Experts Debate Value of Breast Self-Exams

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 Breastcancer.org. "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 Breastcancer.org 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.

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