Breast Self Exams Do Not Appear To Reduce Breast Cancer Deaths

Main Category: Breast Cancer
Article Date: 16 Jul 2008 - 2:00 PDT

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It is a staple of women's health advice and visits to the OB/GYN: the monthly breast self-exam to check for lumps or other changes that might signal breast cancer. However, a review of recent studies says there is no evidence that self-exams actually reduce breast cancer deaths.

Instead, the practice may be doing more harm than good, since it led to almost twice as many biopsies that turned up no cancer in women who performed the self-exams, compared to women who did not do the exams.

"At present, screening by breast self-examination or physical examination [by a trained health worker] cannot be recommended," Jan Peter Kosters, Ph.D., and Peter Gotzsche, Ph.D., of the Nordic Cochrane Centre, conclude in the review.

The review is an updated version of a 2003 review of studies, which came to a similar conclusion.

Debbie Saslow, Ph.D., director of breast and gynecologic cancers for the American Cancer Society, said the assoication revised its guidelines and stopped recommending monthly breast self-exams five years ago in light of the evidence that had emerged. The guidelines now call the monthly exam "an option" for women beginning in their 20s.

"We are advising that women should be aware of what is normal for how their breasts looked and felt, and to promptly report any changes to their health care provider," Saslow said. "Women who want to should keep doing breast self-exam, and women who don't want to, don't need to."

The authors recognize that some women will want to continue with breast self-exams and women should always "seek medical advice if they detect any change in their breasts that might be breast cancer," Kosters said.

"We suggest that the lack of supporting evidence…should be discussed with these women to enable them to make an informed decision," he said.

Carolyn Runowicz, director of The Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center, encourages women to do the self-exams if they are comfortable with them, noting that 50 percent to 60 percent of women detect their own breast masses.

"I think what we are seeing is that women are familiar with their breast through breast self-exam and when there is a lump, they notice the difference," she said.

The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

In the two large studies of 388,535 women in Russia and China included in the review, women who used self-breast exams had 3,406 biopsies, compared with 1,856 biopsies in the group that did not do the exams. At the same time, there was no significant difference in breast cancer deaths between the two groups.

The China study published data on how breast cancers detected in the women were treated. Rates of both mastectomy and breast-conserving surgery such as lumpectomy were very similar between the exam and no-exam groups.

Kosters JP, Gotzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. The Cochrane Database of Systematic Reviews 2008, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

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