Monthly breast self-exam (BSE) has been an important part of breast cancer screening for women of all ages. A suspicious area or lump found during BSE has led to many diagnoses and successful treatments of breast cancer.
Still, screening techniques aren't perfect. One problem with both BSE and mammography is what's called a false positive. A false positive is a suspicious result that causes concern when nothing is wrong. Besides the fear of being diagnosed with breast cancer, a false positive usually means more tests (including biopsies) and follow-up doctor visits. The process can be very stressful and upsetting.
The retrospective study reviewed here looked at the results of two studies, one from Russia and one from China, which compared the health histories of nearly 400,000 women. Some of the women did BSE. Others did not.
The researchers found that:
It's not clear how these findings apply to women in the United States because U.S. healthcare is very different than Russian and Chinese healthcare. Still, similar research results led the American Cancer Society to change its BSE recommendations. Instead of a recommended breast cancer screening tool, the American Cancer Society now views BSE as an optional screening tool.
Because BSE has helped diagnose and successfully treat many breast cancers, it might be hard to understand why opinions about BSE have changed. It helps to look at the issue from both a large, public health viewpoint and a smaller, individual health viewpoint.
From a public health perspective, research suggests that regular BSE (and money spent to promote regular BSE) doesn't really change the overall effect breast cancer has on a population of women. So regularly recommending it (and spending money to promote it) may not make sense.
From an individual health perspective, if you or someone you know had breast cancer diagnosed and treated because of something found during BSE, BSE is very valuable to you. So any woman who wants to do all that she can to monitor her breast health should do BSE, despite the risk of false positives.
Healthcare decisions, including BSE, are individual choices based on the information available and each person's unique situation. A woman can choose to make doing regular BSE part of her personal breast health monitoring and breast cancer screening plan. In many cases, official recommendations and guidelines can affect whether or not insurance companies cover a screening technique or procedure. But this isn't true for BSE, which costs only your time and commitment.
Talk to your doctor about the pros and cons of regular BSE and whether BSE should be part of your personal breast cancer screening plan. Together you can make a choice that makes the most sense for you. No matter what you decide about BSE, it's very important to remember that if you're over 40 regular screening mammograms must be done. Regular mammograms help diagnose breast cancer early, when it's most treatable.
Visit the Breastcancer.org Breast Self-Exam section to learn more about how to do BSE.
COPENHAGEN, July 16 (MedPage Today) -- Breast self-examination does not reduce breast cancer mortality and may cause harm by prompting unnecessary biopsies, according to data on almost 400,000 women.
Women who performed self-examination had virtually identical breast cancer mortality rates as women who did not examine their breasts, Jan Peter Kosters, Ph.D., and Peter C. Gotzsche, Ph.D., of the Nordic Cochrane Center here, reported in a Cochrane Review.
What's more, women who did breast self-examination had almost twice as many negative breast biopsies as women who did not perform self-exams.
"At present, screening by breast self-examination or physical examination [by trained healthcare personnel] cannot be recommended," the authors said.
The results updated and confirmed those from a 2003 review that reached similar conclusions.
Debbie Saslow, Ph.D., a spokesperson for the American Cancer Society, said the organization revised its recommendations for breast self-examination more than five years ago in response to emerging evidence of a lack of benefit. Monthly breast self-exams remain optional, however.
"We are advising that women should be aware of what is normal for how their breasts looked and felt, and to promptly report any changes to their healthcare provider," said Dr. Saslow. "Women who want to, should keep doing breast self-exams, and women who don't want to, don't need to."
In their current review, Drs. Kosters and Gotzsche analyzed data on 388,535 women involved in population-based studies in Russia and Shanghai. Objectives of both studies included a comparison of breast self-examination and no examination.
The comparison showed no significant difference in breast cancer mortality between the two groups (RR 1.05, 95% CI 0.90 to 1.24).
In the Russian study, women who performed breast self-exams identified more cancers (RR 1.24, 95% CI 1.09 to 1.41), but the Shanghai study demonstrated no difference in detection rates (RR 0.97, 95% CI 0.88 to 1.06).
Breast self-examination led to 3,406 negative breast biopsies, compared with 1,856 in the control group (RR 1.88, 95% CI 1.77 to 1.99).
"Data from two large trials do not suggest a beneficial effect of screening by breast self-examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed," the authors concluded.
Drs. Kosters and Gotzsche reported no disclosures.
Primary source: Cochrane Database of Systematic Reviews Source reference: Kosters JP, Gotzschke P "Regular self-examination or clinical examination for early detection of breast cancer (Review)" Cochrane Database Syst Rev 2008; 3:DOI: 10.1002/14651858.CD003373.
Breastcancer.org 7 East Lancaster Avenue, 3rd Floor Ardmore, PA 19003
Learn more about our commitment to your privacy
© 2009 Breastcancer.org - All rights reserved.
Breastcancer.org is a non-profit organization dedicated to providing information and community to those touched by this disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information.
