July 18, 2008 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.
However, 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.
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- Kösters et al. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews Reviews, 2003; DOI: 10.1002/14651858.CD003373
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