Ask the Care Team
Should all women practice breast self-examination (BSE)?
The idea behind BSE is that a woman who performs the monthly exams carefully and routinely may reduce her chances of death from breast cancer. That is, she may detect a tumor at an earlier stage than it would otherwise be found, when it is relatively small and curable. But firm scientific evidence is lacking that BSE, by itself, actually leads to a lower breast cancer death rate.
Last fall, the report of a 10-year study of BSE in Chinese factory workers showed that women who were trained in BSE and were monitored to make sure they were performing it correctly had the same breast cancer mortality rate as women who didn't receive the training. Some experts have questioned whether the Chinese study is relevant to American women because of differences in cancer patterns, but Eric Winer, MD, head of Dana-Farber Cancer Institute's Breast Oncology Center, says the study was well done and cannot be dismissed. At a minimum, the study suggests that teaching women to perform BSE in developing countries is probably not the best use of scarce health care resources.
Hasn't the U.S. death rate from breast cancer been dropping?
It is true that breast cancer mortality has been steadily declining in the United States as a result of early detection and improved treatment. And tumors are being detected when they are smaller than they were in the past. The chief factors in early detection are probably mammography and an increased awareness of breast cancer.
So, does that mean women shouldn't practice BSE?
It is important for a woman to be aware of her breasts and report any changes to her physician. We can't say that all women should perform monthly BSE, though it is certainly fine for any women who choose to practice. BSE to do so. There is no question that some women are able to detect small tumors when they do BSE.
Are there any categories of women for whom BSE might have a benefit, even if the overall conclusion is that it doesn't save lives?
BSE might be a useful adjunct to other screening measures for women who are at high risk of developing breast cancer. The Chinese study did not exclude the possibility that women who practice BSE with unusual skill and conscientiousness might be able to find small lumps early enough to make a difference in survival.
