Breast Self-Exam Doesn't Reduce Mortality

Oct. 1, 2002 -- Breast self-examination is commonly taught as a way for women to detect breast cancer, but new research says cancer detection may be best taken out of their hands — because the exams don't help, and may even hurt.

A study appearing Wednesday in the Journal of the National Cancer Institute finds no reduction in breast-cancer mortality for women who perform breast self-exams.

The study examined more than 266,000 women from Shanghai, China, who were randomly assigned to a group taught breast self-examination, or BSE, in which women learn to feel for suspicious changes in their breasts, or to a control group with no such instruction.

"The women in the instruction group did not find their tumors when they were any smaller or at a less-advanced stage than women in the control group that did not get the intensive breast self-exam instructions," lead author Dr. David Thomas of the Fred Hutchinson Cancer Center in Seattle told ABCNEWS' Jackie Judd.

Not only was there no reduction in overall mortality in the instruction group after 10 to 11 years of follow-up, but there was the suggestion that women who routinely check their breasts are at greater risk of undergoing more biopsies. More biopsies mean increased potential for false positive results, which can result in increased anxiety and excessive interventions, the study said.

This is not the first study failing to find benefits of BSE.

"It really fits many of our biases, which is that routine BSE has never been shown to effectively reduce mortality, even in retrospective studies. It does not surprise me that BSE is not very helpful at all," said Dr. Daniel Hayes, clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center in Ann Arbor.

If It Ain’t Broke …

So does this mean that women should stop their self-exams, or at the very least, stop feeling guilty if they haven't been doing them?

For some experts, the answer is yes. Dr. Susan Love, author of Doctor Susan Love's Breast Book, has always doubted the value of self-detection. She says this report is long overdue.

"Instead of having advice and suggestions based on wishful thinking, we're actually having them based on science," Love said. "And for that, we should all be cheering."

But other experts, while applauding the study design and its results, say the findings will likely have little impact on the recommendations they make to their patients.

"It won't change the way I tell women how to examine and notice changes in their breasts," said Dr. Jay Brooks, chairman of hematology and oncology at the Ochsner Clinic in Baton Rouge, La. "I think that breast self-exams should be taught to women because it gives them empowerment over their own health and lives."

The self-exam is part of an array of possible detection tools, which include clinical exams like mammography and ultrasound. While BSE in and of itself may not be proven to reduce cancer mortality, it may have the effect of increasing overall awareness of the importance of evaluating breast-health using additional tools whose effectiveness has been clinically proven.

Furthermore, with the breast-cancer death rate on the decline overall, experts are loathe to do away with any part of that detection equation.

"The fact is that American women are dying at a lower rate than they were 10 years ago from breast cancer," said Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York City. "So until you are absolutely sure you know that something is useless, I would not stop it."

Maintaining Awareness

The bottom line, experts said, is that women should be aware that breast self-examination may increase the possibility of having benign biopsies, which does have consequences. But doing away with it altogether may be equally consequential.

"There is the harm of false positive results and excess interventions, but there could be harm the other way," said Hudis. "If you say to people from a public health point of view, you don't have to worry about this, everybody may pay a little less attention to themselves."

An editorial on the study suggests that awareness need not disappear along with routine breast self-examination should clinical practice change and women stop doing them. Physical examination of the breast, when conducted by a clinician, has been shown in some research to be as effective as mammography in reducing breast-cancer deaths.

"Routinely teaching BSE may be dead, but giving women information — and continuing research on the effectiveness of excellent physical examination — should live on," the editorial said.