Thermography in place of mammography

1. Introduction

Version followed: breast thermography as it is marketed by some clinics, spas and practitioners as a stand-alone or replacement breast screening test, described from regulators' and screening bodies' published statements (US FDA 2019 news release and consumer update; Health Canada 2017 advisory; UK Advertising Standards Authority 2015 ruling; BreastScreen Australia statement). This guide describes the practice from regulators' statements and sets out the psychotherapist's own work alongside it; the psychotherapist does not perform, sell, recommend or interpret thermography. Thermography is not a substitute for mammography, and nothing in this guide presents it as one.

What it is. Thermography (thermal or infrared imaging) produces an image of heat patterns on or near the surface of the body. Promoters' premise is that the skin over a malignant lesion may be warmer, so "hot spots" on a thermogram are said to signal cancer or other abnormalities [source: FDA consumer update; Breastcancer.org; BreastScreen Australia]. Promoters stress that the test is painless, involves no radiation and does not compress the breast, and some offer it as an alternative to mammograms, sometimes with "risk" ratings and wellness advice attached [source: Breastcancer.org; UCSF Radiology 2019].

Regulators' position, in one line each.

USA (FDA): thermographic devices are cleared only as an adjunctive tool, to be used alongside a primary test such as mammography; the FDA says thermography "should not replace mammography" and that there is "no valid scientific data" that it is an effective screening tool for any medical condition [source: FDA news release, 25 Feb 2019].
Canada (Health Canada): thermography devices are licensed only to measure skin temperature, "similar to a thermometer", not to screen for breast cancer; advertising or selling them for breast cancer screening is prohibited [source: Health Canada advisory RA-64636, 28 Sep 2017].
UK (advertising): the ASA upheld complaints that a thermography clinic's "Breast Screening" claims were misleading and could discourage essential treatment for a condition requiring medical supervision [source: ASA ruling, Medical Thermal Imaging Ltd, 9 Sep 2015].
Australia: the BreastScreen Australia advisory committee does not recommend thermography for early detection of breast cancer, and the programme uses mammography because it can find tumours at a smaller size [source: BreastScreen Australia statement on use of thermography; the statement is published without a date, so its date is uncertain].
Evidence status (one line): regulators and the American Cancer Society, American College of Radiology and Society of Breast Imaging do not support thermography for breast cancer screening or diagnosis; mammography is the screening method shown to reduce breast cancer deaths [source: FDA 2019; Breastcancer.org; UCSF Radiology 2019].

How change happens in the psychotherapist's work. The therapist's change process is not about the device. It is the client making an informed, values-based decision about breast screening and breast symptoms, with fears (radiation, pain, compression, embarrassment, trauma, distrust of medicine) understood and addressed, and with the client's doctor or screening service involved. False reassurance is the core risk: a "normal" or "low-risk" thermogram can lead someone to skip screening or delay investigation of a symptom [source: FDA consumer update; Health Canada 2017; UCSF Radiology 2019] [synthesis for the change model].

2. Framework

What a client of a thermography clinic typically experiences (as sources describe it). The client undresses from the waist up and sits or stands in front of an infrared camera; a technician takes several front and side images without touching the body; the images are usually sent to a doctor or reader for interpretation; the test is typically paid out of pocket rather than covered by insurance [source: Breastcancer.org]. Some providers return a risk category and lifestyle advice (in one published case, exercises and a cleanse with a repeat scan) rather than referral for breast imaging [source: UCSF Radiology 2019]. Mammography facilities in the US must meet FDA quality standards; there are no equivalent standards for thermography [source: Breastcancer.org]. Practitioner-organisation training and certification routes for thermographers exist but are not described here [uncertain]. Any client preparation instructions given by clinics are not reproduced here.

Who practises it. Clinics, spas, some doctors and other practitioners, and online influencers promote it; some businesses sell camera-and-software packages to new providers [source: Breastcancer.org; FDA 2019].

