Breast self-examination: What it means and why the thinking about it has changed

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Publication Date: 
Tue, 2012-07-17

For his part, Narod calls the Shanghai trial good, but idiosyncratic. “The problem is that everybody thinks the answer is written in stone, and there is very little new research into BSE… I could be wrong, but I think it is way too premature, based on too little evidence, to suggest that it is harmful and doesn’t work. My gut feeling is that it works.”

In fact, the 2001 Canadian Task Force recommended that further research be conducted on BSE. And in an interview in The Lancet, the lead author of the 2001 recommendation, Dr. Nancy Baxter, expressed concern that women might stop being aware of their breasts and “that is not the message we want to come out of this.”

While the randomized controlled trials on BSE attribute harm to unnecessary biopsies, Task Force spokesperson Tonelli said it’s not known whether there are any more unnecessary biopsies from BSE than from mammograms, because the Task Force did not compare these rates.  Instead, he stressed: “The key difference between mammography and BSE is that mammography appears to slightly reduce mortality while there is no evidence that BSE reduces mortality.”

The Cochrane Collaboration is a well-regarded independent group that examines the available evidence to support health care delivery decisions. In its review of the BSE trials, it also found no evidence of benefit from BSE in terms of an improvement in mortality.

Nonetheless the review concludes that women should know about the results of the randomized controlled trials “to enable them to make an informed decision.”

The Cochrane review continues: “Women should, however, be aware of any breast changes. It is possible that increased breast awareness may have contributed to the decrease in mortality from breast cancer that has been noted in some countries. Women should, therefore, be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer.”

In the examining room
Wilson says she used to be a “zealot” for BSE. She organized meetings in church basements and community centres to teach women how to perform the self-examination.

And she admits that she was surprised about the evidence of harm from the randomized controlled trials. As director of health policy for the College of Family Physicians of Canada, Wilson now supports the 2011 Task Force recommendations and has stopped teaching BSE.

“So, in practice what do I do? I say, ‘Do you examine your breasts regularly every month?’ If she says yes, I say, ‘Good for you. You might find a lump before I do.’ If she says no, I say ‘that’s just fine. There is no evidence that it would make a difference.’ I actually affirm a woman’s choice to do regular BSE or not. “

And if one of her patients finds a lump or a worrisome change in her breasts “we take it seriously,” she stresses.
Meanwhile Wilson says that, instead of taking time to teach BSE, she now devotes any extra time with patients to ask questions about health promoting activities such as smoking cessation and exercise.

Not just the women’s health movement
Surprisingly, the push for BSE predates the women’s health movement of the 1960s and 1970s. In 1950 the American Cancer Society and the National Cancer Institute “introduced a film, Breast Self-Examination, that was eventually viewed by more than 13 million women.” This is according to an essay published in the Canadian Medical Association Journal by Dr. Baron Lerner, author of The Breast Cancer Wars, a social and medical history (read the essay; read a review of this book).

Lerner writes that, in a report on the film, “Look magazine confidently reported that American women who performed BSE ‘can virtually conquer the fatal aspects of this disease by their own initiative.’”
He also notes that by 1951, the Canadian Cancer Society “was distributing the American Cancer Society leaflets about BSE and generating its own material.”

Ann Silversides is an independent journalist and author who specializes in health policy.

For more information about the recommendations, see the Canadian Task Force on Preventive Health Care website

And see the Task Force Patient FAQs