Report Calls Breast Self-Exams Unhelpful

The study reported on below by my colleague Dr. Robert Shmerling provides sobering news. It is yet another piece of evidence that brings into serious question the true value of early detection of cancer by breast self examination (BSE) and its ability to alter outcomes. While certain screening tests, such as the PAP test for detection of cervical cancer, seem to save lives, other routine screenings, such as PSA testing, have not shown that “early” detection leads to more lives saved compared to those who do not undergo testing. Breast self examination, once thought by some to be useful, is now in question.

Because of the medical-legal issues that physicians face, a woman who detects a lump in the breast will almost undoubtedly undergo a biopsy, even if the physician really believes that the “lump” felt by the patient is a part of normal breast anatomy. My interpretation of the information provided below is that until more definitive data are available, the benefits of BSE are in question, and perhaps not all patient-detected lumps need biopsy.

The New Study

Breast self-exams may do more harm than good, a group of experts says. The Cochrane Collaboration looked at previous research from Russia and China. A total of 388,535 women were randomly assigned to perform breast exams, or not. There was no difference in breast cancer deaths between the groups. But women who did breast exams had twice as many biopsies of lumps that were not cancer. Cochrane reached a similar conclusion in 2003. But the American Cancer Society and other groups still recommend self-exams. That's because many women with breast cancer find lumps themselves. Time Magazine online, ABC News and CNN reported on the story July 15 or 16.

What Is the Doctor's Reaction?

There's good reason to do all you can to prevent and detect breast cancer. An estimated 180,000 women in the United States will learn they have breast cancer this year. More than 40,000 women die of the disease each year.

That's why doctors have urged women for decades to be vigilant about the detection of breast cancer. You're probably familiar with the drill:

·         Self-breast examination each month

·         Regular breast exams by your doctor

·         A mammogram each year

Women at high risk may get other tests, including ultrasound and MRI. These tests also are used to evaluate abnormal areas seen on a mammogram.

For routine breast cancer screening, advice has not changed much in recent years. But that could happen soon. According to a new study that combines the results of previous research, self-breast exams may be useless. They may even be harmful.

In separate research, researchers in Russia and China studied more than 388,000 women. They found similar death rates due to breast cancer among women who regularly examined their breasts and women who did not. The two groups also had similar rates of mastectomy (breast removal), an indication of more advanced breast cancer.

One concern is that women who examined their breasts had many more breast biopsies than women who did not. If self-breast exams lead to more biopsies but no advantage in early detection or survival, it may be time to reconsider this advice.

Does this mean you should stop performing self-breast examination? Talk to your doctor about it. Even if self-examination is not useful on average, it may be useful in some situations. For example, it's possible that women with breast cysts or a strong family history of breast cancer would benefit from self-breast examination.

Whether you examine your breasts regularly or not, tell your doctor if you notice a change.

What Changes Can I Make Now?

You can take steps that could lower your risk of breast cancer:

·         Don't smoke.

·         Lose excess weight

·         Exercise.

·         Moderate your intake of alcohol.

·         Choose a low-fat diet that is high in cruciferous vegetables. These include cauliflower, Brussels sprouts and broccoli.

·         See your doctor regularly for breast examinations.

·         Get your mammograms as recommended.

·         Don't take hormone replacement therapy (or take the lowest effective dose for the shortest possible time).

·         Have genetic testing if you are at high risk of hereditary breast cancer. For example, testing may help if one or more family members developed breast or ovarian cancer when younger than age 50.

If you examine your breasts each month, talk to your doctor about whether it's worth continuing to do so. Even if it there is no convincing evidence that it's helpful, it may provide you with peace of mind. But keep in mind that these self-exams may increase your chance of having a breast biopsy.

What Can I Expect Looking to the Future?

This study calls into question one of the most common recommendations doctors make to their female patients. It may be too soon to abandon the self-breast examination without more information. For example, we need to know whether self-exams help certain groups of women. Self-exams may turn out to be worthwhile for women at higher-than-average risk, but not others.

It also would help to know why women who perform self-exams have more breast biopsies. Presumably, it's because they find more breast lumps. Their doctors would recommend biopsies to make sure they aren't cancerous. Future research may reveal better ways to tell which lumps are likely to be cancerous (and therefore require a biopsy) from those that don't need a biopsy. I expect new and better tests to become available for breast cancer screening.

Until we have more information, women and their doctors will have to decide whether breast self-exams are worthwhile in the face of this new review's surprising results.

Marc Garnick, M.D., is an internationally renowned expert in medical oncology and urologic cancer, with a special emphasis on prostate cancer. He is a Clinical Professor of Medicine at Harvard Medical School and maintains an active oncology practice at Beth Israel Deaconess Medical Center. Dr. Garnick serves as Editor in Chief of Perspectives on Prostate Diseases, a quarterly report from Harvard Health Publications.

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