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?