In this study, did doctors go overboard and recommend too many biopsies without using their clinical judgment because the women were part of a study testing the accuracy of breast self-exam? Women want to be partners with their doctors -- not sole participants -- in decisions about their care.
A problem with a study evaluating the self-breast examination as a screening test is that a woman's breast examination is a highly subjective, variable, personal and emotionally charged. It should not have been judged as a screening test in the first place. What other screening test recommended today relies on the subjective assessment of the patient?
We recommend that young men examine their testicles for cancer, but this has reasonably never been subjected to the same scrutiny as breast self-exam in women. Fortunately for men, testicular cancer is much less common than breast cancer, yet it is considered good advice to teach a young man to examine his testicles and report any changes or concerns.
A man's testicles are much easier to examine than a woman's breasts. Our breasts undergo continuous change each month with fluctuations in our hormones, medications, diet, and body weight. Who knows our own breasts better including all the cyclic changes that go with it than a woman (or her partner)?
Women see their practitioners on a regular basis to screen for cervical cancer with one of the best screening tests we have -- the Pap test. The Pap test however also leads to many false positive and false negative results and follow-up procedures, but it has helped reduce the risk of cervical cancer death in this country by 75 percent. With the addition of the HPV test for women ages 30 and over, a negative result of both the Pap test and HPV test can now give you much greater peace of mind.
At the same time they undergo the Pap test (and HPV test if 30 and over), women also have a clinical breast exam with their practitioners. I suspect that this yearly exam of the breast is not nearly as important as a woman's vigilance in knowing her breasts and reporting any changes, but no one would suggest doctors stop performing this annual part of the exam because it may lead to more biopsies.
I fear the study conclusions will send the wrong message to women. My understanding is that many, if not most, women today who are ultimately diagnosed with breast cancer first found their lumps or changes before a clinical breast exam with their doctors. Often women find cancers that are rapidly growing and that didn't show up on their last mammogram. These women may truly have saved their own lives through breast examination and having the confidence to speak up.
The study also didn't evaluate whether some cancers were detected earlier by breast self-exam than others. For example, lobular cancers, which are on the rise, often cause few if any calcifications or other changes on mammogram. Some of these women can feel subtle changes in their breasts long before the cancer is diagnosed by mammogram.
I remember a number of my female patients waiting for me to complete my breast exam before concurring that they too found the "lump" that I discovered on exam; they were just hoping and praying that I didn't find it. It was almost as if they believed that if the doctor didn't find it, then it wasn't serious or important enough to report.