Doctors React to Breast Self-Exam Study

Oct. 3, 2002 -- One year ago Kelly Larkin-Holmes was doing a regular breast self-exam when she noticed an unusual lump. She went to her doctor, who did a biopsy and determined that the lump was cancerous.

That same month, the 33-year-old Seattle resident's mother Diane Larkin, 57, of Kent, Wash., noticed a similar lump in her own breast. Her doctor encouraged her to wait six months before doing anything about it, but after four she insisted on a biopsy. She had cancer, too.

Doctors are encouraged over the women's chances of survival after the chemotherapy and radiation treatments both have received.

Cases like these have led many family physicians to plan on continuing recommendations of regular breast self-exams, regardless of a recent study saying that they may not improve the survival rate for women with breast cancer.

The study published this week in the Journal of the National Cancer Institute followed more than 266,000 women from China who were randomly assigned to give themselves breast self-examinations, or BSE. Ten to 11 years later, the women who received instruction showed no decrease in mortality rates.

The study also hinted that these women were at a greater risk of having more biopsies, which could increase the number of false positives. This has the potential for causing the patient undue stress and unnecessary medical intervention.

However, for Larkin and Larkin-Holmes, they feel that the self-exams had nothing but a positive effect for them — in helping with an early diagnosis.

They also think that the self-exam was even more critical for Larkin-Holmes since she is too young to receive annual mammograms. "To me it is just wrong to say not to do breast self-exams," said Larkin, "because that is the only way for young women to know that they have a problem."

Doctors Remain Encouraged

"All of us have a story or two of a woman who found her own lump and is still alive," said Dr. Patricia Clancy, a family practice physician in Concord, N.H. "So for that reason, I am reluctant to abandon these methods without something to replace them."

Patient success at detecting suspicious lumps is not the only reason doctors plan to continue promoting regular self check-ups. Some doctors feel that having patients think about the health of their breast keeps them more in tune with their bodies and may lead to the greater likelihood of remembering to go to the doctor for annual visits.

"Women who do BSE are more informed, more interested in their breasts and detecting cancer than those who don't," said Dr. David Miller, a family physician in North Carolina. "That translates into better compliance with mammography recommendations, which have been proven to detect cancers at earlier and more curable stages in appropriate age groups."

Another reason that doctors are expressing a problem with switching the current standard of recommending self exams is the fact that the mortality rate associated with breast cancer has decreased significantly since breast screening programs were introduced in the early 1980s.

This included education about the importance of mammograms, clinical breast exams and self-examination. Some doctors feel the combination of these efforts may be the best method for protecting women against the disease.

"I have always thought and still believe," said Miller, "that [this combined approach] has the best chance for finding breast cancer in a curable stage."

Some doctors have also expressed a fear of being sued if a woman gets breast cancer and they didn't encourage her to do self-exams.

But some question this motive. "One can't let fear of malpractice guide practice in every detail," said Dr. Mark Ebell, associate professor at Michigan State University. "I think it is unethical to recommend that women do something [for this reason]."

Regardless of their motives for doing so, many doctors will continue to recommend regular self-exams to their patients.

Additional Studies Needed

Some doctors say that further research is needed before a conclusive decision can be made on whether to promote self-exams or not.

"Although [this study] appears to be a well-done trial, many other trials have shown conflicting information on many other issues," said Dr. Carolyn Eaton of Palacios, Texas. "For many years mammograms failed to show a decrease in mortality, yet the last few studies done have demonstrated their effectiveness."

For this reason, many doctors are going to continue the current practice until more evidence proves that self-exams are unhelpful.

"The best option," said Dr. Cathy Baldwin-Johnson of the Providence Matanuska Health Care System in Wasilla, Ala., "is to probably continue the combination of periodic mammography, regular clinician exams and breast self-exams, as we wait for future studies and improvements in diagnostic modalities."

As for Diane Larkin, she will never regret the decision she and her daughter made to do self-exams.

"I can't help but hope and believe that breast self-exams can save lives," said Larkin. "The more women can help themselves, the better."