Controversial Findings About Breast Self Exam Explained
July 16, 2008 by Karen Lynch
Filed under Women's Health
Yesterday I received a media advisory email stating this: “New Guidelines Against Breast Self-Examination Could Seriously Endanger Women’s Health,” says Dr. Marisa Weiss, President and Founder of breastcancer.org.
New Danish guidelines advising the population not to perform BSEs are supported by a review – to be released later today – of BSE studies previously conducted in Russia and China. The review, co-authored by Dr. Peter Gotzsche, suggests that breast self-exams do not reduce deaths from cancer and “cannot be recommended.”
I requested a copy of the review so I could investigate the issue for you. Here’s the deal:
The review was conducted by The Cochrane Collaboration. The conclusions are indeed as follows:
Data from two large trials do not suggest a beneficial effect of screening by breast self-examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. At present, screening by breast self-examination or physical examination cannot be recommended.
The problem seemed to be the high incidence of biopsies based on Breast Self Exam (BSE) that did not result in malignancies. My strong opinion is that a biopsy that gives a woman a clean bill of health is worth the cost of the procedure and the resulting anxiety if the alternative is an advanced stage breast cancer detection!
The author of the review (Dr. Peter Gøtzsche, director of the Nordic Cochrane Centre and Lecturer in medical science theory and ethics at Copenhagen University) did say in his report that “It would be wrong, however, to conclude that women need not be aware of any breast changes.” He stated these implications for research:
It is unlikely that additional trials investigating breast self-examination as a single general screening method would be worthwhile.
That makes a difference — it’s not recommended as a single general screening method (I’m not sure any one said BSE was being used as one though). Meanwhile, the ABC News Medical Unit reported on this story today. They presented both sides of the debate and included in their article the American Cancer Society most likely wouldn’t change their recommendation that BSE is an option for women starting in their 20s. I’d love for someone at the ACS to confirm or deny that opinion.
I’m with Dr. Weiss on this point:
“Early detection of breast cancer is crucial not only to the ‘survivorship’ of a patient, but to her quality of life while treating the cancer, and thereafter. For many patients, early detection could mean not having to lose a breast through mastectomy or not having to experience aggressive chemotherapy,” says Dr. Weiss.
Maybe, just maybe, a diagnosis spreads some light and sheds some clarity in this debate. Don’t you agree?
Hey Karen,
I think I can confirm what you’re asking. This new review looked at data from two major trials that took place a few years ago. The American Cancer Society reviewed this same data back in 2002 and – as a result – adjusted our guidelines for early detection in 2003. So in a sense this really isn’t new information that would make us change anything at this point.
We don’t recommend against monthly breast self exam, however the evidence doesn’t allow us to say BSE is something all women must do every 30 days. That’s what we mean when we say it’s an option. More important is general awareness of your own breasts look and feel and any changes you notice. You don’t have to do BSE to accomplish that.
Here’s the link to a story we had on the local news here in Albany, NY last night on the review:
http://www.youtube.com/watch?v=jPqw5FlWisA
And here’s a link to our page on how breast cancer is found from our website:
http://www.cancer.org/docroot/CRI/content/CRI_2_2_3X_How_is_breast_cancer_found_5.asp?sitearea=
Hope this helps.
Paul
Paul, your apt point that it is more important to have general awareness of how your own breasts look and feel and any changes you notice is one that keeps being overlooked in this general conversation.
BSEs have been suggested as one way in a regime of methods to help detect breast cancer. They have never been recommended as the only way. Ultimately, BSEs are a way to get familiar with your breasts and stay familiar with your breasts and that is something that must still be encouraged. The tone and language that people are using discredits the useful aspects of the exams. It also suggests to those women who have gotten in the habit of checking their breasts that they should stop. PLEASE DON’T!
The science is saying that BSEs have caused increased biopsies but the approach that is being taken to disseminate this information is taking the breast health movement back to days when it was not encouraged to be breast aware.
My passion here is exploding in this email but it is my fear that women will take this to mean that they shouldn’t be regularly checking their breasts.
Thank you to you both, Paul and Emily. (I share your passion, for sure!)
I hope all the Pink Ribbon Readers will take your words to heart and continue to check their breasts for changes!