The psychotherapist's work alongside it: phases [synthesis, built on the regulator statements cited in section 1]:

Notice and ask. Goal: learn whether the client uses or is considering thermography, for what (screening, a symptom, reassurance, "breast health"), and whether it has replaced mammography or medical review. Move on when the use and its purpose are recorded.
Understand. Goal: the client's explanatory model, hopes and fears (radiation, pain, compression, past experiences, identity, distrust). Move on when the client feels understood and the therapist can name what the choice protects for them.
Inform and decide. Goal: the client knows what regulators say, knows that any breast change needs prompt medical review, and makes their own decision. Move on when the decision is the client's, informed, and recorded.
Coordinate. Goal: with consent, the GP, family doctor or breast screening service knows about fears and barriers and can offer adjustments. Move on when a contact or appointment exists, or the client has declined with understanding.
Follow up and support. Goal: support through screening, results, waiting, anxiety, or the consequences of a delayed diagnosis; report misleading marketing where appropriate.

Format and length. Usually woven into ongoing therapy, with a check-in around screening appointments or results [synthesis]. Immediate step change: if the client reports a current breast change (lump, thickening, nipple discharge, change in the nipple's appearance), skip straight to prompting same-week contact with their doctor; exploration can follow [source for the symptom list: FDA consumer update] [synthesis for the prioritisation].

3. Guiding principles

Never a substitute. Thermography is never discussed as a replacement for mammography or for medical assessment of a symptom. Practical meaning: you can explore why it appeals without ever endorsing it. [source: FDA 2019; Health Canada 2017]
The therapist does not recommend, perform, sell or interpret it. Practical meaning: no opinions on a client's thermogram; route every result to their doctor. [synthesis]
Curiosity without judgement. Practical meaning: ask in a way that makes it safe to disclose; shame drives concealment from doctors. [synthesis]
Autonomy plus accurate information. Practical meaning: the client decides; your role is to make sure the decision rests on what regulators actually say, not on marketing claims. [synthesis]
Symptoms are urgent; screening choices are deliberative. Practical meaning: a breast change prompts medical contact now; screening decisions can be explored over sessions. [source: FDA consumer update; Health Canada 2017] [synthesis]
Fears behind the choice are legitimate targets of therapy. Practical meaning: fear of radiation, pain, compression, exposure or loss of control can be worked with directly and shared, with consent, with the screening service. [source: Health Canada 2017 on radiation concerns; DBTH NHS breast screening carers' page on adjustments] [synthesis]
Stay inside scope. Practical meaning: no advice on screening intervals, tests or medicines; those belong to the client's doctor or screening programme. [synthesis]
Watch for false reassurance and its mirror, false alarm. Practical meaning: a "clear" thermogram may lower vigilance; an "abnormal" one may drive anxiety and further paid testing. [source: Breastcancer.org on false positives and false negatives; UCSF Radiology 2019]
Commerce is a risk factor. Practical meaning: packages, repeat scans and bundled wellness products deserve the same gentle scrutiny as any other spend. [source: FDA 2019 on business packages] [synthesis]
Report misleading marketing; never name or shame the client. Practical meaning: regulators accept reports; the client's confidentiality governs what you share. [source: FDA 2019 MedWatch; Health Canada 2017; ASA 2015]

4. Intervention inventory

All interventions below are the psychotherapist's own work. None involves performing, recommending or interpreting thermography. Where a step is not taken from a cited source it is marked [synthesis].

4.1 Routine, non-judgemental inquiry and recording

Purpose / when: at intake, at annual review, and whenever breast health, cancer fear, "natural" health, wellness spending or body image come up. Clients often do not mention tests they paid for privately [synthesis].
Steps: (1) Ask about health checks and complementary tests as a routine category, not singling out the client. (2) If thermography is mentioned, ask what it was for: general "breast health", screening instead of mammography, a specific symptom, or reassurance after a scare. (3) Ask whether their doctor knows and whether they are also having standard screening. (4) Ask whether any breast change is present now. (5) Record: what was used, when, purpose, whether it replaced mammography or medical review, any current symptom, and the client's stated plan [synthesis].
Example language (illustrative): "Some people I see use private health checks or scans alongside their GP care. Is there anything like that in your life at the moment?" / "What were you hoping the thermogram would tell you?" / "Is your doctor aware you had it?"
Watch for: defensiveness or embarrassment (slow down and normalise); a thermogram used instead of screening or instead of having a symptom checked (move to 4.3 and 4.6); a recent "all clear" in someone who had a symptom (highest-risk pattern, per the cases in UCSF Radiology 2019). Working sign: the client talks openly and the record is complete.

