benign lesions that will never cause any harm. However, there is harm from detecting them, and the harm comes from further investigations that can cause both direct harm and indirect harm by picking up further harmless abnormalities; as well as harm from actually removing these lesions; in addition to the emotional and psychological trauma of thinking you have a fatal cancer diagnosis.

Saw this a few days ago. First I thought another Alien vs Predator movie came out. Then after reading a few paragraphs I figured that People magazine would maybe stop gushing so much on this thermal camera and realize there was clothing over that part of the body so good luck figuring out what yellow over the right breast means in that picture. Now I’m thinking people are going to get getting upper body selfies at Camera Obscura and then drive their physicians nuts, possibly even someone familiar with RI 😉

That was my though as well, Dr. Hickie.
Did she strip off her top and take off her bra to take the image or is it through multiple layers of clothing?
Gee, it seems that if some kid had rested his head against mom’s breast only minutes before the clothing over that breast would be much warmer that the ambient air temp and voila – a “cancer” termogram in the shape of a kids head.
Or if she had rested her bare palm across her chest the same thing would happen with the heat trapped in the cloth of her garment.
etc., etc., etc.
The whole concept as described in Orac’s article is idiotic.

I remember a presentation many years ago by Dr. Barnes, who was a pioneer in thermal imaging, showing a thermal image with a warm spot in an area that that turned out to be over a cancer. I don’t think it was breast cancer. When this was made public there was a big increase in his company’s stock, but further studies proved disappointing. Back then thermal imaging required mechanical scanning, now anyone can buy a thermal camera for a few hundred dollars.

Is this iodine thing the next alt-med scam the supplement scammers are pushing?
From Orac’s article:


That jogged my brain cell in that I had just read some lunacy citing “Lynne Farrow” and her pamphlet “The Iodine Crisis”.
It was at Gnatural Gnus, of course:
Disabled link: naturalnewsblogs(dot)com/how-fluoride-a-toxin-got-in-our-water-and-iodine-a-critical-nutrient-disappeared-from-medical-school-textbooks/
Note how the article cites Lynne Farrow’s iodine pamphlet.
Mikey and naturopathetic Ms. Thomasina Copenhaver** seem to be promoting smearing yourself with iodine to cure just about everything including cystic breasts and ovaries, low IQ, asthma and lung diseases, infections, gout, ulcers, burns, inflammation, croup, syphilis, tumors, etc.
They also mention “Iodine suppositories were marketed for prostate issues”. Yeah? So was radium used in suppositories, toothpaste, water, etc.
There was a big push by the supplement sellers and survivalist scammers for iodine back during the Fukushima events. A whole lotta iodine/iodate and Lugol’s solution was sold to the terminally terrified hunkered down in their sod bunkers in Idaho.
Is this just the usual kook tendency to not be original and recycle kookery every few years for profit?
In any event, it seems there is some push to promote iodine supplementation again.
**Thomasina Copenhaver – naturalnewsblogs(dot)com/author/naturopathicdoctor/
IMO – Something that should really be addressed is RFK, Jr.’s push to convince pregnant mothers to not get the flu vaccine to protect themselves, her fetus, and the eventual infant.
This is so deadly a piece of misinformation I can’t decide whether Junior is actually truly evil or just truly insane. Or both.
Junior should be vigorously called out by numerous medical and pediatric orgs over this deadly article and made to retract, apologize, admit the error, and take it down.
Any politico who meets with this lunatic should be chastised and ridiculed to the fullest extent.
His “advice” is outrageously dangerous to the public to the point of being deadly.

Speaking of scams:

Ms. Bacon and I have been mailed complimentary VIP tickets to a Stem Cell Event at a local restaurant, sponsored by a local “regenerative medicine doctor”.

He advertises that “YOU NEED TO ATTEND THIS EVENT” if you have any of the following symptoms (list follows which includes):

Knee pain
Can’t Go Up Or Down The Stairs (never knew there was a type of stem cell that worked on that)
Back pain
Hip pain
Difficulty sleeping
Balance problems
Swollen, stiff and sore joints

I was toying with the idea of attending this event, scarfing up what free food and drink is offered, and asking embarrassing questions of this “doctor”.*

Might be fun.

*as Gomer Pyle might’ve said “Surprise, surprise, surprise!” The guy turns out to be a chiropractor. 🙂
**I thought chiropractic adjustments were supposed to fix problems on the list. What happened??!?

My first thought was that that spot was could have been her phone. When I don’t have pockets (a common failing in women’s clothing) and I need to do something with my phone for a short period of time, rather than set it down somewhere and forget it, I tuck it into my bra. I know I’m not the only woman who does this.

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