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    Breast Self-Exam Flunks Test

    <P>They Don't Cut Breast Cancer Deaths, but May Increase Unnecessary Biopsies</P>

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    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."

    Breast-cancer expert Cornelia J. Baines, MD, professor emerita at the University of Toronto, has some problems with the study. She notes that many of the women were no older than 40 or 50 at the end of the study period -- ages at which relatively few women get cancer. And she says that any kind of breast-cancer screening usually takes more than 10 years to show a survival benefit.

    "The most important message here is that women who don't want to do BSE shouldn't be made to feel guilty for not doing it," Baines tells WebMD. "But if women are sufficiently motivated to do BSE well and want to perform it, it probably is a very good idea. The majority of breast cancers are still found by the woman and not by her doctor. If she is doing BSE she is more likely to notice it earlier than later. BSEs are worth doing, but not worth doing badly."

    Russell Harris, MD, MPH, is co-director of health promotion at the University of North Carolina, Chapel Hill. He's also the author of an editorial accompanying the Thomas study. Harris points out that the study compares BSE alone to no screening at all. BSE would be expected to have even more of an effect in this setting than in the U.S., where women get regular mammograms as well as regular clinical breast exams (CBEs) from their doctors. That the study found no effect, he says, means that most women might as well take down those shower cards illustrating BSE techniques. Thomas agrees.

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