Infrared Thermography and Breast Cancer
Breast cancer diagnosis using thermography is one of the most controversial applications. However, thanks to the technology advances, its future in hospitals is absolutely promising for the early detection of growing tumors.
Breast cancer is the most common type of cancer in women globally, demanding accurate diagnosis to take remedial measures to treat (Hashemi et al., 2019; Hand et al., 2021). Moreover, breast cancer is the second or third most common malignancy in developing countries (Acharya et al., 2012), the most common cancer diagnosis in women aged less than 40 years and the second most common cause of cancer death in this age group (Daly et al., 2021).
“…innovative interventions are needed to address the growing burden of breast cancer globally…”Hand et al. 2021
There is a proportional relationship between the growth of the breast cancer tumor and its temperature (Usuki H., 1990). Indeed, infrared thermography began to be used in 1956 when Lawson discovered that the skin temperature of a cancerous area in the breast was higher than that of a normal tissue (Lawson R., 1956).
Due to promising results (Connell Jr et al., 1966) Thermography began to be used in a massive way as a diagnostic tool during the 60s and 70s. However, between the 70s and 90s, different studies appeared describing a significant number of false positives (Williams et al., 1990; Moskowitz et al. 1976), thus having called into question the capacity of infrared thermography as standalone diagnosis device for breast cancer. Those studies impacted dramatically on the use of this technology and on the number of scientific publications (Figure 1), and more importantly, they inevitably influenced the reputation of infrared thermography on the medical field.
Nevertheless, for the last 15 years and thanks to the improvement of the cameras and the inclusion of artificial intelligence techniques (such as automatic software and machine learning) thermography has become a useful tool for supporting breast cancer diagnosis. In fact, it has been shown that in the clinical field, the use of automatic thermography software allows us to improve the accuracy and reduce the time of analysis.
“…X-ray screening mammography proves to be the most sensitive non-invasive technique for detecting early tumors, though other non-radiation imaging methods of cancer detection such as thermography, diaphanography (light scanning), whole breast ultrasound, and magnetic resonance imaging (MRI) are employed from time to time…”Hashemi et al. 2019.
We can highlight the following PROS of thermography related to breast cancer:
- Higher specificity in detecting benign breast tumors compared to mammography (Hashemi et al. 2019) (Figure 2)
- It allows the early detection of breast cancer (Kuhl C. K. et al., 2017)
- Inexpensive (Omranipour R. et al. 2016; Kolarić, D. et al. 2013)
- Immediate results, no venous access, and no radioactive dyes (Hashemi et al. 2019; Singh, D., & Singh, A. K., 2019)
- Artificial intelligence using deep neural networks to analyze the thermograms shows better results and seems to be a strategy of analysis with a promising future (Mambou et al., 2018)
- Three-dimensional functional infrared imaging (3DIRI) is thought to operate independently of breast density and generates three-dimensional vascular maps of the breast to detect peripheral breast vasculature asymmetry, as well as variations in vascular morphology, density, and perfusion rate between the breasts. (Hellgren R.J., et al 2019).
The CONS of IRT are:
- Lack of knowledge and experience in the use of this technique by medical practitioners (Hellgren R.J., et al. 2019; Hashemi et al. 2019; Ng, E. K., 2009)
- Specific conditions are needed in order to properly use infrared thermography (Hashemi et al. 2019).
- Infrared thermography has 52-61% of sensitivity compared to 70,6 – 94% in mammography (Hashemi et al. 2019; Williams et al. 1990; Omranipour R. et al. 2016)
- Less specificity compared to ultrasound, with 78,5% and 95,3% respectively (Alikhassi A. et al. 2018)
- A bad reputation in the medical field (Moskowitz et al. 1976; Fitzgerald A. & Berentson-Shaw J., 2012).
Despite the pros and cons of this technology, as Hashemi and collaborators (2019) pointed out: “Infrared thermography can also be recommended to be used as a complementary imaging tool along with other well-known imaging methods for earlier detection of breast cancer” and as a complementary test to a breast clinical exam (Omranipour R. et al. 2016).
In conclusion, despite technical advances in thermography, it cannot substitute mammography for breast cancer diagnosis at the present time (Omranipour R. et al. 2016). However, infrared thermography can be proposed as a complementary tool in breast cancer detection along with other clinical exams.
Alikhassi, A., Hamidpour, S. F., Firouzmand, M., Navid, M., & Eghbal, M. (2018). Prospective comparative study assessing role of ultrasound versus thermography in breast cancer detection. Breast disease, 37(4), 191-196.
Acharya, U. R., Ng, E. Y. K., Tan, J. H., & Sree, S. V. (2012). Thermography based breast cancer detection using texture features and support vector machine. Journal of medical systems, 36(3), 1503-1510.
