Should women do breast self-exams?
We asked a leading voice on each side of the debate to weigh in on the pros and cons of breast self-exams
By Claudia Cornwall
For years, many of us were told by our doctors to do regular breast self-exams (BSEs)—when we look at and feel our own breasts to detect lumps. It seems like a no-brainer, a kind of early warning system. But lately GPs have been telling us we should not do BSEs. That’s because, in 2007, the Canadian Cancer Society stopped recommending it as a way to find cancer. In 2006, the Society of Obstetricians and Gynaecologists of Canada changed its long-standing position, stating that BSE shouldn’t be taught to women unless they request it. We spoke with two leading voices for and against BSEs to shed some light on the issue.
The "no" argument: Dr. Nancy Baxter
Baxter was the lead author of a paper published in 2001 that helped start this sea change in Canadian medical opinion. She found that in several randomized control trials, women who regularly did BSEs were just as likely to die of breast cancer as those who did not. Preliminary results from one such study were especially striking because the trial was so large—267,040 Shanghai women age 31 to 64. Baxter is a surgeon at St. Michael’s Hospital in Toronto, and has a Ph.D. in clinical epidemiology. Determining the effectiveness of different cancer screening methods is one of her abiding research interests.
Best Health Since your paper on BSE was published, are you still of the opinion that BSE shouldn’t be encouraged?
Dr. Nancy Baxter The evidence is even stronger today. Not long after my paper was published, the Shanghai trial published its final results and showed no benefit of teaching of self breast examination in a randomized study.
BH What about for young women who don’t normally get mammograms?
NB There’s no recommended screening for them, including BSE. Their risk is low, so most BSE findings will be benign.
BH How many women discover their own breast cancers?
NB In the past, most discovered their own. That proportion is decreasing with screening mammography. I can’t give you the exact number. But most women who find their own breast cancers do not find them in regular BSE, but during casual palpation: that is to say, during bathing, dressing, sexual relations. You have to differentiate finding a breast cancer in that “accidental” way from performing BSE.
BH But if you do BSE regularly, aren’t you more likely to find something just because you’re more familiar with your breasts?
NB It doesn’t seem you find things early enough to make a difference. Tumours found with BSE are relatively large compared to other screening tests such as mammography. Women may be able to find tumours
a few months earlier if they examine themselves with BSE versus with casual palpation. But by the time a cancer is big enough to feel by BSE or casual palpation, the biology of the tumour and the treatment influence the outcome more than finding the tumour a few months earlier would. Early detection is just one of the things that’s important in treating breast cancer. Even very small breast cancers can be deadly. Some people with tiny breast cancers found in mammography will die of their disease. And people can survive some very large breast cancers. The biology of the cancer—how aggressive it is—is probably the most important thing in determining the disease’s outcome.
BH Is there a risk that women who do BSEs will have more biopsies—ones that find no cancer?
NB Yes; the main risks are having more unnecessary physician visits for breast problems and more unnecessary biopsies.
BH Women who have found their own cancer are confused; they feel it’s what saved their lives.
NB I understand that to them their self-detection was very important in terms of their survival. I’m not trying to disparage that. People have beliefs, but that’s not something that should be applied to the population as a whole. What is recommended is routine screening. Also, people should live a healthy lifestyle. And if during casual palpation they find a lump they are concerned about, they should report it to their doctor.
The "yes" argument: Diana Ermel
Ermel is president of the Canadian Breast Cancer Network. A nurse for 42 years (and a teacher of nursing for 35 of those), Ermel, who lives in Regina, discovered her own cancer 16 years ago.
Best Health Should women regularly examine their own breasts?
Diana Ermel Definitely. The point of regular breast self-examination has always been to learn what’s normal for you, and then you know when there’s a change. If you find a change, you go to an expert—a nurse practitioner or primary care physician—and have it checked out. Most likely it’s nothing, but it’s important to get it checked out. Women need to know at a relatively young age what’s normal for them. It’s not necessary to go through a big rigorous procedure, but breast health is still important.
BH Are you concerned that some women will go to the doctor too often?
DE No; if you know your breasts and you know there is something different, you need to get it checked out. In most cases, it will turn out to be nothing. It’s an opportunity for the health professional to do some health teaching on what is normal and what is not.
BH How can women tell when there could be something wrong?
DE They need to know what their breasts feel like, their texture, and what they are looking for. Are there rashes? If your nipple has never been inverted and then suddenly it is, that’s not good. Women need to know where to feel —under the armpits, too—and how. If you poke with your finger or feel with your palm, you aren’t likely to pick up changes. There are good websites that show how to do a self-exam—for example, breastselfexam.ca.
This article was originally titled "Should women do breast self-exams?," in the October 2009 issue of Best Health. Subscribe today to get the full Best Health experience—and never miss an issue!—and make sure to check out what's new in the latest issue of Best Health.
Best Health Magazine, October 2009
People, do you get it? Doctors will loose business if you self exam yourself. Common, they want you in the office, this is how they get paid! How do surgeons earn their living? Surgery, of course! If no surgery, no income that simple! The longer and the more you wait, translate to dollar signs for the surgeons. Forget mammogram, this is old technology, obsolete - let bring MRI.
I don't think the problem here is that self breast examination is ineffective, but that those practicing it aren't taught effectively. It takes practice to feel things under the skin. As stated, learning what is normal is the key to early detection. Practice, practice, practice.
Educating women on other factors that can affect the consistency of their mammary tissue is also important. Things like caffeine can make mammary glands fibrous (read, hard).
