When I was a resident (over ten years ago!) we were taught that there was no evidence that breast self-examination saved lives.  A new review puts another nail in the coffin of breast self-examination.  This week the Cochrane Review published a re-analysis of a review of the scientific studies on breast examination.  The conclusion: women who perform breast self-examination undergo more breast biopsies but die of breast cancer at the same rate as women who do not examine themselves.  The same applies to periodic breast examination by a clinician.  The authors’ conclusion is quite clear.

“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.”

It’s important to note that any lumps or other breast changes that are noted should still be reported to a doctor.  The message of this finding is simply that it doesn’t help to look for such changes periodically.

This review has generated much attention in the general press this week.  (See the link to the WebMD article below.)  Interestingly, despite the clear conclusions of the study, the American Cancer Society doesn’t recommend for or against breast self-examination, but rather says that it remains “an option”.  What kind of position is that?  Of course it’s an option.  Stuffing marshmallows in my ears is an option too.  Are they for it or against it?  Given that the evidence is entirely lopsided against it, why won’t they advise women not to examine themselves and spare them the needless biopsies?

The answer is that the American Cancer Society derives its mission (and its funding) from diagnosing and treating cancer.  Their recommendations are consistently skewed towards recommending more testing than the evidence supports, since more testing leads to the diagnosis of more cancer cases.  That is an important reason to rely on recommendations from groups that are entirely unbiased and whose income doesn’t depend on whether they recommend for or against any intervention.  The Cochrane Review and the US Preventive Services Task Force are such groups.

Learn More:

WebMD: Breast Self-Exams: No Survival Benefit

Cochrane Review: Regular self-examination or clinical examination for early detection of breast cancer

US Preventive Services Task Force recommendations for breast cancer screening

Tangential Miscellany:

There won’t be a medical news post next week.  Posting will resume in two weeks.  I’ll miss you too.

This week the Food and Drug Administration (FDA) requested a new warning on a family of antibiotics called fluoroquinolones.  This family includes ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox) and others.  The warning has to do with the increased risk of tendonitis and tendon rupture due to these antibiotics.

This information is not new.  The increased risk has been known for a few years, but as additional cases have been reported, the FDA chose to act.

This complication is more frequent in patients over 60, patients taking corticosteroid medications, and patients who have had an organ transplantation.  It is a rare complication (though I couldn’t find a numerical estimate of its frequency) but in the case of tendon rupture can be quite disabling and can require surgery.  In my practice, this complication has happened exactly once (to a patient who is probably reading this!).

Doctors and patients will almost certainly continue to rely on this family of antibiotics.  Doctors should be more cautious in higher-risk patients.  Patients should know to call their doctor immediately and discontinue the antibiotic if they develop tendon pain, and to avoid exercising the sore area.

Though in general the medications available to us have steadily become safer and more effective, we should not hold our breaths for an era of perfect safety.

Learn more:

Wall Street Journal article:  FDA to Add Warning to Antibiotics

FDA press release:  FDA Requests Boxed Warnings on Fluoroquinolone Antimicrobial Drugs

“Summertime,
And the livin’ is easy”
– George Gershwin

Summer is here, and especially in Southern California, that means opportunities to enjoy lots of outdoor activities including fun days at the beach and in the pool.  Unfortunately that also means more accidental drowning.  In 2005 there were 3,582 drowning fatalities in the United States, a quarter of them in kids 14 and under.

So this is a good time to remind ourselves never to leave children unattended in or near a pool.  With kids younger than 5 an adult should be within arm’s reach.  Teach your kids to swim.  Learn CPR.  Fence your pool.

So let’s all enjoy America’s two hundred thirty-second birthday in a way that will keep us around for the next one too.  Oh, and wear sunscreen.

Learn more:

The Centers for Disease Control and Prevention Water-Related Injuries Fact Sheet

American Academy of Pediatrics Pool Safety for Children