Connell Jr, J. F., Ruzicka Jr, F. F., Grossi, C. E., Osborne, A. W., & Conte, A. J. (1966). Thermography in the detection of breast cancer. Cancer, 19(1), 83-88. doi: https://doi.org/10.1002/1097-0142(196601)19:1<83::AID-CNCR2820190109>3.0.CO;2-6
Daly, A. A., Rolph, R., Cutress, R. I., & Copson, E. R. (2021). A Review of Modifiable Risk Factors in Young Women for the Prevention of Breast Cancer. Breast Cancer: Targets and Therapy, 13, 241.
Fitzgerald, A., & Berentson-Shaw, J. (2012). Thermography as a screening and diagnostic tool: a systematic review. NZ Med J, 125(1351), 80-91.
Hand, T., Rosseau, N. A., Stiles, C. E., Sheih, T., Ghandakly, E., Oluwasanu, M., & Olopade, O. I. (2021). The global role, impact, and limitations of Community Health Workers (CHWs) in breast cancer screening: a scoping review and recommendations to promote health equity for all. Global Health Action, 14(1), 1883336.
Hashemi, B., Hasanaj, F., Akbari, M. E., Mirzaei, H. R., Mojtahed, M., & Bakhshandeh, M. (2019). Assessment of Computer Regulation Thermography (CRT) as a Complementary Diagnostic tool for Breast Cancer Patients. Journal of biomedical physics & engineering, 9(6), 621.
Hellgren, R. J., Sundbom, A. E., Czene, K., Izhaky, D., Hall, P., & Dickman, P. W. (2019). Does three-dimensional functional infrared imaging improve breast cancer detection based on digital mammography in women with dense breasts?. European radiology, 29(11), 6227-6235.
Kolarić, D., Herceg, Ž., Nola, I. A., Ramljak, V., Kuliš, T., Katančić Holjevac, J., … & Antonini, S. (2013). Thermography–a feasible method for screening breast cancer?. Collegium antropologicum, 37(2), 583-588.
Kuhl, C. K., Strobel, K., Bieling, H., Leutner, C., Schild, H. H., & Schrading, S. (2017). Supplemental breast MR imaging screening of women with average risk of breast cancer. Radiology, 283(2), 361-370.
Lawson, R. (1956). Implications of surface temperatures in the diagnosis of breast cancer. Canadian Medical Association Journal, 75(4), 309.
Lawson RN. A new infrared imaging device. Can Med Assoc J. 1958;79(5):402-3. PubMed PMID: 13573292. PubMed PMCID: 1830404.
Mambou, S. J., Maresova, P., Krejcar, O., Selamat, A., & Kuca, K. (2018). Breast Cancer Detection Using Infrared Thermal Imaging and a Deep Learning Model. Sensors (Basel, Switzerland), 18(9), 2799. https://doi.org/10.3390/s18092799
Moskowitz, M., Milbrath, J., Gartside, P., Zermeno, A., & Mandel, D. (1976). Lack of efficacy of thermography as a screening tool for minimal and stage I breast cancer. New England Journal of Medicine, 295(5), 249-252.
Ng, E. K. (2009). A review of thermography as promising non-invasive detection modality for breast tumor. International Journal of Thermal Sciences, 48(5), 849-859.
Omranipour, R., Kazemian, A., Alipour, S., Najafi, M., Alidoosti, M., Navid, M., … & Izadi, S. (2016). Comparison of the accuracy of thermography and mammography in the detection of breast cancer. Breast Care, 11(4), 260-264.
Sillero-Quintana, M., Gomes Moreira, D., & Fernández-Cuevas, I. (2018, 4th -7th July 2018). Evolution of sports thermography and new challenges for future. Paper presented at the XIV Congress of the European Association of Thermology, National Physical Laboratory, Teddington, United Kingdom.
Singh, D., & Singh, A. K. (2019). Role of image thermography in early breast cancer detection-Past, present and future. Computer methods and programs in biomedicine, 183, 105074.
Umadevi, V., Raghavan, S. V., & Jaipurkar, S. (2011). Framework for estimating tumour parameters using thermal imaging. The Indian journal of medical research, 134(5), 725.
Usuki, H. (1990). Relationship between thermographic observations of breast tumors and the DNA indices obtained by flow cytometry. Biomedical Thermology, 10, 282-285.
Williams, K. L., Phillips, B. H., Jones, P. A., Beaman, S. A., & Fleming, P. J. (1990). Thermography in screening for breast cancer. Journal of Epidemiology & Community Health, 44(2), 112-113.
Moskowitz, M., Milbrath, J., Gartside, P., Zermeno, A., & Mandel, D. (1976). Lack of Efficacy of Thermography as a Screening Tool for Minimal and Stage I Breast Cancer. New England Journal of Medicine, 295(5), 249-252. doi: 10.1056/NEJM197607292950504