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New View in Debate on Breast Self-Exams

Study Shows Self-Exams Are Helpful for Women at High Risk for Breast Cancer
By
WebMD Health News
Reviewed by Louise Chang, MD

April 22, 2009 -- Women at high risk for breast cancer can benefit from performing regular breast self-exams, according to a Duke University doctor who found in a small study that self-exams were as good as mammograms and MRI in detecting new breast cancers.

"Self-exam should be taught to high-risk women," says Lee Gravatt Wilke, MD, assistant professor of surgery at Duke University Health System in Durham, N.C. She presented the findings of her study at this week's meeting of The American Society of Breast Surgeons in San Diego.

But an expert from the American Cancer Society says the study was small and its results are no reason to alter the current recommendations. The American Cancer Society considers breast self-exam an option in breast cancer screening; the organization changed its recommendation of breast self-exam in 2003.

Wilke and her team compared the ability of breast self-exam, mammography, and MRI to detect new breast cancers in 147 women at high risk for breast cancer due to having the genetic mutations in the BRCA1 or BRCA2 genes, a history of breast cancer, or other factors known to increase the risk.

The women were seen from mid-2004 through late 2007 at the Duke University Breast Wellness Clinic, which monitors and treats women at high risk for breast cancer.

The women had yearly screening with mammograms and MRI along with clinical breast exams and training in how to do breast self-exams.

The researchers compared breast self-exam to mammography and MRI in the accuracy of detecting cancers. The American Cancer Society recommends that high-risk women have a mammogram and MRI each year.

In all, 14 breast cancers were found in 12 women. Six were detected by breast self-exam, six by MRI, and two by mammography, she says.

They looked at the number of masses found by each technique and which ended up being cancer:

  • With breast self-exam, 24 masses were found; six turned out to be cancer.
  • With MRIs, 23 had abnormal results; six turned out to be cancer.
  • With mammography, eight had abnormal results; two turned out to be cancer.

All the cancers but one were stage I, she says.

Breast Self-Exams: Other Opinions

"Her data are interesting, and it is more compelling because the women found the cancer at an early stage," says Debbie Saslow, PhD, director of breast and gynecologic cancer for the American Cancer Society, who reviewed the study abstract for WebMD.

But, she says, the accuracy of MRI and mammography reported by Wilke's team is much lower than what is reported in medical studies and clinical trials. Wilke acknowledged that discrepancy and says it is undoubtedly due to the small sample size.

Even though the American Cancer Society now looks on breast self-exams as an option, not a mandatory recommendation, Saslow says, "nobody would argue that BSE [breast self-exam] doesn't find breast cancers." 

The American Cancer Society changed its recommendation on breast self-exam after large studies -- one involving more than 250,000 women in Shanghai, China -- did not show that breast self-exam reduces deaths from breast cancer.

While breast self-exam may be more "top of mind" for high-risk women, Saslow says that "women shouldn't feel guilty about not doing BSE."

It's also crucial, she says, to perform the exam correctly. "Women who do it should do it lying down, not in the shower," she says. The American Cancer Society web site offers detailed instructions, or a woman may also ask her doctor for instructions.

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