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Breast self-exams don't help. Or do they? *

July 16, 2008 |  3:40 pm

Do you make a point of regularly checking your breasts for suspicious lumps that might bear further investigation? My doctor told me to do just that at my last physical.

But overall, such exams do little to prevent deaths from breast cancer and "cannot be recommended," according to a review of two large trials of 389,000 women -- and may even do more harm than good. That's because people who check their breasts have nearly twice as many biopsies exploring lumps that turned out to be harmless. Exams by trained doctors aren't to be recommended either, for the same reason, report authors of the review, conducted by the Cochrane Collaboration. (It's an update of an earlier, 2003 review by Cochrane on the same topic.)

The position of cancer specialists is more nuanced, it appears, from a report at the Center for the Advancement of Health. In fact, it doesn't exactly seem that cancer experts entirely want to dump the breast exam.

In that report, Debbie Saslow, (I mispelled Debbie Saslow's surname as Sazlow in an earlier version of this post. Apologies!) director of breast and gynecologic cancers at the American Cancer Society, says that as a result of the 2003 findings, the American Cancer Society changed its guidelines to no longer recommend such exams. Instead, it lists them as "an option."  Saslow does say that women should "be aware of what is normal for how their breasts looked and felt, and to promptly report any changes to their health care provider." That sounds awfully like examining one's breasts, though the ACS does state that breast awareness is more important than a structured exam -- indeed, most changes women detect fall outside of a structured exam. The cancer society does recommend regular clinical breast exams by a healthcare professional -- and states they should last from 6 to 12 minutes(!). (You can read about that, and lots more about breast cancer, right here.)

We checked the website of the National Cancer Institute, which permits, but doesn't recommend, self-exams: "You may perform monthly breast self-exams to check for any changes in your breasts ... you should contact your health care provider if you notice any unusual changes in your breasts ... studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer."

And in the Center for Advancement of Health report, Carolyn Runowicz of the University of Connecticut Health Center "encourages women to do the self-exams if they are comfortable with them," the article notes. She says that 50% to 60% of women detect their own breast masses.

All a tad confusing? Here's an article at U.S. News and World Report that attacks the topic in more depth.

--Rosie Mestel

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Comments (4)

I am an RN, and was 52 when I discovered a 1 inch lump in my breast during a monthly breast exam. It was not found on my yearly mammogram 5 months prior, nor did my GYN palpate it during my yearly physical 3 months before my discovery.

When I found it, my surgeon said it needed to come out, but not to worry, because it was freely moveable, and cancer "doesn't move around". Well, I had stage 2 breast cancer, with 1 possible (unable to determine) positive node. I underwent 4 months of chemo after having an elective bilateral mastectomy. That was almost 3 years ago. It appears I was very lucky. I am told I probably will never here from this cancer again. I fear I would be dead now if I haden't found my lump. I was told it had been inside me for many years by the time I detected it.

Please...perform monthly breast exams. Have your mammograms, but they do not always tell the whole story.

Rosie

Your lighthearted critique about breast self-examination advice quite accurately describes the impossible quandary facing women. It is true that current, painfully ambiguous recommendations for US women emerged from a review of older experiments with women in Russia and Shanghai.

The veil was placed over breast self-exams five years ago with the "don't perform" self-exams advisory by an influential, private US cancer organization, followed by others and a few government agencies. Evidence suggests however that the resistance to BSE for Western women is discrepant with current clinical and scientific reality. Women are now slowly lifting the ”veil”imposed over self examination for clinically sound reasons.

The 2003 “Cochrane” review of research conducted in Russia and Shanghai actually advised women that there was no good reason to examine their breasts and essentially recommended they cease doing so. The advice was based on self-examination studies conducted in Russia and Shanghai (beginning in the mid 80’s). Women trained to examine their breasts in these studies did not live longer than women who were no trained to examine their breasts. The “trained” women in the studies found both more benign lesions and more cancers.

For reasons that are difficult to understand, the 2003 Cochrane advice was just recycled in July 2008 via a press release from the Cochrane Centre. It repeated the old warning to women not to examine themselves (but suggested they become breast “aware”.) The new press release led US media to the false conclusion that something new had emerged from Russia or Shanghai. There was actually no news but hundreds of media outlets repeated the story as if it was new.

It is puzzling to many US clinicians and scientists why the Russian and Shanghai data have dominated Western thinking (and women) for so many years. It is also troubling why the story was recycled intact in 2008 with a warning to US and Western European women to cease and desist from what clinical evidence confirms is a life-saving practice. Clinically these reports and results do not appear to apply to Western women, their breast health practices or their current intervention options.

We, the team of clinicians and scientists that worked with NCI to develop proficient BSE tools and technology known as Mammacare, were asked to comment on the continuing media releases. (goto> google scholar and enter "mammacare" ). So we and academic colleagues evaluated the body of current and past research on self-exams to be bring it up-to-date. A report is in progress and the evidence supporting it can be seen at: www.mammacare.com/bseupdate

The cumulative evidence suggests strongly that most breast cancer is palpable and that the majority of women detect (palpate) and report their own breast cancers. It is reasonable to conclude, based on reported clinical experience and published evidence, that the options for early cancer detection, diagnostic confirmation and successful early intervention in the US are superior to those available in late 80's in Russia and China. It may no longer be reasonable to recycle the Russian and Shanghai experience as a cause to discourage breast self examinations in the West in 2008. It is also reasonable to expect that ACS and other well intended giant organizations will eventually catch up with the times, the data and the women.

Mark Kane Goldstein, Ph.D.
Senior Scientist
MammaCare
Mary Ann Mehn, Ph.D.
Director of Education
MammaCare

HI Rosie, Thank you for your article because shedding light on the controversy is healthy and provides information that women can use to make their own decisions. Dr. Goldstein did not tell the whole story in his comments. MammaCare has for decades been the standard of care by which many breast care specialists including myself use as the benchmark for best practices in breast examination. The company has developed the most proficient and effective methods for training interested women with disabilities as well, often forgotten in traditional awareness campaigns. The bottom line is that until future technology evolves and a blood test or other means of detection or prevention becomes available, we need to maximize the use of current tools to save more lives. The goal is to find a preclinical, tiny tumor that has not begun to spread yet, so called Stage 0 Breast cancer or a tiny tumor found by either the human hand (woman or clinician) or state of the art mammography. The goal for tumor size detection is 14 millimeters or about the size of a pea. This can be done by adhering to the American Cancer Society guidelines (www.cancer.org) and by making sure every woman goes to a Breast Imaging Center of Excellence (http://www.acr.org/accreditation/AccreditedFacilitySearch.aspx)
as defined by the American College of Radiology. Thank you for supporting early detection and more research to find a cure for this dreadful disease. Cathy Coleman, RN, OCN, CPHQ, Tiburon, California

HI Rosie, I meant to say LESS THAN 14 millimeters in my previous comment. Thank you. Cathy



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