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Saturday, 19 July 2008 21:40

Study of nearly 400,000 women: breast self-exam may not help

The Cochrane Collaboration reviewed the use of the breast self-exam (BSE). It based its conclusions on two studies that together gathered data from 388,535 Chinese and Russian women. The CC study found that the BSE does not help, and actually harms women.

The review performed by the Cochrane Collaboration (CC), a medical research evaluation organization, found that the use of breast self-examinations shows no evidence with reducing the death from breast cancer. It further states that the breast examination may, in fact, “do more harm than good. [MSNBC: “Ladies, give your breasts a rest, research says"]

The results by the researchers were published in the Tuesday, July 15, 2008 issue of The Cochrane Library.

The paper entitled "Regular self-examination or clinical examination for early detection of breast cancer" was performed by Jan Peter Kösters (The Nordic Cochrane Centre, Rigshospitalet, Dept. 7112, Copenhagen Ø, Denmark) and Peter C Gøtzsche (The Nordic Cochrane Centre, Rigshospitalet, Dept. 3343, Copenhagen Ø, Denmar).

It states “Data from two large trials do not suggest a beneficial effect of screening by (BSE) but do suggest harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. At present, screening by breast self-examination or physical examination cannot be recommended.” [CC paper]

The CC report learned that women who performed BSEs and those who did not had the same number of breast cancer deaths.

In addition, the CC report stated that women who performed BSEs were twice as likely to get breast biopsies. In many cases, those biopsies turned out to be benign. Consequently, the researchers concluded "screening by breast self-examination or physical examination cannot be recommended." [Peoria Journal Star: “New study doubts breast self-exams”]

David B. Thomas, who headed one study within the CC report makes some comments on the use of BSE. Please read on.

Dr. David B. Thomas, of the Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, headed one of the two studies. The Thomas study involved over 250,000 Chinese women, which was published in 2002.

Thomas states, “It’s important to separate out the public health implications from the implications for an individual woman. If a woman is highly motivated — let’s say her mother or sister has been diagnosed with breast cancer — then of course she should practice breast self-exam. But that’s a different situation than trying to reach women on a mass scale. Our study shows that that’s 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.” [MSNBC]

He adds, “The price you pay for doing more thorough breast exams is you’re going to find more benign lesions and that will result in unnecessary surgical procedures, and “Women in their 20s and 30s rarely get breast cancer. But they do have a lot more benign lumps and bumps. It’s not worth emphasizing breast self-exams for women at this age.”

And, Thomas, continues, “When women are in their 40s, it’s a good time for them to become more aware of their breasts and more aware of changes that might be due to breast cancer. It’s kind of controversial as to whether it’s worth the screening — either BSEs or mammograms — but they can do both if they want.”

The CC report also made this statement: "Breast cancer is a common cause of cancer morbidity and mortality in women. Breast self-examination (examination of the breasts by the individual) or clinical breast examination (examination of the breasts by a doctor or a nurse) have been promoted for many years as screening methods to diagnose breast cancer at an early stage, in order to decrease the risk of dying from breast cancer. This review searched for well-designed trials that assessed these methods and found two large population-based studies involving 388,535 women who compared breast self-examination with no intervention."

It added, "The review of data from these trials did not find a beneficial effect of screening in terms of improvement in breast cancer mortality. The trials showed that women who were randomised to breast self-examination were almost twice as likely to undergo a biopsy of the breast, with 3406 biopsies performed in the screening group compared to 1856 biopsies in the control group. The only large population-based trial of clinical breast examination combined with breast self-examination that was identified was discontinued. This was because of poor compliance with follow up and no conclusions can be drawn from the study."

And, it concludes, "Some women will continue with breast self-examination or will wish to be taught the technique. We suggest that the lack of supporting evidence from the two major studies should be discussed with these women to enable them to make an informed decision. Women should, however, be aware of any breast changes. It is possible that increased breast awareness may have contributed to the decrease in mortality from breast cancer that has been noted in some countries. Women should, therefore, be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer."

The debate about the use of BSE or not will continue. Please read page three for more information.

According to the Peoria Journal Star article, “American Cancer Society's 2003 recommendation that a BSE should be optional and "is less important than self-awareness" about one's body.”

Although this conclusion was reached regarding breast self-exams, it is unlikely that women and doctors will eliminate BSEs from their routines.

The debate between doing BSEs or not will, no doubt, continue to be analyzed and debated in the medical community and among all women.

For more information on both sides of the debate, please read the ABC News article “Experts Debate Value of Breast Self-Exams: Controversial Review Reinforces Idea That Self-Screening Does Little Good.”


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