Study Questions the Value of Breast Self-ExaminationsTechnique does not cut rate of breast cancer deaths, large-scale study finds, but some experts disagree.< October 1, 2002 > New research is questioning the value behind teaching women the technique of examining their own breasts, stating it does not decrease the number of deaths from breast cancer. The controversial finding comes from a study involving 266,064 Chinese factory workers, half of whom were taught breast self-examination (BSE), and half of whom were not. They were followed over a period of 10 or 11 years, and the researchers found no difference in breast cancer deaths between the two groups. The group that did BSE did not find cancers any earlier, but they did find more benign lesions, which lead to more testing. The study appeared in a recent Journal of the National Cancer Institute, and is accompanied by an editorial carrying the headline: "Routinely Teaching Breast Self-Examination Is Dead." That is a little strong, says Dr. David Thomas, a cancer epidemiology researcher at the Fred Hutchinson Cancer Research Center in Seattle and lead author of the study, whose co-authors are from Seattle, China, and Norway. "I wouldn't have used that particular title for the editorial," he says. Thomas says he is not suggesting women give up breast self-examinations entirely, especially if they have a family history and the examinations ease their anxiety. The purpose of the study, he says, was to determine whether teaching the technique to the entire population made sense from a public health perspective, especially in areas where mammography screening is not routine. The results, he says, suggest that funding large-scale programs to teach breast self-examinations is not a good use of money. And, he adds, in countries like the United States, where mammography is widely available, BSE should never be a substitute for a mammogram. "If I were a clinician, and I am not, I would not spend a lot of time teaching women BSE," Thomas says. The only exception might be women at high risk for disease who are anxious, he says. They can take the time to do BSE, along with a clinical examination and a mammogram. One problem with the self-examination technique, he adds, is that women do not often do it correctly. "BSE is not simply being aware of your breasts," he says. "It is a formalized, systematic search for tiny lumps. To do it takes some practice to learn." To women who continue using it, Thomas says "there is no guarantee that it works." They should also know, based on the study results, of an increased risk of finding a benign breast lesion that will require biopsy and perhaps raise anxiety unnecessarily. BSE should not give women a false sense of security, he adds. Not surprisingly, the study results raise the ire of some who stand behind BSE as an important adjunct to mammography and the clinical breast examination by a health-care provider. "I do not believe it is dead," says Sherry Goldman, a registered nurse at the Revlon/UCLA Breast Center in Los Angeles. She teaches the technique, and credits it with helping to save her own life. A little over a year ago, she was performing BSE and found a lump; she has since undergone a lumpectomy and radiation treatment and is doing well. In Goldman's opinion, the study "doesn't change the fact that women should still be checking their own breasts." To learn the technique properly, she says, women should be taught BSE by a healthcare provider. Women should not expect to learn it from patient education materials or the ubiquitous illustrated cards designed to be hung in the shower. While self-examinations have been recommended for years by cancer prevention experts, many organizations, including the US Preventive Services Task Force, say there is insufficient evidence to recommend for or against BSE. In 2001, the Canadian Task Force on Preventive Health Care analyzed medical literature on BSE, and concluded there is no benefit to routine teaching of BSE. Currently, the American Cancer Society, which recommends annual mammography screening beginning at age 40, endorses monthly breast self-examination beginning at age 20 and clinical breast examination every three years from age 20 to 39, then yearly thereafter. Always consult your physician for more information.
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For more information on Breast Health, visit the Breast Health information module on this Web site. Breast Health: Three-Step Plan for Preventive CareThe thought of having breast cancer is frightening to everyone, and especially devastating to women. But, ignoring the possibility that you may develop breast cancer or avoiding the processes to detect cancer, can be dangerous. Although there are some women who are at higher risk, the fact is that all women are at risk for breast cancer. That is why it is so important to follow this three-step plan for preventive care. Although breast cancer cannot be prevented at the present time, early detection of problems provides the greatest possibility of successful treatment. What is the three-step plan? Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts, are often discovered through routine care. Step 1. Breast Self-Examination (BSE) Regular BSE teaches you to know how your breasts normally feel so that you can more readily detect any change. Changes may include:
If you notice any of these changes, see your healthcare provider as soon as possible for evaluation. Step 2. Clinical Examination
A physical breast examination by a physician or nurse is very similar to the procedures used for breast self-examination. Women who routinely practice BSE will be prepared to ask questions and have their concerns addressed during this time. Step 3. Mammography Mammography is a low-dose x-ray of the breasts to find changes that may occur. It is the most common imaging technique. Mammography can detect cancer or other problems before a lump becomes large enough to be felt, as well as assist in the diagnosis of other breast problems. However, a biopsy is required to confirm the presence of cancer. Since there is controversy among cancer organizations regarding when to begin having mammograms, as well as how often, talk with your physician about a mammography schedule that is appropriate for you based on your overall health and medical history, risk factors, and personal opinion or preference. According to the National Cancer Institute, women in their 40s and older should begin having a screening mammogram on a regular basis, every one to two years. But, the American Cancer Society recommends that by age 40, women should have a screening mammogram every year. (A diagnostic mammogram may be required when a questionable area is found during a screening mammogram.) Both organizations suggest that women who may be at increased risk for breast cancer should talk with their physicians about whether to begin having mammograms at an earlier age. Always consult your physician for more information. |