Breast Self-Exam Flunks Test
<P>They Don't Cut Breast Cancer Deaths, but May Increase Unnecessary Biopsies</P>
Oct. 1, 2002 -- Breast self-exams can work -- but not the way most women do them. A major study shows no fewer breast-cancer deaths among women taught to check their own breasts for lumps.
Experts agree that women should know their breasts and that they should see a doctor if they notice any suspicious changes. Most U.S. doctors follow the recommendation of the American Cancer Society. They teach women to do detailed checkups -- called breasts self-exams or BSEs -- every month.
Many doctors may change their minds after seeing the new study in the Oct. 2 issue of the Journal of the National Cancer Institute. The huge trial compared large groups of women taught -- and faithfully reminded -- to do BSEs with women not taught to do BSEs. The result: both groups had the same rate of breast-cancer death. Study leader David B. Thomas, MD, DrPH, heads the epidemiology program at Seattle's Fred Hutchinson Cancer Research Center.
"It has not been proved that BSE will result in a reduction in a woman's risk of dying of breast cancer," Thomas tells WebMD. "I would also say, however, that it hasn't been definitely proved that if a woman diligently practices BSE on a monthly basis very carefully, it will not do some good. We don't know if it works."
The study signed up more than 266,000 women working in factories in Shanghai, China. When the study started, nearly 40% of the women were aged 30-39 and about 15% were age 40-49. Half the women were taught BSE and regularly reminded to check their breasts. The other half -- the control group -- got no training or reminders. None of the women in either group had access to mammograms or clinical breast exams performed by doctors. All women who found suspicious lumps or other signs of trouble got free medical care. Women who developed breast cancer got aggressive treatment including surgery, radiation therapy, and/or chemotherapy. U.S. observers rated this treatment as adequate.
After 10-11 years, there were 135 breast-cancers in the BSE group and 131 in the control group. Women taught BSE underwent more biopsies for lumps that turned out to be benign. They also detected their cancers sooner than did women who didn't do BSE, but they didn't get any survival benefit from this.
Why? The study doesn't show that BSE doesn't work. It does show that most women have trouble doing BSE well or often enough. BSE isn't easy to do, Thomas says. Most women in the study learned to do it moderately well. But that wasn't good enough.
"If you practice BSE, you have to do a better job than they did," Thomas says. "BSE is rather a formal technique. It is not just poking your breasts when you are taking a shower, but systematically searching the breast for very small changes and lumps. You have to do an excellent job."