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.

Figure 1: Number of publications about thermography until 2020. (Adapted and improved from Sillero-Quintana et al. 2018)

“...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).

Figure 2: Statistical results of various diagnostic methods compared with the biopsy as the gold standard (PPV: Positive Predictive Value, NNP: Negative Predictive Value). Adapted from Hashemi 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 thermographycan 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.

REFERENCES

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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.

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Fitzgerald, A., & Berentson-Shaw, J. (2012). Thermography as a screening and diagnostic tool: a systematic review. NZ Med J, 125(1351), 80-91.

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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