Breast Self-Exams: No Survival Benefit

Review Shows No Cancer Survival Benefit From Monthly Screening; Cites Benign Biopsy Risks

(WebMD)  Doing a breast self-exam doesn't improve breast cancer survival, and it makes biopsies of benign breast lumps more likely.

That's according to an updated review of research on breast self-exams and breast cancer survival.

The updated review, published in the Cochrane Library, is in line with the findings from the original review, published in 2003.

"We would like to inform women that there is no evidence from two large studies that screening by regular breast self-examination (once a month) improves their chances of surviving breast cancer, whereas there is evidence that regular breast self-examination almost doubles their risk to undergo a biopsy," reviewer Jan Peter Kosters, MD, of the Nordic Cochrane Centre, tells WebMD via email.

Breast Self-Exam Report

The new review is based on two studies that together included more than 388,500 women in Russia and China who ranged in age from 30-66.

Some of the women were trained to do breast self-exams. They also got regular reminders or refresher classes to make sure their technique was correct. For comparison, the other women in the studies weren't taught or urged to do breast self-exams.

The women were followed for 10 years. During that time, 587 women died of breast cancer, with similar numbers of deaths in the breast self-exam group (292 breast cancer deaths) and in the group of women who weren't trained to do breast self-exams (295 breast cancer deaths).

The women who did breast self-exams were nearly twice as likely to get breast biopsies, many of which turned out not to show cancer.

In short, doing breast self-exams made no difference to the groups' breast cancer survival rates, and it boosted the biopsy rate.

Do Breast Self-Exams or Not?

The decision about whether or not to do a breast self-exam needs to be made by the women themselves, says Kosters, adding that "a rational choice would be not to do regular breast self-examination."

The American Cancer Society sees it differently.

Doing a breast self-exam is "an option," Debbie Saslow, PhD, the American Cancer Society's director of breast and gynecologic cancer, tells WebMD. "We don't want to recommend against it but there's no evidence to recommend for it."

"Certainly, if any woman wants to do breast self-exam, then her doctor should give her assistance and make sure that her technique is what it should be, and also let her know what the limitations are so that she's not expecting that this is going to have big impact on her if she gets breast cancer," Saslow says.

Susan Love, MD, president and medical director of the Dr. Susan Love Research Foundation, calls the review a "wake-up call to say, 'You know what? We've been relying on things that don't work that well and we really have to start demanding something that works better.'"

Breast Awareness Is Key

The review doesn't support breast-self-exams. But it does urge women to be aware of -- and seek prompt medical assessment of -- any breast changes.

"Whenever one notices symptoms which could be breast cancer or any other cancer, one should not hesitate to seek a doctor for rapid assessment," Kosters tells WebMD.

To Saslow, the key message is to get medical attention for any breast lumps, whether those lumps are found during a breast self-exam or "in the shower or getting dressed or looking in the mirror or her husband [notices it]."

The review "doesn't say never touch your breasts again. It says that the normal poking around that we all do is enough, and that formal ... breast self-exam doesn't add to that," says Love, who calls the review "excellent."

"Where we really should be putting our efforts is how to prevent breast cancer, not how to find cancers that are already there, but how can we make it not happen in the first place," Love says. "If we could get to a point where we're not even looking for cancer, we're looking for cells that might be cancer some day when they grow up, then we have a more reasonable chance to get rid of this disease."

The review doesn't mean that breast self-exams haven't helped individual women. Good Morning America anchor Robin Roberts said in 2007 that she found the lump that turned out to be breast cancer during a breast self-exam.

But in large groups of women, the numbers aren't there to show a survival benefit, Kosters and colleagues report.

[medmom04]

survivor_2:

if you''re still checking back... This is a disease that attacks the heart of us women, spiritually. Please don''t go through this alone. There are many, many others in similar situations, and the strength in their numbers and their determination is a great thing to have around you. Strength and peace to you, sister.

[Meg003]

I am a 2 yr. breast cancer survivor and since my husband doesn''''t even touch me anymore, if I do get it back I will have a mastectomy or I will do nothing at all and just live until it takes my life.

Posted by survivor_2

Hey, don''t be so hard on yourself, you can''t do this alone. Get out and find some support. It gets better, you are at a tough stage at two years. And don''t forget that your husband may be suffering, too. He has lost his security that you will always be there, and maybe his best friend if you are depressed and withdrawn. And if you cannot make things work with him, start finding other things to make you feel better. Make a list of things to do that might get you going again, and do one of them today. Come on, you can do it.

Long term survivor

[lcava2]

I very rarely did self exams, but after I turned
40 I got regular mamograms. Six years later I
got breast cancer, and the night I got the bad news,
alone in the dark, I felt the lump myself. Keep doing
those self exams, get that mamogram every year, &
who cares if a biopsy is uneccessary-it is better to
play it safe. Get the BRAC gene testing done if
available & if Cancer runs in your family or if you
get diagnosed with Cancer.
And I don''t usually aggree with Dr. Susan Love
(her website scared me and gave me too much techo info) But I do aggree with her comments about cell research and finding better ways to
detect. I was not feeling well 3 months prior,
went from Dr. to Dr. and they all said
nothing was wrong with me. I put off my mamogram
for a couple of months because I was ill with an
unspecified something that to this day they insist
had nothing to do with my breast cancer. Listen to
your bodies. I am lucky-mine was caught early.

[survivor_2]

I am a 2 yr. breast cancer survivor and since my husband doesn''t even touch me anymore, if I do get it back I will have a mastectomy or I will do nothing at all and just live until it takes my life.

