Should women do breast self-exams?

Source: Best Health Magazine, October 2009

For years, many of us were told by our doctors to do regular breast self-exams (BSEs)’when we look at and feel our own breasts to detect lumps. It seems like a no-brainer, a kind of early warning system. But lately GPs have been telling us we should not do BSEs. That’s because, in 2007, the Canadian Cancer Society stopped recommending it as a way to find cancer. In 2006, the Society of Obstetricians and Gynaecologists of Canada changed its long-standing position, stating that BSE shouldn’t be taught to women unless they request it. We spoke with two leading voices for and against BSEs to shed some light on the issue.

The "no" argument: Dr. Nancy Baxter

Baxter was the lead author of a paper published in 2001 that helped start this sea change in Canadian medical opinion. She found that in several randomized control trials, women who regularly did BSEs were just as likely to die of breast cancer as those who did not. Preliminary results from one such study were especially striking because the trial was so large’267,040 Shanghai women age 31 to 64. Baxter is a surgeon at St. Michael’s Hospital in Toronto, and has a Ph.D. in clinical epidemiology. Determining the effectiveness of different cancer screening methods is one of her abiding research interests.
Best Health Since your paper on BSE was published, are you still of the opinion that BSE shouldn’t be encouraged?
Dr. Nancy Baxter The evidence is even stronger today. Not long after my paper was published, the Shanghai trial published its final results and showed no benefit of teaching of self breast examination in a randomized study.
BH What about for young women who don’t normally get mammograms?
NB There’s no recommended screening for them, including BSE. Their risk is low, so most BSE findings will be benign.
BH How many women discover their own breast cancers?
NB In the past, most discovered their own. That proportion is decreasing with screening mammography. I can’t give you the exact number. But most women who find their own breast cancers do not find them in regular BSE, but during casual palpation: that is to say, during bathing, dressing, sexual relations. You have to differentiate finding a breast cancer in that ‘accidental’ way from performing BSE.
BH But if you do BSE regularly, aren’t you more likely to find something just because you’re more familiar with your breasts?
NB It doesn’t seem you find things early enough to make a difference. Tumours found with BSE are relatively large compared to other screening tests such as mammography. Women may be able to find tumours
a few months earlier if they examine themselves with BSE versus with casual palpation. But by the time a cancer is big enough to feel by BSE or casual palpation, the biology of the tumour and the treatment influence the outcome more than finding the tumour a few months earlier would. Early detection is just one of the things that’s important in treating breast cancer. Even very small breast cancers can be deadly. Some people with tiny breast cancers found in mammography will die of their disease. And people can survive some very large breast cancers. The biology of the cancer’how aggressive it is’is probably the most important thing in determining the disease’s outcome.
BH Is there a risk that women who do BSEs will have more biopsies’ones that find no cancer?
NB Yes; the main risks are having more unnecessary physician visits for breast problems and more unnecessary biopsies.
BH Women who have found their own cancer are confused; they feel it’s what saved their lives.
NB I understand that to them their self-detection was very important in terms of their survival. I’m not trying to disparage that. People have beliefs, but that’s not something that should be applied to the population as a whole. What is recommended is routine screening. Also, people should live a healthy lifestyle. And if during casual palpation they find a lump they are concerned about, they should report it to their doctor.

The "yes" argument: Diana Ermel

Ermel is president of the Canadian Breast Cancer Network. A nurse for 42 years (and a teacher of nursing for 35 of those), Ermel, who lives in Regina, discovered her own cancer 16 years ago.
Best Health Should women regularly examine their own breasts?
Diana Ermel Definitely. The point of regular breast self-examination has always been to learn what’s normal for you, and then you know when there’s a change. If you find a change, you go to an expert’a nurse practitioner or primary care physician’and have it checked out. Most likely it’s nothing, but it’s important to get it checked out. Women need to know at a relatively young age what’s normal for them. It’s not necessary to go through a big rigorous procedure, but breast health is still important.
BH Are you concerned that some women will go to the doctor too often?
DE No; if you know your breasts and you know there is something different, you need to get it checked out. In most cases, it will turn out to be nothing. It’s an opportunity for the health professional to do some health teaching on what is normal and what is not. 
BH How can women tell when there could be something wrong?
DE They need to know what their breasts feel like, their texture, and what they are looking for. Are there rashes? If your nipple has never been inverted and then suddenly it is, that’s not good. Women need to know where to feel ‘under the armpits, too’and how. If you poke with your finger or feel with your palm, you aren’t likely to pick up changes. There are good websites that show how to do a self-exam’for example, breastselfexam.ca.

This article was originally titled "Should women do breast self-exams?," in the October 2009 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!’and make sure to check out what’s new in the latest issue of Best Health.