Breast cancer is the second most common cause of cancer death and the seventh most common cause of any type of death in women in the United States, according to the Centers for Disease Control and Prevention. Medical professionals used to recommend breast self-exams as a good way to find breast cancer in its early stages. While some still advocate for self-exams, the guidelines have changed.
Definition
Breast self-examination is a method women use to check for signs of potential breast cancer. The process includes visual and manual examination to detect lumps, pain, discharge and changes in appearance.
Recommendations
In 2003 the American Cancer Society changed its long-standing recommendations about breast self-exams, stating that they play a small role in finding breast cancer. At that point, the exams became optional. The U.S. Department of Health and Human Services agrees that a monthly self-exam is optional. However, both groups emphasize that a regular self-exam is a good way to become familiar with how your breasts normally look and feel and this will help you identify changes that might indicate cancer.
Studies
The ACS changed its recommendation because of two large clinical trials. One was conducted in Shanghai, China and the other was in Great Britain. In the Shanghai study, 266,064 women were divided into two groups and one received instruction in performing breast self-exams and encouragement to do so. Ten years later, there was no difference in the number of breast cancer deaths between the two groups, indicating that self-exams did not increase the chance of early detection or prevent death. The study also raised another unexpected concern: that women instructed in how to perform self-exams had more unnecessary breast biopsies than women in the other group. The results from the UK Trial of Early Detection of Breast Cancer were similar.
A study published in the November 2009 issue of Annals of Internal Medicine, provides an overview of breast cancer screening with data from the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Medline and Web of Science. The conclusion was that "no benefit has been shown for clinical breast examination or breast self-examination."
U.S. Preventive Services Task Force
As of November 2009, the U.S. Preventive Services Task Force advised clinicians to stop teaching women how to perform breast self-examination.
The task force, which is part of the U.S. Department of Health and Human Services, gave self-exams a "D" rating, meaning "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."
The task force is an independent panel of experts that review research and develop recommendations about services.
Debate
The new recommendations have created a debate between those who stand by the USPSTF and those who believe that self-exams save lives. An article published in the New York Times in December 2006, "Self-Exams Are Passé? Believers Beg to Differ," quoted health professionals on both sides of the issue. One side points to the research studies, while the other reports anecdotal evidence of lives that have been saved by self-exams. The Baltimore Sun published an article, "Guidelines against self-exams for breast cancer ignite firestorm," following the USPSTF announcement in November 2009. "There isn't a lot of harm," Dr. Lawrence Fogelson said of self-exams. "And I don't think it hurts."
