The Thermography Myth By Renee Alwan Percell, MS, PA-C

The American College of Obstetricians and Gynecologists recommend women have annual screening mammograms starting at age 40 and continue screening through age 75. There are recommendations about further imaging such as breast MRI or sonogram that should be decided case by case depending on your medical history, risk factors and family history. A mammogram is a low dose X-Ray of the breast tissue. A cancerous mass in the breast tissue would appear white on the image. A mammogram is the gold standard for detection of breast cancer. It can often detect cancer before there are any symptoms, resulting in a better outcome for many.

Several women opt for an “alternative” testing method called Thermography. Women are drawn to thermography because there is no radiation exposure, no compression of your breasts, and no real risks associated with the test. Thermography produces an infrared image that shows the patterns of heat and blood flow on or near the surface of the body. It tracks blood flow which has been thought to be sufficient in interpreting precursors to breast cancer. Although thermography is safe, there isn’t any evidence to prove it’s effective. People had looked at thermography as an early detection tool, but there is NO data to support such claims. The FDA approved thermography as an adjunctive (to be used with mammography) tool in the assessment of breast masses in 1982. Since then, there have been several offices, health spas and mobile imaging units that falsely advertise that thermography is an effective stand-alone test that is safer than mammography in detecting breast cancer. The American College of Radiology and the Society of Breast Imaging DO NOT endorse thermography for detecting breast cancer. Recently the FDA sent out a warning against thermography for breast cancer detection. This was a result of several cases reported where women had breast cancer and treatment was delayed due to thermography.

At the Couri Center, we care about breast health and have a variety of options for patients to reduce the risk of breast cancer. Prevent is a personalized, proactive, evidence-based program that will help you understand your future health risks. We can also calculate your lifetime risk for developing breast cancer and give lifestyle modification guidance. These are tools that we offer and recommend you use in addition to your annual screening mammogram so that you can be your healthiest self. If you would like more information on the programs we offer, please call our office to make an appointment. Most importantly, get your mammograms every year!

Be well,

Renee Alwan Percell, MS PA-C

Introducing Prevent By Dr. Michele Couri, MD, FACOG, ABIHM

The Importance of Knowing One’s Breast Cancer Risk Score

In the last edition of our newsletter, I wrote about the importance of knowing one’s breast cancer risk score.  As you may recall, the average woman’s risk of developing breast cancer in her lifetime is 12%.  But, my question to you is how many of us are average?  What, if after genetic testing or after a software-based model calculation, we find out that our breast cancer risk score is >12%.  What can we do to lower or modify that risk score?  You also may recall that 30% of breast cancer cases are linked to a poor lifestyle.  That modifiable risk factor is very much in our control.  Our lifestyle is a powerful driver of either disease or lack thereof.  How do we harness the power of lifestyle as it pertains to our risk of developing breast cancer?  Allow me to introduce you to the Prevent Program here at the Couri Center.

Introducing Prevent By Couri

Prevent By Couri is a lifestyle-based wellness program designed to help women lower their individual risk of developing breast cancer. Grounded in both the science of Western medicine combined with the healing traditions of Integrative Medicine is born a program that through a thorough data gathering process and a comprehensive laboratory evaluation provides us with information that we use to formulate a personalized plan unique to each individual. This program will address nutrition, exercise, hormone metabolization, inflammation, and detoxification as it pertains to lowering the risk of breast cancer.   All women are candidates for Prevent, but it is particularly well suited for women whose breast cancer risk score is >20%.

How Do I Determine if I am at High Risk?

I encourage all women age 40 and older to have their breast cancer risk score calculated.  This can be done in one of two ways.  The first option is relevant for women who qualify for genetic testing for breast and ovarian cancer.  If you meet criteria to have Myriad genetic testing performed, the test will include a breast cancer risk score based on your individual genetic makeup and non-modifiable factors including but not limited to your age, family history of cancer, breast density, age at first period and age at first pregnancy.  To have a better idea if you qualify for Myriad genetic testing, please take the hereditary cancer quiz at  For women who do not qualify for genetic testing, your breast cancer risk score can be calculated using a computer-based software model that incorporates several of the variables listed above.  We would love to help you find your score.

How Can I Get Started?

The first step is to make an appointment with Leslie Rusch-Bayer, our Registered Dietitian.  She will help guide you down the right path for testing and then get you enrolled in Prevent, if appropriate.  The New Year is a great time to invest in your health.  Know your number, change your destiny.  Oh, the power of the female spirit – it is like nothing else.

