Are Breast Self-Exams Still a Valuable Tool?

Study Shows No Reduction in Breast Cancer Deaths Among Women Who Self-Examine

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March 17, 2004 (Hamburg, Germany) -- Most women have endured the lecture in a doctor's office on precisely how and how often they should conduct a breast self-examination (BSE). Many women have also felt guilty because they don't think they do BSE exactly right or often enough.

Now a study by Russian investigators, involving nearly 200,000 women, shows that the breast self-exam is not associated with reduced breast cancer mortality. However, some experts say that focusing on breast cancer mortality misses the point and overlooks its other benefits.

According to a study by Vladimir F. Semiglazov, MD, an oncologist at the N.N. Petrov Research Institute of Oncology in St. Petersburg, Russia, women who received intensive training in breast self-exams had similar rates of cancers diagnosed and deaths due to breast cancer as did women who received no training.

"The breast cancer mortality rate was not reduced in the group that received training in BSE," Lars Holmberg, MD, tells WebMD.

The study shows that we need more sensitive screening instruments, such as mammography to detect breast abnormalities, says Holmberg, who is a spokesman for the European Breast Cancer Conference and a professor of clinical cancer epidemiology at the Regional Oncological Center at Uppsala University Hospital in Uppsala, Sweden.

"However, it would be wrong to conclude that women should not be aware of their bodies and symptoms," he says.

Similar Rates of Cancer

Semiglazov's study looked at whether an intensive program of BSE instruction would reduce breast cancer mortality. Between 1985 and 1989, 96,000 women who were between 40 and 64 years old were taught BSE in intensive training sessions. A comparison group of women were given no instruction. For all women in the study, abnormalities on breast exams were biopsied, and the women were treated according to their diagnoses.

Among the women trained to do breast self-exams, 7,061 reported abnormalities, compared with 3,825 in the comparison group. The researchers found 1,032 benign (noncancerous) breast lesions in the BSE group and 547 in the comparison group.

But despite finding more abnormalities, the two groups had similar numbers of cancers diagnosed -- 733 and 702, respectively. Fifteen years after they were diagnosed with breast cancer, both groups had similar survival rates, 53.8% in the BSE group and 51.1% in the comparison group.

"We had a hope that in BSE we would have a low-tech screening method that would work in [countries] with limited resources, where mammography screening isn't feasible," Holmberg says. "Sadly, the results didn't show that BSE could be seen as a substitute."

Exam Still Useful

"A lot of people don't interpret correctly the results of this study and another study from China with similar results," Therese B. Bevers, MD, tells WebMD.

"They think that because the intensive teaching of BSE doesn't reduce mortality, that women shouldn't examine their breasts," says Bevers, who was not involved in the study. "I firmly believe that women need to know what their breasts feel like and promptly report any change. This study says there's no right way to do it. Women already do a great job; they can find masses without anyone instructing them." Bevers is chairwoman of the Breast Cancer Screening Guidelines Panel of the National Comprehensive Cancer Network.

She says that enormous amounts of resources are used to teach women how to do the specific system of breast self-exam, ranging from individual doctor office visits to the printing of shower cards. "I say, 'Know what your breasts feel like and report changes.' If you don't feel a difference, there's probably nothing different. If you feel something different, call your doctor. There's no magic to checking your breasts."

"This is not the first study to show that BSE does not reduce breast cancer mortality, but there are other benefits," says Lawrence D. Wagman, MD, chairman of the division of surgery at the City of Hope Cancer Center in Duarte, Calif. "It would be interesting to know if women who do BSE [also] get their blood pressure checked more frequently, for example, since they may have more follow-up trips to the doctor to report changes. A lot of the strategies we use to get women in for mammograms are teachable moments for other wellness issues."

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SOURCES: 4th European Breast Cancer Conference, Hamburg, Germany, March 16-20, 2004. Lars Holmberg, MD, professor of clinical cancer epidemiology, Regional Oncological Center, Uppsala University Hospital, Uppsala, Sweden. Therese B. Bevers, MD, medical director of clinical cancer prevention and prevention outreach programs, University of Texas M.D. Anderson Cancer Center, Houston. Lawrence D. Wagman, MD, chairman, division of surgery, City of Hope Cancer Center, Duarte, Calif.
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