Bye-Bye to Breast Self-Exams?
June 27, 2001 -- The importance of breast self-exams to aid in detecting cancer has been made known to women for decades. Celebrities like Rosie O'Donnell have even come forward to report finding a lump on a routine self-exam.
A self-exam is simple, it's free, and it can be done in the privacy of your own home. Why then would anyone recommend against doing them?
A Canadian task force has done just that in an article published in the June 26 issue of the Canadian Medical Association Journal.
Based on data from several studies, including two large trials in China and Russia comparing women who conduct regular breast self-exams with those who do not, the task force says there is "fair evidence of no benefit and good evidence of harm." They therefore recommend that doctors stop teaching breast self-exam to women 40-69 years old.
The harm associated with self exams is that they may lead to an increase in women with false-positive breast lumps who must undergo biopsy and follow-up doctor visits only to learn that the lump is benign. According to the task force, false-positives can also cause unnecessary worry, anxiety, and depression.
But a representative of the American Cancer Society tells WebMD that in addition to overinterpreting the data from the Chinese and Russian studies, the task force has overlooked the fact that surveys suggest the majority of women accept false-positives and biopsies as a trade-off for finding breast cancers early and saving lives.
"It's true we need to put what [breast self-exams] can accomplish in perspective," says Robert Smith, PhD, director of cancer screening for the Society. "And after the age of 40 it primarily serves as a safety net for what mammography does not find or will not find. Before the age of 40, a woman bringing symptoms to her doctor at the earliest point where she notices something wrong is invaluable."
Smith says he believes the task force was premature in making its recommendations against breast self-exams based on the Chinese and Russian studies, especially since the investigators of those studies have themselves refrained from drawing too many conclusions until the studies are actually completed.
In a commentary accompanying the task force report, two researchers from Harvard Medical School further support this position by saying the studies may not even be "directly applicable" to women in the U.S. or Canada.
Studies suggest that most primary care doctors in the U.S. either teach breast self-exam to their patients or refer them to someone else for instruction.
Smith says for doctors to suddenly stop teaching women how to do self-exams doesn't seem wise. In addition, he says doctors should periodically ask women about their self-exams and ask to see their technique to make sure they are doing it correctly.
"Until we can get a more conclusive body of evidence I think we need to continue with what we're doing now, which is continue to teach monthly breast self-exams," concurs Linda L. Frame, RN, senior clinical advisor for the Susan G. Komen Breast Cancer Foundation in Dallas.
"The majority of breast lumps and breast cancers are found by women themselves, so we need to continue the practice and we need to further document the practice," she says. "This is something that has not been studied very well."