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Breast Self-Exams Don't Save Lives: Study

But experts disagree on whether it's "dead"

TUESDAY, Oct. 1, 2002 (HealthDayNews) -- Teaching women the technique of examining their own breasts does not decrease the number of deaths from breast cancer, new research contends.

The controversial finding comes from a study involving 266,064 Chinese factory workers, half of whom were taught breast self-examination (BSE), and half who weren't. They were followed over a period of 10 or 11 years, and the researchers found no difference in breast cancer deaths between the two groups. The group that did BSE didn't find cancers any earlier, but they did find more benign lesions, which lead to more testing.

The study appears in tomorrow's Journal of the National Cancer Institute, and is accompanied by an editorial carrying the headline: "Routinely Teaching Breast Self-Examination Is Dead."

That's a little strong, says Dr. David Thomas, a cancer epidemiology researcher at the Fred Hutchinson Cancer Research Center in Seattle and lead author of the study, whose co-authors are from Seattle, China and Norway. "I wouldn't have used that particular title for the editorial," he says.

Thomas says he is not suggesting women give up breast self-exams entirely, especially if they have a family history and the exams ease their anxiety.

The purpose of the study, he says, was to determine whether teaching the technique to the entire population made sense from a public health perspective, especially in areas where mammography screening is not routine. The results, he says, suggest that funding large-scale programs to teach breast self-exams is not a good use of money.

And, he adds, in countries like the United States, where mammography is widely available, BSE should never be a substitute for a mammogram.

"If I were a clinician, and I am not, I would not spend a lot of time teaching women BSE," Thomas says.

The only exception might be women at high risk for disease who are anxious, he says. They can take the time to do BSE, along with a clinical exam and a mammogram.

One problem with the self-exam technique, he adds, is that women don't often do it correctly. "BSE is not simply being aware of your breasts," he says. "It is a formalized, systematic search for tiny lumps. To do it takes some practice to learn."

To women who continue using it, Thomas says "there is no guarantee that it works." They should also know, based on the study results, of an increased risk of finding a benign breast lesion that will require biopsy and perhaps raise anxiety unnecessarily.

BSE shouldn't give women a false sense of security, he adds.

Not surprisingly, the study results raise the ire of some who stand behind BSE as an important adjunct to mammography and the clinical breast exam by a health-care provider.

"I do not believe it is dead," says Sherry Goldman, a registered nurse at the Revlon/UCLA Breast Center in Los Angeles.

She teaches the technique, and credits it with helping to save her own life. A little over a year ago, she was performing BSE and found a lump; she has since undergone a lumpectomy and radiation treatment and is doing well.

In Goldman's opinion, the study "doesn't change the fact that women should still be checking their own breasts." To learn the technique properly, she says, women should be taught BSE by a health-care provider. Women shouldn't expect to learn it from patient education materials or the ubiquitous illustrated cards designed to be hung in the shower.

While self-exams have been recommended for years by cancer prevention experts, many organizations, including the U.S. Preventive Services Task Force, say there is insufficient evidence to recommend for or against BSE. In 2001, the Canadian Task Force on Preventive Health Care analyzed medical literature on BSE, and concluded there is no benefit to routine teaching of BSE.

Currently, the American Cancer Society, which recommends annual mammography screening beginning at age 40, endorses monthly breast self-examination beginning at age 20 and clinical breast examination every three years from age 20 to 39, then yearly thereafter.

What To Do

For information on how breast cancer is found, visit the American Cancer Society. To read the recommendation from the U.S. Preventive Services Task Force, click here.

SOURCES: David Thomas, M.D., epidemiologist, professor, epidemiology, University of Washington, Seattle; Sherry Goldman, R.N., N.P., nurse practitioner, UCLA/Revlon Breast Center, Los Angeles, Calif.; Oct. 2, 2002, Journal of the National Cancer Institute
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