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The validity of the autonomic cold challenge for use in screening breast thermography is reviewed. A review of the literature is discussed along with reasoning for the choice of the cold stress method used. Breast thermogram results from 23 patients with histologically confirmed breast cancers are presented demonstrating positive and negative responses to the challenge. Cold challenge responses from 500 patients without breast cancer and with normal and persistent abnormal thermograms are also discussed. The question is posed, should the use of the cold challenge be continued considering that a negative response does not rule out the possibility of neoplasm nor does a positive response guarantee its existence? Conclusions are drawn from the available data that suggest that the use of the cold challenge be left up to the discretion of the interpreting thermologist and not mandated with every breast thermogram. Until further studies are performed and ample evidence can be presented, a review of the available data indicates that infrared imaging of the breast can be performed excluding the cold challenge without any known loss of sensitivity or specificity in the detection of breast cancers.