4.2 Exploring meaning, hopes, expectations and the explanatory model

Purpose / when: once use is known, to understand what thermography offers the client that mammography seems not to. Promoters emphasise no radiation, no pain, no compression and "early" detection; clients' own reasons commonly include these [source: FDA consumer update; Breastcancer.org].
Steps: (1) Ask what drew them: radiation worry, pain or compression, embarrassment or exposure, a past distressing mammogram, a trauma history involving touch, distrust of medical services, a wish to act "naturally", a community or influencer recommendation. (2) Ask what they believe the image shows and how they understand "risk" ratings. (3) Ask what a "good" result meant to them emotionally (relief, control, permission to avoid the clinic). (4) Reflect the underlying value (safety, bodily autonomy, dignity, control) without endorsing the test. (5) Note any link to illness in family or friends, prior cancer scares, or health anxiety [synthesis].
Example language (illustrative): "It sounds like avoiding radiation and keeping control over what happens to your body really matter to you." / "When you got the 'low risk' result, what did that change for you?" / "Who first told you about thermography, and what did they say it could do?"
Watch for: fears that are strong enough to be a phobic or trauma response (consider 4.5 and 4.9); a closed belief system reinforced by a group or seller (4.10); grief or anniversary reactions behind the choice. Working sign: the client can name the fear or value that the choice protects.

4.3 Sharing what regulators say, accurately and briefly

Purpose / when: after exploration, when the client is open to information, or immediately if a symptom is present.
Steps: (1) Ask permission. (2) Give a short, neutral summary of named sources: the US FDA says thermography is cleared only for use alongside a primary test such as mammography and should not replace it; Health Canada licenses the devices only to measure skin temperature, not to screen for breast cancer, and advises women who relied on thermograms to contact their physician; the FDA says it knows of no evidence that thermography finds cancer years earlier or works better in dense breasts [source: FDA 2019; FDA consumer update; Health Canada 2017]. (3) Offer the sources so the client can read them. (4) Ask what they make of it. (5) Do not interpret their own thermogram, give screening intervals or advise on tests: refer those questions to their doctor [synthesis].
Example language (illustrative): "Would it be useful if I shared what the health regulators have said about thermography? You can decide what to do with it." / "The US regulator's wording is that it 'should not replace mammography'. What's your reaction to hearing that?" / "Questions about which test and when are really for your doctor. Could we think about how you'd raise them?"
Watch for: information delivered as persuasion, which tends to harden positions [synthesis]; the client hearing "you were foolish" (address self-blame explicitly). Working sign: the client asks questions or wants to discuss it with their doctor.

4.4 Supporting an informed, values-based decision without coercion

Purpose / when: when the client is weighing whether to have mammography, continue thermography alongside it, or neither.
Steps: (1) Separate the decisions: having standard screening; what to do about any symptom; whether to spend money on additional private tests. (2) For each, ask what matters most and what they fear most. (3) Identify what information is still needed and who can give it (GP, screening service, breast clinic). (4) Explore what would make standard screening tolerable (see 4.5). (5) Summarise the client's own decision and reasons, and record it. (6) Respect a decision you disagree with, keep the door open, and revisit if circumstances change. Specific published breast-screening decision aids are not reproduced here [uncertain: not verified]; if your service uses one, use it as published [synthesis].
Example language (illustrative): "There seem to be three separate choices here. Shall we take them one at a time?" / "If your fear of the compression could be eased, would that change things?" / "It's your decision. I just want to be sure you've had the chance to hear everything you need from the people who can answer the medical questions."
Watch for: the therapist's own anxiety pushing pressure (coercion damages trust and may end disclosure) [synthesis]; a decision made to please the therapist; ambivalence that keeps postponing. Working sign: the client states a decision in their own words and knows the next practical step.

