Saturday, October 4, 2008

Breast Self Exam: why not?

Happy breast cancer industry month. With all the horror stories you'll hear during October, you may be wondering why any doctor would tell a woman NOT do breast self exams.

Turns out it's a bit complicated. From the Cochrane Review, 2008:
Data from two large trials do not suggest a beneficial effect of screening by breast self-examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. At present, screening by breast self-examination or physical examination cannot be recommended.
The Cochrane Review used the so-called "gold standard" of mortality for its outcome measure. So if you are trying to avoid DYING from breast cancer, don't worry! No need for self exams. If your doctor finds a lump before you do, and it turns out to be cancer, it can be treated it pretty successfully -- statistically speaking, of course. Although there are regional and, especially ethnic variations, MOST BREAST CANCER IS NOT FATAL.

But what if your standard is more stringent? If your goal is to avoid being the one-in-eight American women who has an incidence of breast cancer in her lifetime, then it makes sense to be familiar with your breasts. Know where a monthly swelling occurs, or where a lymph node is prominent. Understand that most lumps are not cancer and most biopsies are negative.

If you are diligent about self exams, be prepared: while you don't want to panic if you or your doctor finds a lump, you will probably want further investigation. MRI, ultrasound, biopsies can all help you rule out cancer but they can also take a toll on your body and your psyche. This is part of the bargain.

The highly respected breast cancer researcher Dr Susan Love has more analysis at her website, including why you don't need to feel guilty if you don't perform self exams with precision.

Remember, statistics and epidemiology are vastly different than individual experience, so arm yourself with greater understanding of the risk factors for breast cancer and make your decisions from a position of strength.

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