No Wrong Way to Check Self for Breast Cancer

New Screening Guidelines Reflect Terminology Change

Since the 1970s, women have heard the mantra about monthly breast self-examinations (BSE) as an empowering breast cancer screening tool. In recent years, however, a study on the ineffectiveness of learning this formal method of detecting cancer has confused women, prompting cancer experts to clarify the issue.

The study, which was conducted in Shanghai, China, reported that a woman being taught how to conduct a breast self-exam was not any more effective than a woman finding an abnormality without specific instruction, says Therese Bevers, M.D., medical director of the Department of Clinical Cancer Prevention at M. D. Anderson.

"That does not mean we don't want women to check their breasts," she says. "It just means that women do not need formal instruction in how to find breast abnormalities because women already have the natural ability to feel and see changes in their breasts."

The word "examinations" in "breast self-examinations" also implies that there is a right way and a wrong way for women to see and feel their breasts, Bevers says.

"We're trying to take it out of the rocket science category now and help women realize that this is simple - they already know when something is different with their bodies. To help them understand, we changed the terminology in our breast screening guidelines from 'breast self-exam' (BSE) to 'breast self-awareness' (BSA)."

M. D. Anderson's cancer screening guidelines now recommend BSA as part of the triad of breast cancer screening which includes breast exams by physicians and mammograms.

Studies show no benefit for Breast Self-Exam

The change from BSE to BSA was inspired by the Shanghai study, as well as feedback from breast cancer patients who discovered their breast lumps without formal BSE training or reminders to conduct monthly self-exams.

The Shanghai study featured an intervention group, in which women were taught how to perform BSE, and a control group, in which no BSE instruction was given. Participants were followed up 10 years later.

Study results showed that the instruction of BSE did not change breast cancer outcomes.

The Shanghai study found:

• Death rates were similar: 135 vs. 131 (intervention:control)
• Benign breast lesions led to unnecessary biopsies

"These results, combined with data from a nonrandomized trial in the United Kingdom, come to the same conclusion: Being instructed in breast self-exam and reminded to do it is not more effective in saving lives than breast self-awareness," Bevers says.

The study also showed that there's an over-detection rate. Women in the Shanghai study who were taught BSE had a much higher rate of "false-positive" biopsies, in which the lesions were non-cancerous. Bevers says that comes with both a financial and emotional cost. "Unnecessary diagnostic tests as a result of BSE are expensive and have adverse psychological effects such as anxiety," she says. "Monies spent to promote BSE could potentially be used for other preventive strategies of proven benefit."

BSA demystifies BSE, which intimidated patients

The majority of breast cancers are found by women themselves, and the majority of those women do not accomplish that through formal means like BSE, Bevers says. More commonly, women describe the accidental finding of their mass while showering or dressing.

"What that tells us is that women have an unconscious awareness of what is normal with their breast and when they detect something different they will pause and investigate it."

Many of Bevers' patients have told her that they found BSE intimidating. They did not understand how to conduct a breast self-exam and they were afraid of doing it the wrong way, so they didn't do it at all. "We needed to make a change because there is no wrong way to detect breast cancer."

From: Yahoo Health