Breast health can be further increased by physical manipulation of the mammary tissue, such as through massage. Yes, you heard right - you can get a breast massage. And if your medical insurance plan covers massage, you can get the breast massage covered, too.
Also, these facts don't sound too convincing to me. It's stated that there hasn't been an avoidance of death due to self exam. But if your cancer has progressed to the point where death is an immediate issue, you're probably not going to save yourself by checking for a lump. Again, the key is to find it early. There wasn't any mention of the statistics of women who decreased the extent of their surgeries due to early detection stated. THOSE are the statistics I'm interested in.
I guess me moral is: read and analyze. There's an alternate opinion about everything.
I just can't believe someone is getting credit for the research done to find that of the number of women who die of breast cancer, 100% die of breast cancer. Is that really telling us anything?
As a mammographer, I can tell you that I have had many women who found breast lumps themselves and were very proactive in their own healthcare. Some of them turned out to be cancerous, others did not, but the whole point is that they were discovered, followed-up on, and treated early, often in between those yearly check-ups that we receive from our doctors. Those few months can make a HUGE difference in outcomes, especially in pre-menopausal women, where cancer tends to be extremely agressive, and grows much more quickly.
Shame on our health care system for suggesting that breast self-exams are a useless tool. I would encourage all women to learn how, and to examine on a monthly basis. If it only saves one life, it is well worth it. It could be yours!
If I hadn't done a monthly self-exam 13 years ago, the two tumours would have been missed. I'm 49 now, and since that time have yearly screenings, but I still do the self-exam monthly. It doesn't hurt to know your body well.
1st, the issue isn't whether BSE is in itself SAFE, but rather, is BSE EFFECTIVE. I guess insinuating BSE might be "unsafe" gets more readers? 2nd, why would you pit a "medical expert's" opinion over a single "layperson"? It just doesn't seem like balanced fair reporting.
I was diagnosed with cancer in 1997.I didn't find the lump by doing bse,even my doctor didn't feel it.I went for mammogram and they found it deep down in my left breast .And in order for the specialist to do surgery they had to put a very thin pin
through my breast for the Dr. to perform surgery.So I think that mammogram once
a year is the best option.
I have heard that MRI's can detect cancer years ahead of a mammogram. Is that true? If so, why is it not possible to get an MRI every second year or so?
I am no doctor, but i would disagree with the interview stating that breast cancer cannot be discovered or beaten by doing self breast exams. My wife is a survivor of 9 1/2 years now and she found her tumor by self exam at the age of 34. She has had both breast removed and reconstructed. I as a man since this has happened to my wife have always told women that early detection and self exams will save you. I will continue to spread the word as this practice saved my wife's life. Other methods are not readily available for women under certain ages as in my wife's case. She had not had any tests before she found her lump. So are they to just sit and wait for it to happen???? Ladies feel free to help yourself and have your partner help everyday.
May we all survive this horrible disease.
According to Dr. Nancy Baxter, who printed a paper in 2001, randomized control trials, women are just as likely to die of breast cancer than those who don't. Why Shanghai?? Why not Toronto where she does her work?? Most BSE findings will be benign. However, if a woman DOESN'T bother doing her monthly BSE, how would she KNOW if she had a lump. The Cancer Society's Thing-a-ma-boob is the almost perfect tool for finding lumps ranging from the smallest to the biggest. Whether being a young woman or older, the whole point of doing monthly BSE is to find lumps, BENIGN or not! NOT doing them, a woman, young or older would NEVER know. A woman should not assume that a lump is NOT benign...that's ludicrous! I would rather find out, through doing monthly BSE's whether a lump is BENIGN or other. That's NOT a chance I'm going to take. That comparable to falling and just assuming nothing is fractured. That concept is absurd!
A woman REGARDLESS of age, NEEDS to do monthly BSE's to help herself. To NOT BOTHER is more or less like playing Russian roulette. It's fool-hardy!
you pple are pathetic it still couldnt hurt to teach women how to check their breast wether they have the same chance or not of finding anything.You never know they may wind up saving their own lives, obviously you won't.
Self examination on a regular basis shows up any changes.
It is not a diagnostic tool but makes women aware of their own bodies and is a first alert to get professional medical advice, should any change occur.
This is the conundrum! You want to believe early detection will be better by doing breast exams. The reality is you can only palpate a timour 1 cm in diameter. Mammogram still remains the 'gold standard' and even here there is some conflicting evidence.
I am not saying no breast self exam or mammogramm. The nurse practitioner gives signs that suggest the cancer is more advanced i.e. an inverted nipple or a rash.
I stick with the physician from Toronto on this one!
No matter what science says, I think it's important to be familiar with your own body so that if something changes, you know. Personally, I noticed a lump in my own breast because I knew it wasn't normally there. I went to my doctor and requested a breast exam, without telling her my findings. She did the exam and told me I was fine. When I redirected her to the lump I had found she was apologizing because she had missed it. If it hadn't have been for my self exam, it would have gone unnoticed - at least until it was larger. I was only 24, so I wasn't getting mammograms. Because I found the lump, I was able to go for an ultrasound and get the issue dealt with much sooner. I would certainly argue that while there is no evidence to proof a significant benefit - is there any reason NOT to teach it JUST IN CASE?
I'm 55 had a mam a little over a year ago. I was told the pain and swelling would go away after a few weeks, hurts big time. I even can draw a diagram on that breast.
I never had pain there until it was squeezed in the mam detector! No Boobs, cause their LITTLE