Breast Self-Exam Flunks Test
<P>They Don't Cut Breast Cancer Deaths, but May Increase Unnecessary Biopsies</P>
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.
"I don't want to tell women not to examine their breasts, but it is definitely not a substitute for mammography," Thomas tells WebMD. "Women should go regularly to get mammograms and to get examined by professional personnel. Formal breast examination includes palpation in a proper way using the pads of the three middle fingers, systematic searching of the whole breast in both sitting and lying positions, and looking for asymmetry. That takes time and a real effort. That is what a woman has to learn if wants to do BSE. It is more than looking at a card in the shower."
Harris says that the time doctors spend teaching BSE could be better used in giving more thorough clinical examinations. But Baines insists that women who want to learn BSE should be encouraged to do so.
"Trained eyes see more than untrained eyes. Trained fingers feel more than untrained fingers. Women who do BSE regularly have more trained eyes and more trained fingers," Baines says. "When women find their own tumors, they are more likely to do it if they do BSE -- regardless of how they actually notice them. I approve of the concept of breast self-awareness."