Breast Self-Exam Not Effective in Reducing Mortality

An ongoing study has shown that more intensive teaching of breast self-examination (BSE) has showed to increase the rate of benign breast biopsies, but has not reduced the rate of mortality related to breast cancer.

Published in the October 2 issue of the Journal of the National Cancer Institute this report shows that the investigators believe the time would be better spent teaching women about breast cancer symptoms and performing a more thorough clinical breast examination.

In this controlled trial, 266,064 female factory workers in Shanghai were randomly selected to participate in either a BSE instruction group or a control group receiving no information on breast cancer screening. Women in the instruction group were initially taught how to perform BSE, they took part in reinforcement sessions one and three years later, they received regular reminders to practice BSE monthly, and they practiced BSE under medical supervision every six months for five years.

Results showed after 10 to 11 years, breast cancer mortality was the same in both groups. During every year of the trial, women taught BSE found more benign breast lesions than did controls, suggesting that healthcare costs related to biopsies could increase without necessarily detecting breast cancer at an earlier stage.

“In developing countries, where mammography screening is not available, it would not seem to be a good use of the limited funds available for preventive services to promote practice of BSE,” says David B. Thomas and colleagues from the Fred Hutchinson Cancer Research Center in Seattle, Washington.

Because of inconsistent evidence from nonrandom observational studies, the U.S. Preventive Services Task Force currently does not recommend for or against the teaching of BSE.

For women with access to mammograms the authors therefore recommend that BSE not substitute for regular mammograms. However, they recommend additional studies to determine whether highly motivated women could be taught to detect cancers developing between regular screenings, and whether diligent BSE enhances the benefit of mammograms.

Russell Harris and Linda Kinsinger from the University of North Carolina’s School of Medicine, enumerate the problems with breast self-examination, stating that expense, difficulty in learning proper technique, and a lack of follow-up in maintaining the practice long-term also contribute. They suggest that rather than spending time teaching BSE, physicians must find ways to educate women about breast cancer symptoms and devote more time to the clinical breast examination.

“Routinely teaching BSE may be dead, but giving women information and continuing research on the effectiveness of excellent physical examination should live on,” they write.

(Source: Medscape Medical News)