Breast Self-Exams: Are They Beneficial?

Gynecologists encourage them, but are self-exams really that effective?

No. Breast self-exams cause more harm than good.

Yes. Breast self-exams can be helpful with early detection of cancer.

No. Breast self-exams cause more harm than good.
After reviewing eight major studies on breast self-exams (BSE), a Canadian task force has concluded that there is little evidence that the test saves lives. The group found that the number of false alarms and unnecessary biopsies produced by self-exams made it a harmful procedure. The study's authors' conclusions, which were published in the Canadian Medical Association Journal, found that performing regular BSEs was not improving the outcome of breast cancer diagnosis. Whether a lump was found by a woman who regularly examined her breasts or by regular screening by a doctor in women who did not examine their own breasts, the death rate remained relatively the same.

"Negative psychological impacts related to BSE training include increased levels of worrying, anxiety and depression, and increased numbers of follow-up investigations because of false-positive findings," the study's authors wrote. "Although considered a relatively minor procedure, breast biopsy causes permanent scarring and may cause significant breast deformity and emotional distress."

Based on their findings, the group suggests that women stop performing BSE and that routine teaching of BSE be "excluded from the periodic health examination of women."

Yes. Breast self-exams can be helpful with early detection of cancer.
A commentary in the same issue of the Canadian Medical Association Journal raised some important questions about the studies that formed the basis for the recommendation to women to stop performing BSE. Some of the studies were conducted in Russia and China, where treatment and routine screening performed in these countries are not as good as that available in other Western nations. Whether the findings would be the same if the drugs and screening facilities were equivalent is not known.

The authors themselves report, "Organizations that currently recommend the routine teaching of BSE include the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS) and the Canadian Cancer Society (CCS)."

Current ACS recommendations: BSE should be performed monthly beginning at age 20, as part of a three-part program.

"Mammography and clinical breast exam [examination by a medical professional] have the greatest impact on reducing breast cancer mortality, and therefore should receive the most emphasis," notes Debbie Saslow, Ph.D., director of breast and cervical programs at ACS.

BSE's role in early detection is supporting -- but important. "Breast self-exam is useful before age 40 to help a woman learn what her breast feels like when it's normal," Smith says. "That way, she can have an idea of whether a lump she encounters is something that she should see her doctor about."

"And it can help with early detection of the small number of breast cancers found in that under 40 age group," Smith says. "After 40, we should not expect much added benefit from BSE, but we do expect a little, and that little is to provide a safety net for some women whose breast cancers aren't picked up by mammography," explains Smith. "The bottom line is that in breast cancer, early detection is better than later detection, and BSE helps with early detection."

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