4.5 Working with barriers to mammography (fear of pain, radiation, exposure, trauma)

Purpose / when: when fear of the mammogram itself is what drives the turn to thermography.
Steps: (1) Clarify the specific fear: pain or compression, radiation, undressing, being touched while the breast is positioned, loss of control, medical settings. Breast screening involves gentle compression between two plates, which can be uncomfortable, and staff supporting the breast into position [source: DBTH NHS breast screening carers' page]. (2) For radiation worry, suggest the client put the question to the screening service or doctor; Health Canada's advisory states that evidence shows the benefits outweigh the risks [source: Health Canada 2017]. (3) Find out what adjustments the local service offers; one NHS service, for example, lets women visit the clinic and see the equipment beforehand, and supports carers to choose a suitable time and plan for anxiety [source: DBTH NHS breast screening carers' page]. FDA advises asking what to expect if concerned about discomfort [source: FDA consumer update]. (4) Build a coping plan: what to say to the radiographer (including asking for a pause), grounding or paced breathing, a support person if allowed, what to do afterwards [synthesis]. (5) For a trauma history involving touch, plan with consent which information the client wants shared with the service; for a specific phobia, consider graded preparation (looking at images of the equipment, a visit, rehearsal) within an established exposure framework, with consent, a hierarchy the client controls, and the right to stop; trauma processing is a separate, planned piece of work, see Domain II [synthesis].
Example language (illustrative): "Which part worries you most: the squeeze, the X-ray, undressing, or being touched?" / "Would it help to ask the screening unit whether you can visit beforehand and see the room?" / "Let's work out what you'll say if you need the radiographer to pause."
Watch for: dissociation or panic when the procedure is discussed (slow down, ground, titrate); exposure pushed faster than the client agrees to; the plan resting on adjustments the service cannot offer (check first). Working sign: the client can imagine the appointment with tolerable distress and has booked or asked about it.

4.6 Responding to a current breast symptom or a reassuring thermogram after a symptom

Purpose / when: whenever a client reports a breast change, or has used thermography to check a symptom. This is the highest-risk situation: in one published case a woman with a lump was given a "mild to moderate risk" thermography rating and lifestyle advice, and stage III cancer was diagnosed only after symptoms worsened [source: UCSF Radiology 2019].
Steps: (1) Ask directly whether there is a lump, thickening, nipple discharge or change in the nipple's appearance [source: FDA consumer update]. (2) If yes, say plainly that a breast change needs checking by a doctor and that a thermogram cannot rule anything out [source: FDA consumer update; Health Canada 2017]. (3) Agree a concrete step (who to call and when, ideally within days) and offer to help with the call, or with consent contact the GP yourself. (4) Address what is in the way (fear of the result, previous bad experiences, cost, childcare). (5) Follow up at the next contact; record the advice given and the client's response [synthesis].
Example language (illustrative): "I'm glad you told me. A change like that needs to be looked at by a doctor, whatever the thermogram said." / "What would make it possible to ring the surgery before we next meet?" / "Would you like to make the call here, now, with me in the room?"
Watch for: relief at a "clear" result being used to avoid the GP; minimising ("it's probably hormonal"); a provider's advice to wait and rescan. Working sign: an appointment is made and kept.

4.7 Coordinating with the client's doctor or screening service

Purpose / when: when barriers, symptoms, anxiety or a history of trauma make standard care hard to access, or the client wants help talking to the doctor.
Steps: (1) Obtain explicit, specific consent: what will be shared, with whom, for what purpose. (2) Help the client prepare questions for the doctor (what screening is offered to them, what to do about a symptom, how to manage fears). (3) If the client agrees, write briefly to the GP about relevant fears or adjustments, without opinion on the thermogram. (4) Keep the client in charge of what is shared. (5) Medical questions, including about any medicines, go to the doctor or pharmacist only [synthesis]. Health Canada's advice that women who relied on thermograms contact their physician for follow-up supports this step [source: Health Canada 2017].
Example language (illustrative): "Would it help if I let your GP know that the mammogram itself is what feels hardest, so they can think about support?" / "Let's write down the three questions you most want answered."
Watch for: consent drift (sharing more than agreed); the client experiencing coordination as surveillance. Working sign: the client reports a useful conversation with the doctor.

