From Our 2008 Archives
Breast Self-Exams: No Survival Benefit
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Review Shows No Breast Cancer Survival Benefit in Women Who Do Regular Breast Self-Exams
Reviewed By Louise Chang, MD
July 15, 2008 — Doing a breast self-exam doesn't improve breast cancer survival, and it makes biopsies of benign breast lumps more likely.
That's according to an updated review of research on breast self-exams and breast cancer survival.
The updated review, published in the Cochrane Library, is in line with the findings from the original review, published in 2003.
"We would like to inform women that there is no evidence from two large studies that screening by regular breast self-examination (once a month) improves their chances of surviving breast cancer, whereas there is evidence that regular breast self-examination almost doubles their risk to undergo a biopsy," reviewer Jan Peter Kosters, MD, of the Nordic Cochrane Centre, tells WebMD via email.
Breast Self-Exam Report
The new review is based on two studies that together included more than 388,500 women in Russia and China who ranged in age from 30-66.
Some of the women were trained to do breast self-exams. They also got regular reminders or refresher classes to make sure their technique was correct. For comparison, the other women in the studies weren't taught or urged to do breast self-exams.
The women were followed for 10 years. During that time, 587 women died of breast cancer, with similar numbers of deaths in the breast self-exam group (292 breast cancer deaths) and in the group of women who weren't trained to do breast self-exams (295 breast cancer deaths).
The women who did breast self-exams were nearly twice as likely to get breast biopsies, many of which turned out not to show cancer.
In short, doing breast self-exams made no difference to the groups' breast cancer survival rates, and it boosted the biopsy rate.
Do Breast Self-Exams or Not?
The decision about whether or not to do a breast self-exam needs to be made by the women themselves, says Kosters, adding that "a rational choice would be not to do regular breast self-examination."
The American Cancer Society sees it differently.
Doing a breast self-exam is "an option," Debbie Saslow, PhD, the American Cancer Society's director of breast and gynecologic cancer, tells WebMD. "We don't want to recommend against it but there's no evidence to recommend for it."
"Certainly, if any woman wants to do breast self-exam, then her doctor should give her assistance and make sure that her technique is what it should be, and also let her know what the limitations are so that she's not expecting that this is going to have big impact on her if she gets breast cancer," Saslow says.
Susan Love, MD, president and medical director of the Dr. Susan Love Research Foundation, calls the review a "wake-up call to say, 'You know what? We've been relying on things that don't work that well and we really have to start demanding something that works better.'"
Breast Awareness Is Key
The review doesn't support breast-self-exams. But it does urge women to be aware of — and seek prompt medical assessment of — any breast changes.
"Whenever one notices symptoms which could be breast cancer or any other cancer, one should not hesitate to seek a doctor for rapid assessment," Kosters tells WebMD.
To Saslow, the key message is to get medical attention for any breast lumps, whether those lumps are found during a breast self-exam or "in the shower or getting dressed or looking in the mirror or her husband [notices it]."
The review "doesn't say never touch your breasts again. It says that the normal poking around that we all do is enough, and that formal ... breast self-exam doesn't add to that," says Love, who calls the review "excellent."
"Where we really should be putting our efforts is how to prevent breast cancer, not how to find cancers that are already there, but how can we make it not happen in the first place," Love says. "If we could get to a point where we're not even looking for cancer, we're looking for cells that might be cancer some day when they grow up, then we have a more reasonable chance to get rid of this disease."
The review doesn't mean that breast self-exams haven't helped individual women. Good Morning America anchor Robin Roberts said in 2007 that she found the lump that turned out to be breast cancer during a breast self-exam.
But in large groups of women, the numbers aren't there to show a survival benefit, Kosters and colleagues report.
SOURCES: Kosters, J. The Cochrane Library, 2008; Issue 3. Jan Peter Kosters, MD, Nordic Cochrane Centre. Debbie Saslow, PhD, director, breast and gynecologic cancer, American Cancer Society. Susan Love, MD, president and medical director, Dr. Susan Love Research Foundation, Santa Monica, Calif. WebMD Health News: "TV's Robin Roberts Has Breast Cancer."
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