To Your Health,

Dr. Couri

Breast Cancer: Knowing Your Risk Could Change Your Life By Dr. Michele Couri, MD, FACOG, ABIHM

For the most part, I would say that women would agree that screening for breast cancer with annual mammography is very important.  However, mammography is effective at detecting breast cancer but does nothing for PREVENTION.  In fact, do you truly understand what YOUR personal risk of developing breast cancer is?

Breast Cancer Risk Factors

In the general population, 12% of women, or 1 in 8, will develop breast cancer over the course of a lifetime.  However, in our practice, we see many women who have a much higher lifetime risk of developing breast cancer – 20 – 30% lifetime risk or greater.  How do we identify these women and is YOUR risk of developing breast cancer elevated?

70% of breast cancer cases are due to sporadic causes which means that only 30% is attributable to genetic factors.  Of the cases that are genetic in origin, 5-10% are related to the breast cancer genes (BRCA 1 and 2), and 10-15% are seen in family clusters.   Factors that increase the risk of breast cancer include early puberty (before age 12) and late menopause (after age 55).  Women who go through menopause after age 55, have a two-fold increase in breast cancer compared to women who enter menopause younger than age 45.  Women who have never been pregnant and women who are older at the time of their first pregnancy both share an increased risk of developing breast cancer.  Women who have their first birth older than age 30 are at twice the risk of developing breast cancer than women who have their first birth at age 20.  The risk is highest for women who have their first child after age 35.

Risk Factor: Dense Breasts

Another risk factor for breast cancer is having dense breasts.  Dense breasts have less fatty tissue, and the degree of tissue density correlates directly with the increased risk of mammographic failures in detecting cancer.  Women with heterogeneously dense and extremely dense breast tissue should be offered second imaging modalities like breast ultrasound as a means to increase cancer detection over standard mammography alone.  In addition, women with dense breasts should choose 3D mammography or tomosynthesis which has a better detection rate with less likelihood of “missing” cancer due to its enhanced visualization of dense tissue.  If you are unsure if your breast tissue is dense or not, I encourage you to educate yourself and ask your provider to help you interpret your most recent mammogram report.

What Factors Play a Role in Breast Cancer Risk?

Lastly, lifestyle factors play a significant role in breast cancer risk.  In fact, 30% of breast cancers can be attributable to poor lifestyle and could thus be prevented.  Obesity, lack of exercise, alcohol intake, and eating a Standard American Diet lacking adequate intake of vegetables and fruits and high in sugar and unhealthy fats all increase the risk of developing breast cancer.  Obesity increases the risk of postmenopausal breast cancer and increases the risk of relapse after breast cancer diagnosis.  It also decreases the response to chemotherapy and decreases survival.  Alcohol intake increases the risk of breast cancer, and the risk increases with just three drinks per week.  Binge drinking increases the risk, and the risk is associated with cumulative alcohol intake over a lifetime.

What Genetic Testing is available at the Couri Center

So, back to the original question – how do we identify women at higher risk of developing breast cancer? Knowing each woman’s individual risk of breast cancer is very important and drives decision making to help lower or modify that risk.  At the Couri Center, we offer genetic testing for hereditary breast and ovarian cancer with the Myriad myRisk®Hereditary Cancer Panel.  This cancer test is a 29-gene panel that identifies an elevated risk for eight hereditary cancers including breast, ovarian, uterine, colorectal, pancreatic, gastric, prostate, and melanoma.  In addition, the testing also includes a breast cancer riskScore™which uses clinical risk factors and genetic markers to provide women with their remaining lifetime and 5-year risk for developing breast cancer. It is personalized, precision medicine at its finest.

How Can I Prevent Cancers?

Knowing one’s personal risk of breast cancer is powerful because we can use that information to potentially change the trajectory of cancer.  We can provide education about ways to lower personal risk as well as make recommendations for additional screening modalities to aid in detecting cancer or pre-cancer at their earliest stages.  In fact, we have developed a personalized, lifestyle-based program called Prevent, which uses individualized testing and other innovative tools to help women lower their risk of developing cancer. Stay tuned, as more information about Prevent will be showcased in the January/February 2019 newsletter.  You deserve the very best in personalized medicine.  Knowledge is power – rest assured that we are here to empower you to know your risk and use it to outsmart cancer.


To Your Health,

Dr. Couri