4.8 Working with anxiety after an "abnormal" or "high-risk" thermogram

Purpose / when: when a thermogram has reported "hot spots" or raised risk and the client is frightened, or is being offered repeat scans, cleanses or products. Experts cited by Breastcancer.org say thermography carries a higher risk of inaccurate results, both false positives and false negatives [source: Breastcancer.org].
Steps: (1) Contain the acute fear: validate, ground, slow the pace. (2) Do not interpret the image or say it is meaningless; say that only a doctor can assess breast concerns and help the client arrange that [synthesis]. (3) Separate the fear (real) from the test result (not a diagnosis). (4) Plan medical contact as in 4.6/4.7. (5) Support the client through waiting for any standard tests, using the client's existing coping skills and brief worry-management strategies [synthesis].
Example language (illustrative): "This has frightened you, and that makes complete sense. The person who can actually look into it is your doctor. Shall we plan how to get you seen?" / "While you wait, what has helped you get through uncertain times before?"
Watch for: escalating checking or reassurance-seeking (move to 4.9); being sold further scans or remedies to "cool" hot spots (4.10). Working sign: distress falls once a medical plan exists.

4.9 Health anxiety and screening anxiety (cross-ref Domain II)

Purpose / when: when the turn to thermography is part of a pattern of repeated checking, repeated private tests, reassurance-seeking, or, at the other pole, avoidance of all medical contact because of fear of what might be found.
Steps: (1) Assess the pattern: frequency of self-examination beyond what the client's clinician advises, repeat private scans, internet searching, reassurance-seeking, avoidance of doctors, functional impact. (2) Formulate the cycle (threat appraisal, safety behaviours, short-term relief, long-term maintenance). (3) Use established cognitive-behavioural approaches for health anxiety as set out in Domain II, agreeing with the client and their doctor which checks are medically appropriate, so that the therapy targets only the excess. (4) For avoidance, work towards attending standard screening as a valued goal using graded steps (4.5). (5) Review medical contact with the GP so that medical care and anxiety treatment are aligned [synthesis; see Domain II].
Example language (illustrative): "Each scan seems to buy a few weeks of calm, and then the worry comes back stronger. Shall we look at that cycle together?" / "Let's ask your GP what checking is actually recommended for you, and work on letting go of the rest."
Watch for: the therapist being drawn into reassurance; reducing checks the doctor actually wants; undiagnosed symptoms dismissed as "just anxiety" (always keep the medical route open). Working sign: less checking and private testing, and standard screening attended.

4.10 Commercial pressure, bundled products and group influence

Purpose / when: when the client is paying for repeat scans, packages, cleanses, supplements or courses linked to thermography results, or belongs to a community or follows an influencer that frames mammography as harmful. The FDA's 2019 warning letter concerned a business package selling a camera and software to be used as a sole screening tool, with claims of early detection of breast cancer, heart disease and other conditions [source: FDA 2019]; in a published case, a risk rating came with advice on exercises and a cleanse rather than referral [source: UCSF Radiology 2019].
Steps: (1) Ask neutrally about spending and what each purchase was meant to do. (2) Explore how the provider responds to questions or to a wish to have a mammogram. (3) Explore social pressure: what friends, family or online communities would say if the client had a mammogram. (4) Help the client weigh cost, claimed benefit and who gains. (5) If the client is a practitioner who has bought into a thermography business, explore the financial and identity stakes without judgement [synthesis].
Example language (illustrative): "How has the clinic responded when you've mentioned mammograms?" / "What would happen in your group if you decided to book a screening?"
Watch for: debt, secrecy from family, escalating packages, discouragement from seeing doctors, and high-control group features (isolation from outside views, punishment of doubt) [synthesis]. Working sign: the client can make spending decisions freely and discuss them openly.

