Breast Self-examination - Limitations

Limitations

According to a meta-analysis in the Cochrane Collaboration, two large trials in Russia and Shanghai found no beneficial effects 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." They concluded, "At present, screening by breast self-examination or physical examination cannot be recommended."

Although breast self-examination increases the number of biopsies performed on women, and thus revenue for the breast cancer industry, it does not reduce mortality from breast cancer. In a large clinical trial involving more than 260,000 female Chinese factory workers, half were carefully taught by nurses at their factories to perform monthly breast self-exam, and the other half were not. The women taught self-exam detected more benign (normal or harmless lumps) or early-stage breast disease, but equal numbers of women died from breast cancer in each group.

Because breast self-exam is not proven to save lives, it is no longer routinely recommended by health authorities for general use. It may be appropriate in women who have a particularly high risk of developing breast cancer. Some charitable organizations, whose donations depend on promoting fear of breast cancer, still promote this technique as a one-size-fits-all, universal screening approach, even in the low-risk women who are most likely to be harmed by unnecessary invasive follow-up procedures. Among groups promoting evidence-based medicine, awareness of breast health and familiarity with one's own body is typically promoted instead of self-exams.

Breast self-examinations are based on an incorrect theory of cancer development, which assumes steady growth of the tumor. According to breast cancer specialist Susan Love, "Breast cancer doesn't work like that...it's sneaky. You could examine yourself every day and suddenly find a walnut."

Among women with high-risk BRCA mutations, about 10% said that performing breast self-examination increased their anxiety. Others felt that it gave them a sense of control.

Learning breast self-examination increases a woman's level of depression, worrying, and anxiety about breast cancer. Greater anxiety about breast cancer is associated with a higher likelihood of performing breast self-examination. Women are also more likely to perform breast self-examination if they have experienced a false positive error from screening mammography (being wrongly told that breast cancer may be present, when the woman is actually cancer-free).