Breast Self-Exams: Why Recommendations Differ

Cancer advisory groups continue to disagree on the efficacy of the breast self-exam (BSE). Lacking sufficient documentation of reduced deaths, balanced with unnecessary follow-up testing, some organizations have recommended discontinuing the breast self-exam. Others acknowledge that BSEs serve a role in “breast awareness,” which is a more comprehensive approach including education, anatomy, self-advocacy, and understanding.

PROFESSIONAL RECOMMENDATIONS

American Cancer Society

Personal Discretion – Advises women to begin at age 20 and to have their technique reviewed.

U.S. Preventive Services Task Force

Against – Recommends against teaching women to perform a BSE.

National Comprehensive Cancer Network

Personal Discretion – A BSE is one option for familiarizing women with their own breast anatomy.

Canadian Task Force on Preventive Health Care

Against – Recommend against self-exams for women ages 40 and older at average risk.

WHY DO ORGANIZATIONS DISAGREE?

Arguments for BSE

Rate of Self-Detection

  • 2/3 of women find their own breast cancers

Rate of Routine Mammogram Detection

  • Only 15% are found by mammograms

Identify Lumps Sooner

  • Smaller lumps are better detected in routine exams
  • Treating lumps or infections can relieve pain

Arguments Against BSE

Inaccurate Performance

  • 20% of women who examine their breasts do more than 1/2 of the recommended steps.

False Positives

  • 41% accurate for women ages 35 to 39
  • 21% accurate for women ages 60 to 74

Additional testing and procedures leads to more biopsies and diagnosis of more benign breast lesions.

THE NEED FOR EDUCATION

Consider the following stats for college-aged women from a study published in the Journal of American College Health:

  • Only 32.6% knew the advanced risk factors for breast cancer diagnoses.
  • Only 41.8% knew to do their self-exam the first week after the menstrual period.
  • Only 8.6% reported doing a BSE 10 to 12 times in the past year.

WHILE MANY WOMEN KNOW TO LOOK FOR LUMPS, A PROPER SELF-EXAM SHOULD ALSO INCLUDE CHECK FOR:

  • Itchy, scaly sores or rashes on the nipple
  • Nipple discharge other than breast milk
  • Pain in one spot that does not go away
  • Dimpling, puckering, or pulling of the nipple or other parts of your breast
  • Changes in the breast size or shape, especially to one side
  • Hard knots or thickening inside the breast or underarm
  • Swelling, redness, warmth, or darkening of the breast

FOR MORE INFORMATION ON PROPER SELF-EXAM TECHNIQUES, VISIT:

ww5.komen.org

nationalbreastcancer.org

cancer.org

If you are particularly uncomfortable or anxious about performing exams, or want more information on your risk, consider speaking with your primary care provider to develop a plan. Factors to discuss include:

  • Risky behavior
  • Hereditary influences
  • Genetic Risk

Ultimately, self-exams are just one facet of breast self-awareness. Identifying changes in your breasts and being more aware of your risk factors can help empower you to ask the right questions and potentially receive the treatment you need.

SOURCES

  • Early, J., Armstrong, S.N. Burke, S. & Thompson, D.L. (2011). Journal of American College Health. 59(7): 647.
  • Green, B.B.; Taplin, S.H. (2003). Breast Cancer Screening Controversies. The Journal of the American Board of Family Practice. 16(3): 233-241.
  • Jones, R.M., Wallace, I.J., Westerberg, A., Hoy, K.N., Quillin, J.M. Danish, S.J. (2015). Getting Youth to Check It Out!: A New Approach to Teaching Self-Screening. American Journal of Health Behavior. 39(2): 197-203.
  • Kearney, A.J. & Murray, M. (2006). Evidence Against Breast Self-Examination is not Conclusive: What Policymakers and Health Professionals Need to Know. Journal of Public Health. 27: 282-92.
  • Kratzke, C., Amatya, A. & Vilchis, H. (2013). Differences among college women for breast cancer prevention acquired information-seeking, desired apps and texts, and daughter-initiated information to mothers. Journal of Community Health (2014). 39: 291-300.
  • MacBride, M.B., Pruthi, S., Bevers, T. (2012) The Evolution of Breast Self-Examination to Breast Awareness. The Breast Journal. 18(6): 641-643.
  • Mahon, S.M. (2012). Screening for Breast Cancer: Evidence and Recommendations. Clinical Journal of Oncology Nursing. 16(6): 567-71.
  • Parvani, Z. (2011). Breast Self-Examination: Breast Awareness and Practices of Systematic Review. Professional Medical Journal. 18(2): 336-339.

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