Self breast exams: to do or not to do?
Remember when there were monthly emails you could sign up for to remind you and your friends to do your self breast exams at home? Remember seeing the news anchors talking about their monthly self breast exams in an attempt to remind you to do your breast “due diligence?” What happened to self breast exams and are they still important?
Initially, self breast exams were recommended as a screening tool to help early detection of breast cancer. Unfortunately long-term studies have not confirmed that they actually live up to their hype. Two large studies looking at over 200,000 women in both Russia and China didn’t show any difference in breast cancer mortality after 15 years between the women who were performing routine self exams and those who were not. In fact, the women that were practicing self exams found more lumps and underwent more biopsies for benign reasons. Reviews of several other studies failed to show a benefit of regular breast self-examinations including no benefit of early diagnosis, or reductions in deaths or stage at diagnosis. Hence in 2009, the US Preventative Services Task Force advised that clinicians no longer recommend routine self breast examination as a screening tool for breast cancer detection.
Even though you don’t need to be doing a monthly self exam, you should know your breasts. The American Cancer Society recommends that you know what your breasts normally look and feel like. Some women have lumpy breasts that make detection of masses difficult. Other women with very small or very large breasts also have difficulties evaluating their breasts. What I always tell patients is that it is important to notice any changes in your breasts including new lumps, swelling, pain, skin changes or nipple discharge. These changes should prompt you to notify your physician or health care provider.
In terms of further screening, the American Cancer Society recommends a clinical breast examination by a health care provider every 3 years in your 20s and 30s and yearly at age 40. Yearly mammograms should begin at age 40. Some women have an increased risk of breast cancer due to their family history. You should talk to your family and know your family history so that you and your health care provider can evaluate if any of your history puts you at an increased risk of breast cancer.