Studies question usefulness of breast self-exams

Every health magazine on the supermarket checkout aisle touts it. Women's health activists have long championed its practice. And most cancer doctors strongly maintain that it belongs as a standard of care.

So why is it that studies keep coming to the conclusion that breast self-exams are unlikely to reduce breast cancer deaths and might do more harm than good?

This disconnect between recommendation and research cropped up again in August, when a review by the Cochrane Collaborative - an international group that evaluates medical science - agreed with two earlier studies showing no evidence that screening reduces deaths.

In saying that breast self-exams "cannot be recommended," the organization's statement warns that research "suggests harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed."

Two earlier studies involving Russian and Chinese women came to similar conclusions.
Dr. David B. Thomas, who headed Seattle's Fred Hutchinson Cancer Research Center's 2002 study of 250,000 Chinese women, told MSNBC.com: "Our study shows that (a self-exam) is probably a waste of time. You're not going to get women sufficiently motivated to practice it well enough and frequently enough to make that big of a difference."

Also now weighing in against self-exams: the American Cancer Society; the U.S. Preventative Service Task Force, an expert panel that issues the federal government's official advice on preventive medicine; the National Breast Cancer Coalition; and the Journal for the National Cancer Institute.

Yet many health care providers maintain that not having women do monthly breast self-exams is even more risky.

One vocal advocate is Dr. Balazs ("Ernie") Bodai, director of Kaiser Permanente's breast surgical services in Sacramento, Calif.. "Talk to any busy breast cancer surgeon, and they'll tell you 30 percent of the diagnoses are made by the patient - not that they have cancer but they found their own lumps," Bodai says."

Even more vocal is Dr. Marisa Weiss, a breast oncologist and founder of Breastcancer.org, who says the Cochrane guidelines are ill-advised. "This report robs women of one of the key tools in what is already a limited arsenal for detection. ... It sends the wrong message to women about their role in their own health care," Weiss says in a statement.

Susan Stone, chief of certified nurse midwives for Kaiser Permanente in Sacramento, also stresses self-exams.

"The midwifery model of care is based on empowering women to be the experts on their own bodies and health," she says. "I encourage women to check their own breasts once in a while so they can know what's normal for them, and then they would be able to tell if something changes."

That scenario helped Folsom, Calif., resident Patricia Barrow. In 2003, at age 66, she found a lump in her breast a few months after her yearly mammogram showed nothing untoward. It turned out to be cancerous, and she had a mastectomy. She says that, because she caught it early, she avoided radiation and chemotherapy.

Kaiser's Bodai says he's irritated by the self-exam controversy. "Listen, we're not looking for a patient to diagnose herself. We're looking to teach them what their normal breast feels like so if they notice a change they can contact the appropriate caregiver for evaluation."