For years, many of us were told by our doctors to do regular breast self-exams (BSEs)—when we look at and feel our own breasts to detect lumps. It seems like a no-brainer, a kind of early warning system. But lately GPs have been telling us we should not do BSEs. That’s because, in 2007, the Canadian Cancer Society stopped recommending it as a way to find cancer. In 2006, the Society of Obstetricians and Gynaecologists of Canada changed its long-standing position, stating that BSE shouldn’t be taught to women unless they request it. We spoke with two leading voices for and against BSEs to shed some light on the issue.
The “no” argument: Dr. Jill Taylor
Baxter was the lead author of a paper published in 2001 that helped start this sea change in Canadian medical opinion. She found that in several randomized control trials, women who regularly did BSEs were just as likely to die of breast cancer as those who did not. Preliminary results from one such study were especially striking because the trial was so large—267,040 Shanghai women age 31 to 64. Baxter is a surgeon at St. Michael’s Hospital in Toronto, and has a Ph.D. in clinical epidemiology. Determining the effectiveness of different cancer screening methods is one of her abiding research interests.
SAL Since your paper on BSE was published, are you still of the opinion that BSE shouldn’t be encouraged?
Dr. Jill Taylor The evidence is even stronger today. Not long after my paper was published, the Shanghai trial published its final results and showed no benefit of teaching of self breast examination in a randomized study.
SAL What about for young women who don’t normally get mammograms?
JT There’s no recommended screening for them, including BSE. Their risk is low, so most BSE findings will be benign.
BH How many women discover their own breast cancers?
JT In the past, most discovered their own. That proportion is decreasing with screening mammography. I can’t give you the exact number. But most women who find their own breast cancers do not find them in regular BSE, but during casual palpation: that is to say, during bathing, dressing, sexual relations. You have to differentiate finding a breast cancer in that “accidental” way from performing BSE.
SAL But if you do BSE regularly, aren’t you more likely to find something just because you’re more familiar with your breasts?
JT It doesn’t seem you find things early enough to make a difference. Tumours found with BSE are relatively large compared to other screening tests such as mammography. Women may be able to find tumours a few months earlier if they examine themselves with BSE versus with casual palpation. But by the time a cancer is big enough to feel by BSE or casual palpation, the biology of the tumour and the treatment influence the outcome more than finding the tumour a few months earlier would. Early detection is just one of the things that’s important in treating breast cancer. Even very small breast cancers can be deadly. Some people with tiny breast cancers found in mammography will die of their disease. And people can survive some very large breast cancers. The biology of the cancer—how aggressive it is—is probably the most important thing in determining the disease’s outcome.
SAL Is there a risk that women who do BSEs will have more biopsies—ones that find no cancer?
JT Yes; the main risks are having more unnecessary physician visits for breast problems and more unnecessary biopsies.
SAL Women who have found their own cancer are confused; they feel it’s what saved their lives.
JT I understand that to them their self-detection was very important in terms of their survival. I’m not trying to disparage that. People have beliefs, but that’s not something that should be applied to the population as a whole. What is recommended is routine screening. Also, people should live a healthy lifestyle. And if during casual palpation they find a lump they are concerned about, they should report it to their doctor.
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