No Evidence Breast Self-Exams Cut Cancer Deaths

Thus read the headline in yesterday’s Washington Post. Yet another study, this one by the Nordic Cochrane Center (an independent research and information center in Denmark) confirms a 2003 study of breast self-exams and their relation to breast cancer deaths.

Bottom line: Women who religiously do a BSE (breast self exam) every month are no less likely to die of breast cancer than women who don’t.

That same organization recently compiled and released results of a number of studies concerning the effectiveness of mammography in reducing breast cancer deaths. Bottom line on that one? “… for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.”

So what’s going on here?

We no longer have to do breast self exams—check. The American Cancer Society began recommending them as “optional” 5 years ago, and here comes confirmation from the Cochrane, “an international network of individuals and institutions committed to preparing, maintaining, and disseminating systematic reviews of the effects of health care.” They sound legitimate; we should believe them, right?

We no longer have to have mammograms—check. A couple of years ago we read the results of studies showing that women who received regular breast cancer screening via mammography were just as likely to die of breast cancer as those who didn’t. And the Cochrane Center has jumped on that bandwagon.

But—we also hear, constantly, that mammography is the best way to detect breast cancer in its early stages, when it’s most effectively treated. Dr. Michael Naughton, a breast cancer oncologist at the Washington University School of Medicine in St. Louis, noted in a November, 2007 HealthDay News article, "Mammograms are not perfect tests, but they currently are the most effective test available. I think the best evidence that mammograms save lives is the falling mortality rate since we've been using them for early detection." 

So which experts do we believe, when they take 180°, polar-opposite positions, and each seems to have the hard evidence to prove their point?

Here’s what I think.

Breast self exams: Yeah, they’re pretty much out of date. And for good reason. Tell the truth, now: did YOU do a BSE on the correct day of the month (after your period), every month? No, I didn’t think so. I bet I did maybe three in my life. I mean, who can remember A) to do it, and B) HOW you do it? When breast cancer is just one of zillions of things you’re thinking about, it tends to fall to the bottom of the priority list. Right down there with “organize the photo albums” and “scrub the shower curtain.”