August 26, 2008

Breast Wars

In high school, college, even now, I shudder with guilt when I spy a Breast Self Exam (BSE) placard hanging in my friends’ bathrooms. I never do it; I never feel myself up. Yes me, champion cancer patient and advocate. It never occurs to me except for when I’m in a friend’s bathroom and it seems all too complicated to shed my sweater and bra and go to town when I’ve really just run in for a quick pee.

Much to my surprise, when I confessed this three years ago to my general practitioner, instead of raking me over the coals, he said, “Oh no worries, don’t waste your time. A large study, the Cochrane Review, conducted on women in China, shows that BSEs do not impact survival rates.” He explained if a malignant lump is large enough to detect with your hand you are as screwed as if you had waited longer for it to be found by some other method. Plus, the high rate of false positive biopsies of lumps found in BSEs not only cost a bundle, and tax the healthcare system, but the procedure can cause physiological complications to the breast.

I was off the hook and glad for it. I have since learned that based on the Cochrane Review, The American Cancer Society, Canadian Cancer Society, the World Health Organization, the US Preventive Services Task Force, and the UK National Health Services are no longer recommending monthly BSEs.

Well, I thought I was off the hook until today when I spied an article reigniting the controversy. Opponents of the Cochrane study include Breast Cancer Action (the fantastic organization that created the Think Before You Pink Campaign) and The Boston Women’s Health Book Collective (authors Our Bodies Ourselves – who didn’t have a copy of that in college? How can the Our Bodies Ourselves ladies be wrong?)

A blog posting by Rachel Walden on ourbodiesourselvesblog.org states: “Despite concluding that ‘screening by breast self-examination or physical examination cannot be recommended,’ the Cochrane review authors note that ‘Women should, however, be aware of any breast changes..’ and should ‘be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer.’ It is not clear how women are to be aware of any breast changes without doing self-exams. Another potential limitation of the review is the limited information on how the conclusion might apply to other populations, such as women in the U.S.” Good point Rachel, but could this also be a boilerplate legal disclaimer designed to protect the authors of the study?

American researcher Mark Kane Goldstein, PhD, who worked with support of the National Cancer Institute to identify and validate the standards for proficient breast examination, said in an interview with Medscape Oncology: “It is hard to determine whether a single procedure can affect longevity, so it is difficult to come to clear conclusions about the effect of breast self-exams on survival,” he said. “There are too many variables in these types of studies to isolate just 1 for an outcome such as mortality.”

Other advocates of BSE defend that when given proper training women have been taught to find 3mm lesions in their own breasts, and shouldn’t women assert some modicum of control for their own health?

To feel or not to feel? That is the question. I’m still deciding and would like to know, which side of the breast war are you on and why?

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Comment(s)

  1. the calm before the stork Says:
    August 26th, 2008 at 5:53 PM

    I’ve never done a BSE.

    I know! BAD GIRL.

    I was so happy to read the first half of your post and similarly feel off-hook.

    And then the second half gave me pause. Duh, of course those other orgs looked at the percentage of false positives and associated costs and decided to vote against.

    That’s what I’m getting out of your piece — that it costs the industry too much money to deal with checking out what women find. So much more manageable to just order mammograms once a year?

    Again, I’m just guessing here, based on what you’ve written.

    There are so many things I need to do for my health, and my baby’s health, I’m lucky I get to 25% of them. BSE’s are still, unfortunately, low on my list.


  2. Becca Lou Says:
    August 27th, 2008 at 12:34 AM

    Before being diagnosed with thyroid cancer, I was a bit of an anti-hypochondriac. I worried so little about my health, I didn’t think twice about a little bump I may have noticed on my neck a few months ago.(whoops)

    Naturally, I never did BSE’s. I felt vaguely guilty about it but I think deep down I figured I’d never get breast cancer so why worry? I relied on my boyfriend and my annual exam to confirm that all was well with the boobs.

    Today, I’m a new woman as far as my attitude toward my health goes. I’m trying to eat better. I’ve vowed to never puff another cigarette. I’m not using my cell phone and I’m thinking about going off my estrogen-y birth control pill. And yet… I haven’t done a single BSE.

    Maybe examining myself on a regular basis is too foreign to my recently awakened sense of my body’s fragility and potential to go askew. But then I wonder if there’s a funky block at work. Like the prospect of finding something suspicious is way, way too terrifying. Especially now that it seems like it COULD happen to me.

    Thanks for this post, Kairol. I need to think on this one. Lemme know if you dig up any more juice on this topic or have a new revelation/insight.


  3. Motp Says:
    August 27th, 2008 at 11:27 AM

    I saw a video on this research recently and thought that the big issue was whether or not to do PSAs on the issue, since they are expensive and might not return as much ‘bang for the buck’ as other uses of that money.

    Though I also admit to never having done one I can’t see what the harm is in doing them and becoming familiar with how they look/feel to know if something does change. Getting a false positive checked out, as an individual, seems better than the alternative. And I don’t really think they would tax the system all that much when looking at the whole group, but maybe.


  4. Sandra Joseph Says:
    August 27th, 2008 at 11:52 AM

    Becca Lou, I so relate to your words. The thought of possibly finding something is so vomit-inducing, it makes me never want to feel anything up ever again.
    Kairol, I loved this post. I didn’t know there was any controversy going on about BSE’s. I had a golf ball removed from my breast when I was 18, and again (it grew back) when I was 22. Now, with my 40th birthday inching closer, I am well-rehearsed in fondling the girls post-period.
    (BTW, Becca Lou, I am currently going off the pill for the same reasons you are considering it…I’m moody as hell and breaking out like a teenager. It’s torture, but I’m hoping it will balance out eventually.)

    At any rate, I like to think of the BSE in the same way that I think of body brushing (you know, that dry-brushing thing that is supposed to do something for the lymph). I have no idea if it’s actually doing me or my body any good, but it’s a way of connecting to the physical “me”. It’s a chance to say, “Oh, yeah, I have this body, these legs, these breasts, these hips that I wish I could shrink but there they are…” I actually use the BSE time (usually in a tub full of lavendar scented bubbles) to STOP wishing things were different about my body, to take a conscious break from the self-critical chatter that plays in an endless loop in my mind. It’s a gratitude ritual, a time to say thank you to the body that does so much for me. Yes, it has its faulty bits (from the hip circumference to the little tumor hanging out in my brain) but there are an awful lot of things it’s doing RIGHT. Right?


  5. Jennifer Thornton Says:
    August 27th, 2008 at 1:19 PM

    I think that one good reason for the occasional BSE is just for a woman to know her body, whether it’s related to medical health or not. There are a lot of women who are not comfortable with their bodies and have not explored their parts because of beliefs or stigmas in their communities. The promotion of BSE’s enables women to come out of the closet and learn about the body they’re in.

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