Why So Much Confusion About Breast Self-Exams?

Women everywhere are confused by the conflicting messages they receive about breast self-examination (BSE). A few large private and public agencies vacillate in their recommendations. The media often add to the confusion by uncritically repeating official recommendations that seem to cast doubt on the value of BSE.

Yet the fact remains that a large proportion of breast cancers are discovered by women themselves.

A nationally respected team of researchers reported that  “Self-Detection Remains a Key Method of Breast Cancer Detection for U.S. Women” (1) 

Most women know at least one other woman who has been treated for breast cancer. In many cases the cancer was first found by the woman herself, either by accident or as a result of deliberate self-examination.

Why, then, is BSE condemned when it accounts for so many cancers found?

Part of the answer to this question lies in the very concept of BSE itself.  We now know that BSE is a highly specific skill that cannot be practiced effectively without proper training.  Many of the studies that inspired criticism of BSE were done before we knew how to teach BSE correctly.  Investigators relied on pamphlets and demonstrations as teaching devices and failed to address the central question: what does a lump actually feel like?  As a result, the quality of the BSE studied was deemed by experts to be not particularly useful.

The unreported good news is that some of the most eloquent critics of BSE have hastened to advise that BSE done correctly could be of considerable value in early detection.  For example, David Thomas, senior author of the widely publicized Shanghai study says,

“It is possible that highly motivated women could be taught to detect cancers that develop between regular screenings, and that the diligent practice of BSE would enhance the benefit of a screening program.” “…there is no reason to discourage women who choose to practice BSE from doing so.  However, it should be emphasized to such women that they must practice BSE regularly and with a high degree of proficiency.”(2)

In the same issue of the Journal of the National Cancer Institute, editor Russell Harris opined,

“The results from the Shanghai trial do not mean, however, that all physical examinations of the breast are ineffective. There is evidence that excellent physical examination practice, whether CBE or BSE, may indeed be effective.  Not only is there case–control evidence that excellent BSE may reduce mortality, there is also randomized, controlled trial evidence that excellent CBE done by trained nurse-examiners may be as effective as mammography in reducing breast cancer mortality.” (3)

Nancy Baxter of the Canadian Task Force on Preventive Health Care writes, 

“Any woman who wishes to practise BSE and who requests instructions should be counseled regarding the risks and benefits, and the health care professional should ensure that BSE instruction is thorough and that the woman is performing BSE in a proficient manner.”(4)

So, what constitutes effective instruction in BSE?

There are two components:

  1. Fingers must be taught what to feel for, what a suspicious lump might feel like. This can only be accomplished by palpating a tactually accurate breast model, not by watching a video or reading a pamphlet.
  2. The educated fingers must be brought into contact with all of the breast tissue where a tumor might reside.

The only method presently available that contains both of these critical components is known as MammaCare.

The medical research team that developed MammaCare with the support of the National Cancer Institute wanted it to be available to every woman in an easy-to-use and affordable home kit (MammaCare Personal Learning System).  A noted team of medical scientists examined MammaCare and concluded:

 “Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills.”

With practice, every woman can become adept at the skill of breast self-examination. An additional benefit, as Dr. Harris says, is that “women may also feel empowered and more in control with this knowledge.”(2)

References

  1. Self-Detection Remains a Key Method of Breast Cancer Detection for U.S. Women. J Womens Health. 2011 Aug; 20(8): 1135-9. Roth MY, Elmore JG, Yi-Frazier JP, Reisch LM, Oster NV, Miglioretti DL.
  2. David B. Thomas, Dao Li Gao, Roberta M. Ray, Wen Wan Wang, Charlene J. Allison, Fan Liang Chen, Peggy Porter, Yong Wei Hu, Guan Lin Zhao, Lei Da Pan, Wenjin Li, Chunyuan Wu, Zakia Coriaty, Ilonka Evans, Ming Gang Lin, Helge Stalsberg, Steven G. Self.  Randomized Trial of Breast Self-Examination in Shanghai: Final Results. Journal of the National Cancer Institute, Vol. 94, No. 19, 1445-1457, October 2, 2002.
  3. Russell Harris and Linda S. Kinsinger.  Routinely Teaching Breast Self-Examination is Dead.What Does This Mean? Journal of the National Cancer Institute, Vol. 94, No. 19, 1420, October 2, 2002.
  4. Baxter, Nancy. Preventive health care, 2001 update: Should women be routinely taught breast self-examination to screen for breast cancer?CMAJ ; 164 (13) June 26, 2001
  5. How best to teach women breast self-examination. A randomized controlled trial.  Annals Intern Med. 1990 May 15;112(10):772-9. Fletcher SW, O’Malley MS, Earp JL, Morgan TM, Lin S, Degnan D.
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