4.11 Risk recognition and safeguarding

Purpose / when: throughout; especially with symptoms, delayed diagnosis, vulnerability, or third parties.
Steps: (1) Treat any breast symptom being managed by thermography alone as an urgent risk (4.6). (2) Where a client lacks capacity, has a learning disability, or depends on a carer who prefers thermography to standard screening, consider the client's best interests and the local adult safeguarding route; screening services can offer additional support for people with learning disabilities [source for service support: DBTH NHS breast screening carers' page] [synthesis for safeguarding]. (3) In someone with a cancer diagnosis who is using thermography to "monitor" disease instead of their oncology team, coordinate with consent with the treating team and see the integrative oncology guide (172) for conversations about alternatives. (4) Where financial exploitation is suspected, follow local adult safeguarding guidance [synthesis].
Example language (illustrative): "I'm concerned that this change hasn't been seen by a doctor. Can we make that the priority today?"
Watch for: your own collusion with avoidance to preserve rapport. Working sign: risks are named, recorded and acted on.

4.12 Reporting misleading marketing or device harm

Purpose / when: when a client describes a provider marketing thermography as a replacement for mammography or as detecting disease, or a related adverse outcome; or the therapist encounters such marketing professionally.
Steps: (1) Discuss with the client; respect confidentiality and their wishes about any report that involves their care. (2) Use the routes regulators name: in the US, the FDA asks people to report adverse events related to thermographic imaging through MedWatch [source: FDA 2019]; in Canada, Health Canada accepts reports of incidents or concerns about medical devices [source: Health Canada 2017]; in the UK, misleading health advertising can be reported to the Advertising Standards Authority, which has upheld complaints against thermography breast-screening claims [source: ASA 2015]; equivalent routes in other jurisdictions [uncertain]. (3) Where the provider is a registered health professional, consider their professional regulator. (4) Report marketing without client details where possible [synthesis].
Example language (illustrative): "What you were told isn't what the regulators say. Would you want that reported? It can be done without using your name."
Watch for: reporting used to channel the therapist's anger rather than the client's interest. Working sign: the client feels their experience was taken seriously.

4.13 Professional boundaries and conflicts of interest

Purpose / when: always; especially in integrative or wellness settings where thermography may be offered on the same premises or by colleagues.
Steps: (1) Do not refer to, recommend, sell or earn from thermography or related products. (2) If a colleague or service markets thermography as screening, raise it through supervision and the service's governance. (3) Keep personal views on "natural" health or on medicine out of the client's decision. (4) Record decisions and reasoning. Professional ethics codes on conflicts of interest and avoiding harm apply; consult your own code [synthesis].
Example language (illustrative): "I don't offer or recommend any screening tests. That's something to work out with your doctor, and I can help you prepare for that conversation."
Watch for: referral relationships or room-sharing that blur roles. Working sign: clients understand your role and its limits.

4.14 Supporting clients after a delayed diagnosis

Purpose / when: when a client (or a bereaved family member) believes thermography's reassurance delayed a breast cancer diagnosis. See also the Harm account below.
Steps: (1) Coordinate with the oncology team and, where relevant, palliative care. (2) Make room for regret, self-blame, anger at the provider, and family conflict ("why didn't you have a mammogram?"). (3) Distinguish responsibility from blame: the client acted on information presented as credible. (4) Use established grief and adjustment approaches; in psycho-oncology, attend to fear of recurrence and treatment burden. (5) Offer information about reporting (4.12) and legal advice routes if the client wishes [synthesis].
Example language (illustrative): "You made the choice with what you were told at the time. It makes sense to feel angry about what you were told." / "Part of you keeps replaying it. What does that part need?"
Watch for: depression, suicidal thoughts (assess using standard practice), withdrawal from treatment out of shame, family members blaming the client. Working sign: the client can hold the regret without it driving decisions about current care.

5. Handling problems

Most guidance in this section is [synthesis]; source-based points are marked.

