The Breast Self Exam: Why You Don't Need It Anymore
Woman Wearing Bra Examining BreastCredit: Thinkstock
True or false: Doing a monthly breast self-examination (BSE) will help you discover any cancer early, thus improving your chances of survival. For years, the answer we all would have given was “true” – doing a monthly BSE was good insurance against dying from breast cancer.
Women have heard for years that a monthly breast self-exam (BSE) is a critical tool for catching breast cancer at an early stage. Our doctors told us this. The American Cancer Society (ACS) recommended it. We listened, and dutifully palpated our breasts once a month (from both vertical and prone positions and right after your period, please), hoping not to find a lump.
But this practice is no longer recommended by most national groups – including the American Cancer Society. So, what’s changed?
In recent years, the ACS has abandoned its original stance. The National Cancer Institute notes that “regular BSE is not specifically recommended for breast cancer screening.” Even more, the United States Preventive Services Task Force – the governmental agency charged with formulating preventive health measure guidelines – recommends against BSE. The USPSTF’s last update, in July 2012, states the following: “The USPSTF recommends against the service [BSE]. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”
Why the BSE fell out of favor
Why this apparently sudden about-face around BSEs?
Well, the change actually isn’t so sudden. It had gradually built steam since the 1970s, when researchers began observing that there was no real data linking breast cancer survival to BSEs. However, the practice was so entrenched in preventive health practice it took decades for actual studies around BSE to be undertaken and completed.
Studies revealed no difference in outcomes
A major Chinese study published in 2005, involving 266,064 women tracked over a five year period, showed that regular BSE didn’t result in any fewer breast cancer mortalities; but did lead to the discovery of more benign lumps: something researchers had long suspected.
Once that initial study was published, the move to stop recommending BSEs began to gain momentum. The ACS dropped its recommendation in March, 2007, as did the Canadian Cancer Society, which had just completed its own 10-year study of 270,000 Canadian women.
“My doctor still recommends a BSE. Why?”
According to a 2015 study, over 70 percent of doctors continue to recommend BSE to their female patients, despite its proven lack of saving lives.
Why? More than half said they were unaware of the USPSTF guidelines. And of those who knew about the guidelines, over a third – 37 percent – continued to recommend BSE anyway.
Apparently change comes hard – especially when it’s around a medical practice that had been in place for decades.
But surely doing a BSE can’t hurt…
According to the USPSTF, more discovered lumps mean more biopsies. And more biopsies mean more chance of infection or other medical problems; increased health care costs, and needless anxiety on the part of women undergoing the biopsies.
Since ACS data shows 80 percent of all breast biopsies are negative – no cancer – surgeons performing even more biopsies leads to more women having had needless surgery.
Still, the BSE isn’t completely without merit. It can be part of a woman’s regular assessment of breast health. Rather than doing a formal once-a-month survey, most organizations now recommend women become familiar with how their breasts normally feel; and then feel them regularly (a typical suggestion is daily, in the shower), to detect any possible changes.
In fact, The World Health Organization, while not recommending BSE as a reliable screening method, says it’s appropriate for “raising [breast cancer] awareness among women at risk.”
I recently had the chance to ask my own oncologist, Dr. Gary Schwartz, what he thought of BSE.
Schwartz, a breast oncologist at Norris Cotton Cancer Center in Lebanon, NH and an associate professor of medicine at Dartmouth College’s Geisel School of Medicine, said, “I think it’s very appropriate for the ACS to drop their recommendation for monthly breast self-examination, since it was never based on clinical trial data. The last Cochrane analysis from 2008 showed no reduction in breast cancer mortality in two large population-based trials of breast self-examination versus no self-examination.”
“The self-awareness recommendation is reasonable,” he added.
Schwartz’s opinion supports the current bottom line regarding BSE: Know your breasts; notice any changes.
Whether you need a formal once-a-month BSE to accomplish that goal, or simply rely on informal daily checks while bathing, the best way to detect any lumps early is to keep in touch with your breasts – literally!
See More Helpful Articles:
Allen, Tiffany L. "The Breast Self-Examination Controversy: What Providers and Patients Should Know." August 11, 2010, Journal of Nurse Practitioners. Accessed April 08, 2016. http://www.medscape.com/viewarticle/725641.
Loh, KP. Healthcare Professionals' Perceptions and Knowledge of the USPSTF Guidelines on Breast Self-Examination. August 1, 2015. Accessed April 08, 2016. http://www.medscape.com/viewarticle/849351_1.“Final Recommendation Statement: Breast Cancer: Screening.” July 2012. Accessed April 08, 2016. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening. * * *_ Breast cancer survivor and award-winning author_ PJ Hamel_, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network. _