Breast self-examination (BSE) seems like a good idea: it’s simple, cheap, and low-tech. It puts you in charge of your own health and teaches you about your body. Recent evidence, however, indicates the advantages of BSE may not be all that clear-cut.
Besides being difficult to do well, it’s hard to keep performing BSE consistently each and every month. The exam sometimes triggers unnecessary worry and can create the need for additional medical care, including tissue biopsies . Now, research suggests that, for the majority of women, BSE does not even reduce the risk of dying from breast cancer . Based on current data, the prestigious US Preventive Services Task Force says there is insufficient evidence to recommend for or against BSE.
The current controversy over BSE was triggered by the release of results from a large, well-conducted trial sponsored by the National Institutes of Health published in the October 2002 issue of the Journal of the National Cancer Institute . American and Chinese researchers recruited 266,000 female factory workers in China, none of whom had access to mammography and few of whom received professional exams. Some of the women were taught to examine their own breasts and were regularly encouraged to do so each month.
After 11 years, final data from the trial indicated that women who did BSE had no fewer deaths from breast cancer than those who did nothing. However, the number of breast biopsies performed for benign breast disease was considerably higher in the self-exam group than in the control group.
Researchers concluded that the education and follow-up required for widespread BSE are a waste of resources in developing countries where mammograms are not available. But they left open the possibility the exams could be worthwhile in countries where mammograms or professional exams are routinely performed, especially among women who are highly motivated and proficient in examining themselves. Say authors of the study, “Women who choose to practice BSE should be informed that its efficacy is unproven and that it may increase their chances of having a benign breast biopsy.”
In addition to the China data, other research questions the benefits of doing routine BSE. A Russian study and another from the United Kingdom demonstrate no decrease in deaths or stage of breast cancer detected using BSE. Canadian reviewers analyzed eight worldwide studies and in seven of these, found no benefit from doing BSE.
Experts from the US Preventive Services Task Force (USPSTF) question these results, however, asking whether research from other countries can be applied to US women. Based on current data, the USPSTF says there is insufficient evidence to recommend for or against BSE.
The American Cancer Society still considers BSE a useful tool and endorses it along with regular mammography and professional breast exams. The organization recommends that all women be informed about the benefits and limitations of monthly BSE starting at age 20. After discussion with their healthcare providers, the Society says that women may or may not choose to perform BSE.
Advocates of BSE point out several other reasons why women might want to continue doing BSE. Some studies have shown that women who regularly perform BSE—especially those highly skilled in the exam—tend to discover breast cancer when it is smaller and less advanced. Also, since mammograms can miss up to 15% of breast cancers, careful physical exams still have a role to play in early detection. Doctors can routinely perform professional breast exams for women. But who better than the women themselves, ask advocates, to keep tabs on breast health between visits?
With or without monthly BSEs, it continues to be essential for women to stay aware of any changes in their breasts. It’s this self-awareness that’s vital to detecting breast cancer early, according to an editorial that accompanied the China report in the Journal of the National Cancer Institute . Women who stay aware of changes in their breasts may be able to detect breast cancer early, if it occurs, and when there are more treatment options available.
Consult with your doctor to see what combination of mammograms, professional exams, and self-exams is best to help you monitor your breasts. If you notice any changes report them promptly to your doctor. And take heed of the warning signs of cancer. These include a breast lump or thickening; change in breast size, shape, color, or texture; nipple discharge; skin dimpling or puckering; or breast redness, swelling, or heat.
RESOURCES
American Cancer Society
http://www.cancer.org
National Cancer Institute
http://www.cancernet.nci.nih.gov
References:
Apantaku LM. Breast cancer diagnosis and screening. Am Fam Physician . 2000;62:596-605.
Harris R, Kinsinger LS. Routinely teaching breast self-examination is dead. What does this mean? [editorial] J Natl Cancer Inst . 2002;94:1420-1421.
Hellekson KL. American Cancer Society issues 2002 guidelines for the early detection of cancer. Am Fam Physician . 2002;66:682-684.
Katschke RW. Is breast self-examination an effective screening measure for breast cancer? J Fam Pract . 2001;50:994.
Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: Final results. J Natl Cancer Inst . 2002;94:1445-1457.
US Preventive Services Task Force. Screening for breast cancer: Recommendations and rationale. Am Fam Physician . 2002;65:2537-2544.
Last reviewed June 2006 by Lawrence Frisch, MD, MPH
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