Client is certain thermography is "better" and mammography harmful. Do not debate. Reflect the values (safety, autonomy), ask what would change their mind, offer the regulators' statements once (4.3), and suggest the client put their concerns directly to their doctor. Keep the relationship; revisit at natural points such as birthdays, a friend's diagnosis or a screening invitation.
Client has a symptom and refuses to see a doctor. State your concern clearly and once more in writing if appropriate; explore the specific fear; offer to make the call together; with consent, contact the GP; if the client lacks capacity, use safeguarding routes. Record your advice. The FDA lists breast changes that warrant contact with a health care professional [source: FDA consumer update].
Client feels judged and withdraws. Repair: name the rupture, own any pressure you applied, return to their goals. Clients who feel judged may stop disclosing use to anyone.
Overwhelm or panic when discussing cancer or screening. Ground, slow, titrate; shift from information to coping; return later. If the reaction is trauma-linked, plan stabilisation before any exposure work (Domain II).
Non-adherence: appointment booked, then missed. Explore without blame what happened on the day; adjust the coping plan; ask the service about adjustments (pre-visit, timing, support person) [source for adjustments: DBTH NHS breast screening carers' page].
Client wants your opinion of their thermogram. Decline kindly and redirect: you are not qualified, and regulators say thermography is not a stand-alone test [source: FDA 2019].
Client is a thermography practitioner or business owner. Explore without shaming; financial and identity investment can make information hard to hear. Do not advise on their business. If they disclose marketing it as a replacement for mammography, discuss the regulators' positions and their duties; consider your own reporting obligations in supervision.
Family conflict over a relative's choice. Work with the client's own distress and influence, not on controlling the relative; the relative's autonomy remains, unless capacity or safeguarding concerns arise.
Therapist's own reactions. Anger at providers or frustration with the client can leak into pressure. Use supervision.
Cross-jurisdiction confusion. Clients may cite claims of "FDA approval". The FDA has cleared thermography only as an adjunct [source: FDA 2019], and the ASA found a clinic's claim that it was "approved by the FDA" for breast cancer screening misleading [source: ASA 2015].

Harm account

What was actually done

Marketing thermography as stand-alone screening. Providers and device sellers presented thermography as a breast screening test in its own right, or as an alternative to mammography. The FDA's consumer update lists claims it says it has no evidence for: that thermography is a proven alternative to mammography, that it finds cancer years before other methods, and that it improves detection in dense breasts [source: FDA consumer update].
Selling the business. In February 2019 the FDA issued a warning letter to Total Thermal Imaging Inc. of La Mesa, California, which marketed a "Thermography Business Package" (a thermal camera with proprietary software) as a sole screening tool, with claims that it enabled early detection or diagnosis of breast cancer, inflammatory breast cancer, "pre-stroke", heart disease, deep vein thrombosis and other conditions; the FDA's inspection also found missing complaint-handling and corrective-action procedures [source: FDA news release, 25 Feb 2019]. The safety communication the FDA issued the same day ("FDA warns thermography is not effective to detect or screen for breast cancer") listed five earlier warning letters to manufacturers for marketing unapproved thermographic devices or making misleading claims [source: FDA 2019], issued between 2011 and 2017 [source: MedTech Dive, 26 Feb 2019]; later updates to the safety communication [uncertain].
Misleading regulatory claims abroad. In the UK, a clinic website offered "Breast Screening", "Early Stage Disease Detection" and similar services and claimed thermography was "approved by the FDA" for breast cancer screening in 1982; the ASA upheld all complaints, including that the ad could discourage essential treatment, in September 2015 [source: ASA ruling 2015].
Canada. Health Canada issued an advisory in September 2017 reminding Canadians that thermograms are not a substitute for mammograms and telling manufacturers that advertising or selling the devices for breast cancer screening is prohibited [source: Health Canada 2017].
What clients experienced. A non-contact scan, a report of patterns or a risk category, and in some cases wellness advice and a repeat scan in place of referral for breast imaging. In one published US case a woman with a breast lump was rated "mild to moderate risk" and advised exercises and a cleanse with follow-up months later; in another, a woman was told her scan was "all clear" [source: UCSF Radiology 2019].

