A new report from the Cochrane Collaboration, an international group that evaluates medical research, says there is no solid evidence that breast self-exams do any good. Furthermore, the report says it is fine if women don't do them.
Researchers now say that self exams often lead to unnecessary biopsies. In other words, if the self exams turn up what looks like a lump, the woman and doctor don't want to ignore the lump so the woman gets a biopsy that turns out to be unnecessary. Even worse,
TIME points out:
A benchmark study from 1998, published in the Journal of Public Health Medicine, indicates that five months after a benign surgical biopsy, 61% of women still struggled with symptoms of anxiety and psychological distress, including trouble sleeping, change in appetite and a general malaise fueled by thoughts of breast cancer.
This new study was based on women in China and Russia, but it is far from the first to recommend less emphasis on self exams. I recommend this thoughtful and calming story from
US News & World Report about the new study and what it means.
Let's face it. The new findings about breast self-exams contradict conventional wisdom and advice, but they are in line with emerging thought about self exams.
You might recall that about five years ago,
the American Cancer Society stopped recommending that all women do breast self-exams monthly and instead called self exams optional. The society pointed out, however, that while self exams turn up a lot of false alarms and they have not been proven to reduce the risk of cancer, they might still make sense in populations that have known cancer risks.
So what should women do?
The American Cancer Society recommends:
Mammogram: Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.
Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like.
Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to their health professional right away.
If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it’s OK not to do BSE or not to do it on a fixed schedule.
The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.
How did this whole self exam push begin anyway?
An Australian study says it may just be that researchers found that women believed breast cancer was so serious that they would not do self examinations if the exams were going to turn up bad news. So the researchers started pushing early detection as the only hope. One step in early detection was self examination followed by mammograms, even though self examinations had not been clinically proven effective.
One reason self exams are so ineffective is because women do not know what they are feeling for.
A bNet article points out:
But as Dr. Susan Love notes in her
comprehensive book on breast cancer, `Unfortunately, women are rarely given the proper information about BSE, and the misinformation often leads to unnecessary anxiety." She states that the lump a woman is looking for will be at least "a centimeter or two, almost an inch, or the size of grape," and will be persistent and unchanging. She explains that "beebee" sized things are almost never early cancer because at that stage a cancer has not developed the "fibrous, scarlike tissue" which forms around it which together with the cancer "makes up the palpable lump."
Cancer.org's breast cancer resource page is worth a look.
Links from that page include:
"What Causes Breast Cancer?""Can Breast Cancer Be Prevented?""How Is Breast Cancer Found?" "If Breast Cancer Is Suspected""After the Tests: Staging"Use this Web site to send yourself a reminder to get a mammogram.
Several people have asked me for a direct link to...