[erasmus81]

Posted by jerr111 at 08:24 PM : Jul 16, 2008

Cute.

[Meg003]

If there were any changes in my wife''''s breasts I would probably be the first to know!

Posted by Questionnews

Keep up the good work!

[rushlimpdrug]

So why do men have nipples?

[medmom04]

I doubt there are good studies of the family link for men and breast cancer, because brest cancer is so rare in men.
******
There are good studies. Try the BRCA genes.

This propandga arm of Big Pharma contiiues to sell sickness.

[erasmus81]

"If there were any changes in my wife''''s breasts I would probably be the first to know!"
Posted by Questionnews at 05:06 PM : Jul 16, 2008

I am sure you would!:)

[questionnews]

If there were any changes in my wife''s breasts I would probably be the first to know!

[kshifflett-2009]

Being a 2x Breast Cancer survivor, initially diagnosed at 34 and with a recurrence 7 years later, I definitely have an opinion about BSE. Regardless of studies, unless you have lived through the detection, treatment and survival of this disease, a person does not know how effective BSE is. Anything a person can do to detect or prevent this disease is appropriate and resourceful. Having had a bilateral mastectomy at age 41, I still perform BSE, and not just for presence of mind, either. I still feel I am being proactive.

[gwagener]

For gwagener...I think that men should be aware of their bodies and their own personal normal so that changes can be reported to a doctor. Especially where there is a history of breast ...cancer in the family.

-------------------------

Posted by strefo at 02:12 PM : Jul 16, 2008

That sounds reasonable. Men should know breast cancer is possible for men (many men don''t know that). Men should just be aware of any changes in the nipple, which can have several causes, any of which are rare and could be cancer.
I doubt there are good studies of the family link for men and breast cancer, because brest cancer is so rare in men.

[Meg003]

I found my own breast cancer, but I was not doing a regular monthly exam. I simply noticed that something didn''t feel right and went to the doctor. I think that is what this article is trying to explain. Certainly if women notice a lump they should check it out. But for most women, it isn''t going to make you live longer if you schedule and follow through with a regular monthly self-exam.I wish it would, but the facts say otherwise.

And sandy19731, you should do a little research on mammography. It is good, but far from 100%, in catching tumors. You sound completely ignorant on the subject.

[medmom04]

Doing a breast self-exam doesn''t improve breast cancer survival, and it makes biopsies of benign breast lumps more likely.
********
sorry, but benign or not, I would of course prefer a biopsy to have the real story. better to have false positives than false negatives....

[medmom04]

The article is correct, by all statistics. This has been wellknown by the American College of Obstetrics and Gyn for some time now. There are women who have found breast lumps on their own, and this is really the point, yes? We should, as women, of course do our own breast exams. and there''s no truth to developing lumps from digital breast exams. for crying out loud, the truth is that in most cases, those who do not do thorough and correct exams are not palpating deep enough. After all, the ducts, where cancer could develop, are not at the surface.

[erasmus81]

Posted by strefo at 02:12 PM : Jul 16, 2008

Okay, maybe it isn''t "pushing and prodding" for most people, but like they said, there is a lot of people that don''t do it right. And whether it is or not, you are still putting a certain amount of pressure on sensitive tissues. And YES, that can cause problems. They are saying that women that do self-exams have more lumps. They may be benign, but they are still there.

"Breast Cancer from the mammograms?"
Yes, and if you don''t think so, then you are living in lala land. It may not show up for years, and it would also depend on the person.

If a person has a history of breast cancer in their family, then by all means, they should do it.

[sandy19731]

My aunt had a mammogram and they found nothing. During her own self exam ONE WEEK later she found a lump. It was breast cancer. Ridiculous article!
Posted by catsbow at 11:58 AM : Jul 16, 2008

Really! That''s amazing! I assume that there is a lawsuit or something happening here. Perhaps a faulty Mamogram machine? This sound like an urban legend. Tell us more. Which hospital, Which doctor?

[strefo-2009]

Why is it that every time I read information that flies in the face of generally accepted practices there is a quote from the breast conservationist, Dr. Susan Love? She says here we should be preventing breast cancer all together but disagrees with prophylactic (preventative) mastectomies for high risk women. Dr. Love, you can''t have it both ways. Unfortunately science can not detect pre-pre cancer cells right now. When it can, we will all breathe a bit easier. Until then, I will continue BSE, even post-mastectomy.

For gwagener...I think that men should be aware of their bodies and their own personal normal so that changes can be reported to a doctor. Especially where there is a history of breast and ovarian cancer in the family. Then, that man should be talking about risk with a certified genetic counselor.

[strefo-2009]

I would like to start by saying I am not a doctor but, I have a better than average understanding of breast cancer risks based on study and family history.

Erasmus you said...
"It is a constant pushing and prodding, isn''''t it? I have always wondered about it. And if that is causing problems, what is the mammogram doing? Not only is it "squishing" the breasts, you are also getting radiation. My belief is that if you weren''''t already going to get breast cancer, you will eventually, from the mammogram itself. It is like chemotherapy. You get chemotherapy to rid yourself of a cancer, but if you live long enough, that chemotherapy will be the death of you."

Pushing and prodding? Not if you are doing the BSE correctly. I have never had a doctor that suggested pushing or prodding during a BSE.

Breast Cancer from the mammograms? This is fear mongering and dangerous. Please think before you speak. Mammograms have been proven to be far more helpful than you suggest.

Overall, BSE''s may not improve survival from breast cancer but, I have read that many women find their own lumps through BSE. (My mother fell into this group..TWICE and is a two time survivor!) Further, the cancer is often caught earlier through BSE leaving better treatment options.