Breast Cancer Screening Guidelines – Breast Self-Examination

There is an absence of agreement among public agencies and private organizations about the correct guidelines for breast cancer screening.  Several  respected national medical organizations support the practice of breast self-exams based on evidence.  Although a prominent volunteer agency, (USPSTF),  in association with an influential private organization, the American Cancer Society, recommends against teaching women how to perform self exams, the American College of Obstetricians and Gynecologists (ACOG) finds that self exams are effective in detecting breast cancer for a majority of women.

In their Practice Bulletin The American College of Obstetricians and Gynecologists states”

“Although breast-self examination is no longer recommended, evidence of the frequency of self-detection of breast cancer provides strong rationale for breast self -awareness in the detection of breast cancer. Approximately 50% of cases of breast cancer in women 50 years and older and 71% of cases of breast cancer in women younger than 50 years are detected by women themselves. (40, 41). For example, 43% of the 361 breast cancer survivors who participated in the 2003 National Health Interview Survey reported detecting their cancer themselves (42). Additional evidence of the important role of breast cancer self- detection comes from a study of low-income women who received breast cancer care through California’s Breast and Cervical Cancer Treatment Program. Of the 921 women in the cohort, 64% detected their breast cancer (43) ” 

More than 500,00 women die each year from breast cancer. Evidence confirms that most women first detect their own breast cancer, often by accident and at a late stage. Repeated press releases from these two associated agencies influence women and practitioners worldwide to avoid learning to perform self and clinical exams, advice that  may represent a  global disservice to women by increasing the risk of finding breast cancer at a later stage when the disease is more resistant to treatment.

The ACS and USPTF are well intentioned organizations although the recommendation against teaching women how best to perform a self-exam is troubling. It is well understood  that all widely used methods of breast examination, mammograms , self and clinical exams that are performed with inadequate training, experience and  skill produce relatively equal  proportions of false positive results also called false alarms. Thus, it would appear that agencies promoting women’s health would encourage women and their health care provides to learn to perform the least invasive and less costly method to check for suspicious changes in the breast.

Progress in Breast Self-Awareness and Breast Self-Exams.

Many of the studies that inspired criticism of BSE were done before it was known how to perform BSE correctly. Researchers initially relied on pamphlets and demonstrations as teaching devices and failed to address the central question: what does a lump actually feel like? A body of research supported in part by the National Cancer Institute  documents that breast examination ia  a skill that can be learned through practice. A summary of the evidence can be found here

Major agencies that recommend “breast self-awareness”  encourage women to learn the normal look and feel of their breasts. Best-practices based on evidence have  recommended BSE using the MammaCare Method as an effective technique to foster breast self-awareness .

Additional References

ACOG Practice Bulletin, Number 179, July 2017 https://www.acog.org/-/media/Practice-Bulletins/Committee-on-Practice-Bulletins—-Gynecology/Public/pb179.pdf?dmc=1&ts=20180204T1824108792

American Cancer Society. (2014). American Cancer Society Guidelines for the Early Detection of Cancer. http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer

Hauk, Lisa. (2012). American College of Obstetricians and Gynecologists Updates Breast Cancer Screening Guidelines. American Family Physician, 85(6): 654-655. http://www.aafp.org/afp/2012/0315/p654.html

Susan G. Komen. (2015). Screening and Early Detection. http://ww5.komen.org/breastcancer/earlydetectionampscreening.html

Nelson, H.D., Tyne, K., Nalk, A., Bougatsos, C., Chan, B.K., and Humphrey, L. (2009). Screening for breast cancer: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(10): 727-737.