Why Women Must Still Examine Their Breasts

A report last week by a panel of experts evaluating the pros and cons of breast self-examination and clinical breast examination by a trained practitioner stirred up a lot of controversy.

Wonderfully angry responses by women (and their men for that matter) fueled the controversy, arguing that it is absurd to tell women not to examine their breasts. Many of these women found their breast cancers as a result of their own breast exams.

So what is the fuss? A group of experts convened to assess the evidence for the pros and cons of both breast self-exam and clinical breast examination by a trained practitioner. After reviewing two large randomized controlled studies from China and Russia, they concluded that women assigned to do regular breast self-examinations were almost twice as likely to undergo a biopsy of the breast than women in the control group. They found no difference in the number of cancers diagnosed overall.

The researchers found only one large population-based clinical trial evaluating the effectiveness of a clinical breast examination by trained practitioners. This study was ended early, and there were no conclusions because of poor compliance with followup. I am curious to know more about this study and how much better (or worse, according to this panel of experts) doctors perform than women in finding subtle but potentially serious breast changes.

It is interesting to me that no one picked up on this part of the study. I doubt anyone would suggest that clinical breast examination by a practitioner may also be harmful and could lead to more unnecessary biopsies.

Think about this for a minute. Women in the self-exam group knew they were part of a study that was "testing" or "grading" their ability to find possible breast cancers early. It stands to reason that these women would have been extra vigilant as a result and may have reported findings or concerns that they would not have otherwise mentioned to a physician had they not been enrolled in a study.

On the other hand, women in the study were presumably only advised to have breast biopsies after they were first evaluated by a clinician who agreed to proceed with a biopsy based on the expert's clinical judgment. Or is this a problem with the study? Perhaps women underwent biopsy in the self-examination group primarily because of the women's findings, regardless of clinician input?

This is hardly how things usually work in the real world. Rarely do doctors perform breast biopsies solely because of a woman's complaint without a clinician evaluation and recommendation.

Women in the control group likely also examined their breasts, too. Most women are aware of their bodies and fear breast cancer. These control women, however, were not being graded on their breast exam findings, and it is likely they only volunteered concerns that they felt were of importance. Perhaps they didn't report every subtle change and therefore underwent fewer "unnecessary" biopsies.

I find it ironic that more often than not when it comes to the diagnosis of breast cancer, doctors are criticized (and often sued for malpractice) because they don't take a woman's complaint seriously enough to proceed to biopsy.

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