Failing Grade For Breast Exams?

By Christine Gorman

Back in the 1970s, during the golden days of feminism, regularly examining one's breasts for cancer was a sign that a woman had taken control of her life and health and wasn't dependent on (mostly male) doctors. Since then breast self-exams have just seemed like a smart thing to do. After all, mammograms and medical checkups can't catch all breast tumors. And a little empowerment never hurt anybody.

Now comes word that breast self-exams may not be so helpful after all. After reviewing eight major studies, a Canadian task force has concluded that there is little evidence that the technique saves lives. Indeed, the data the group looked at suggest that breast self-exams can do more harm than good, prompting unnecessary testing of what are in fact normal lumps. The task force's recommendation: women should no longer be routinely taught how to screen themselves for breast cancer.

Before you decide never to look at your breasts again, it pays to know a little more about this report. First of all, two of the studies in the Canadian review were conducted in China and Russia, which do not have access to the most advanced diagnostic techniques. Under these circumstances you would expect to see a lot more biopsies of normal tissue. And because it takes so long for most cancers to grow, you also expect to see the risks of a screening test show up before any gains.

But even researchers who have doubts about self-exams are worried that the Canadian group acted precipitously. "It's true that as of now, there is no evidence of efficacy," says Dr. David Thomas, a principal investigator of the Chinese study. "But I don't think we've proven that it doesn't work." Thomas expects further results from his study, which will become available next year, to help clear things up.

Meanwhile, there is a large body of evidence to show that the best way to detect breast cancer is with mammograms and annual breast exams by a physician. Surveys suggest that many women regard breast self-exams as just as good as mammography at finding tumors. That's simply not the case.

It's still possible that breast self-exams will prove to be valuable for many women, say those with a family history of breast cancer. If you decide regular self-exams make sense for you, ask a physician or other health professional to teach you how to do them right. The most important thing is to report any unusual changes to your doctor. Many breast cancers are still found by women themselves, often while showering or during sex. Even if monthly breast exams don't wind up saving lives, knowing what's normal and what's not for your breasts could help save yours.

Questions for Christine? E-mail her at [email protected]