Experts debate value of breast self-exams

With a family history of breast cancer, Myers says she had performed a breast self exam, or BSE, from the relatively young age of 20 on the advice of her mother.

"I had never really felt anything abnormal or unusual," she recalls. "But when I was 28 years old I felt something that was not normal, something that gave me pause."

Her discovery prompted a visit to the doctor. The lump in Myers' breast turned out to be a cancerous tumor in its early stages. Surgeons removed the tumor and Myers underwent radiation and chemotherapy.

Now 30, Myers -- who has since become the director of operations for the patient advocacy group -- says she is breast-cancer free. And she credits breast self examination for the early detection.

"For me, BSE was so important, because women my age do not get mammograms; it's not covered by insurance," she says. "I had talked to my doctor about getting a mammogram, and the recommendation was for me to start at age 30.

"Had I not been doing [BSE], I presume my cancer would not have been detected until I started getting mammograms, and God knows what it would have been by then."

Although Myers says her experience made her a believer in self exams, a review published in the Cochrane Library in 2003 suggested that teaching and encouraging women to conduct self screening may be of little if any use when it comes to decreasing the death risk from breast cancer.

And, in the latest update to this review, which Cochrane released today, Danish researchers further downplay the importance of breast self examination.

"Self-exams are no longer recommended in Denmark, as they have no benefits, only harms," review co-author Dr. Peter Gøtzsche, director of the Nordic Cochrane Centre and Lecturer in medical science theory and ethics at Copenhagen University, told

The harm, Gøtzsche said, comes into play when women find lumps in their breasts that are not breast cancer -- discoveries that he said lead to unnecessary medical procedures and unnecessary worry. Even when a medical procedure is not necessary, a breast cancer false alarm can lead to emotional turmoil that can affect relationships and other aspects of day-to-day life.

"Doctors should not recommend harmful interventions with no proven benefits," he said. "They should explain to the women that self-examination is such as intervention."

The updated review has reignited the debate about breast self exams among breast cancer experts. On one side are doctors who agree with the premise of the review -- that encouraging women to conduct breast self exams does little when it comes to enhancing survival rates from breast cancer.

"The conclusion of the study that the data does not support using BSE as a good screening test for breast cancer is correct," says Dr. Susan Love, president and medical director of the Dr. Susan Love Research Foundation. "The randomized studies are large and well done."

Dr. David Euhus, chair in breast cancer surgery at the University of Texas Southwestern Medical Center at Dallas, says, "I have many patients who confess that doing a breast self exam increases their anxiety considerably. Some of the smartest and most reasonable ones decided long ago to stop examining their breasts. They were right."

On the other side are physicians who maintain that breast self exams are a vital component of breast health for women, and that doctors' advice against them could deny women an important tool in the detection of breast cancer.

"The new guidelines recommending that women not perform breast self-examinations could seriously endanger women's health and lead to later detection of cancers in some women," says Dr. Marisa Weiss, founder and president of "These guidelines do not reflect a new point of view, but they are still very bad advice."

Dr. Cliff Hudis, chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York, says, "We have not measured the impact of actually teaching or advising women to not exam their breasts. What are the 'downstream' effects of such advice? What other health maintenance interventions may get devalued as a consequence?

"Let's hope [the review] has no effect."

Update Unlikely to Change Recommendations

On the clinical level, anyway, the updated review is unlikely to have a major effect on practice. The American Cancer Society recommendations for breast self exam describe the practice as "an option for women starting in their 20s" and add that "women should be told about the benefits and limitations of BSE."

Society spokesman David Sampson says the updated review will not change the existing recommendation. And most doctors agree that it is good advice.

"The ACS recommendation is still reasonable because if fosters breast self-awareness," says Dr. Benjamin Anderson, director of the Breast Health Clinic and professor of surgery at the University of Washington.

But breast cancer experts remain concerned about the effect that the review could have on women in the general population.

"For the 20 percent of women whose cancers are only found by physical exam -- not mammography -- an individual woman's self-examination may be her main opportunity for early detection with a potential survival benefit," Weiss of says.

And some worry that downplaying breast self exams could have a chilling effect on other forms of breast health awareness among women.

"I am very concerned with statements such as, 'Self-exams are no longer recommended,' as that phrase is often picked up by the press without a clear explanation of what women should do," says Dr. Therese Bevers, medical director of the Cancer Prevention Center at the University of Texas M.D. Anderson Cancer Center. "As a result, women believe they are being told to not examine or touch their breasts.

"Breast cancer screening experts have clearly identified that women should be involved in their breast health. The concept of breast awareness does take some explanation but is well received by women."

Keeping Women Involved in Breast Health

Indeed, while breast cancer experts disagree on the effectiveness of breast self exams particular, all note that women's involvement in their breast health is an issue of utmost importance.

"Media campaigns and distribution of shower cards aimed at promoting breast self exam is certainly unwarranted, but it is important that women stay 'breast aware,'" Euhus of Texas Southwestern says. "I think it is wise to pay attention in the shower and notice any changes in the breast."

Lillie Shockney, assistant professor of breast cancer at Johns Hopkins University in Baltimore, agrees.

"We want women to take charge of their health," she says. "If we tell them, 'don't check your breasts,' we are promoting more fear of breast cancer than ever. Not logical."

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