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.
US Preventive Services Task Force recommendations for breast cancer screening
There won’t be a medical news post next week. Posting will resume in two weeks. I’ll miss you too.