How it caused harm

Missed and delayed cancers (false reassurance). The FDA warns that people who choose thermography instead of mammography "may miss the chance" to detect breast cancer at its earliest stage, and that patients having thermography alone should not be reassured by the findings [source: FDA consumer update]. Health Canada describes the "potential risk that cancer could go undetected" [source: Health Canada 2017]. Screening bodies note that a tumour may need to be several centimetres across before thermography can show it, and that fewer than half of mammographically detected cancers had abnormal thermograms in older studies [source: BreastScreen Australia statement, citing Homer 1985 and Martin 1983].
Documented cases. In the first UCSF-reported case, symptoms worsened during the wait, conventional imaging followed, and stage III breast cancer was diagnosed; she later completed conventional treatment. In the second, stage III breast cancer was diagnosed about six months after an "all clear" thermogram, spread to the brain, and she died in 2015 [source: UCSF Radiology 2019]. The women are not named here.
False alarms. Inaccurate results run in both directions; false positives can trigger fear, further private testing and spending [source: Breastcancer.org] [synthesis for the psychological consequences].
Psychological sequelae. After a delayed diagnosis, clients and families may carry regret, self-blame, anger and conflict; after false alarms, heightened health anxiety [synthesis].
Most at risk. People with a breast symptom who use thermography to "check" it; people avoiding mammography because of fear of radiation, pain, compression or exposure; people in communities or influencer networks that frame mammography as harmful; people who distrust medical services [source: FDA consumer update; Breastcancer.org] [synthesis for the ranking].

Recognising it today

Phrases and claims: "no radiation, no compression, no pain" offered as reasons to replace a mammogram; "finds cancer years earlier"; "better for dense breasts"; "FDA approved" for breast screening; "breast health" or "early disease detection" packages; risk ratings with lifestyle prescriptions; advice to rescan rather than see a doctor [source: FDA consumer update; ASA 2015; UCSF Radiology 2019].
Settings: spas, wellness and integrative clinics, mobile scanning, some doctors' practices, online influencers [source: Breastcancer.org].
Red flags in a colleague's or service's practice: thermography offered to people with symptoms; reports that reassure without recommending medical review; bundled cleanses, supplements or repeat-scan packages; discouraging mammography; business-in-a-box offers to new providers [source: FDA 2019; UCSF Radiology 2019] [synthesis for the checklist].
How legitimate care differs: standard breast screening is delivered through regulated mammography services, with quality standards and referral pathways; any breast change is assessed by a doctor with conventional imaging [source: Breastcancer.org; FDA consumer update]. Where thermography is FDA-cleared at all, it is only as an adjunct alongside a primary test, never in its place [source: FDA 2019].

What to do instead and how to help those harmed

Instead: encourage the client to discuss breast screening with their doctor or national screening programme and to report any breast change promptly; address fears that block mammography (4.5) and ask services about adjustments [source: FDA consumer update; Health Canada 2017; DBTH NHS page]. Additional imaging such as MRI or ultrasound is a matter for the client's doctor, not the therapist [source: Breastcancer.org mentions these as proven options] [synthesis for the scope point].
Clients who relied on thermography: Health Canada advises women who relied on thermograms to contact their physician for follow-up and testing; support them to do so (4.6, 4.7) [source: Health Canada 2017].
Clients harmed by a delayed diagnosis: coordinate with oncology and palliative teams; work with grief, regret, anger and family blame (4.14); assess mood and suicide risk using standard practice [synthesis].
Ethical, reporting and legal duties: report device harms and misleading claims through the regulator routes in 4.12 (FDA MedWatch; Health Canada device incident reporting; ASA for UK advertising) with the client's agreement where their information is involved [source: FDA 2019; Health Canada 2017; ASA 2015]; consider professional-regulator complaints where a registered professional is involved; follow safeguarding procedures for adults at risk; the therapist never offers, recommends or profits from thermography [synthesis].

Sources

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