Should We Still Recommend Self-Breast Exams For Our Patients?
In an effort to detect breast cancer early, most women's health care providers stress the role of the self breast exam, or SBE. Historically, experts promoted the belief that women's self-surveillance was the best tool in the detection of early breast masses. Primary care and gynecology providers also reinforced the SBE, knowing that many of their patients held deep-seated fears about breast cancer. SBE seemed a concrete, proactive way to address those fears. However, it may be time for medical professionals to let up on SBE preaching; new evidence questions both its validity and its usefulness.
The Cochrane Collaboration, a highly regarded international organization that compiles research on various medical issues, recently decreed that not only are the benefits of SBEs dubious, but they may do more harm than good. This conclusion was drawn from the analysis of two previously published studies. A total of 388,535 women were involved in these studies. Participants were evenly and randomly assigned to perform SBEs regularly, or not to perform them at all. By the end of these two trials, the authors determined that mortality due to breast cancer was not impacted by self-checks. In other words, women who faithfully performed SBEs gained no additional, long-term benefit from doing so.
It is important to note that there was one area of marked difference between the SBE and no-SBE groups. Women who were assigned to the SBE group were twice as likely to undergo invasive procedures, such as biopsies, for benign breast conditions. As mentioned in a recent Time article by Catherine Guthrie, "Five months after a benign surgical biopsy, 61 percent of women still struggled with symptoms of anxiety and psychological distress, including sleep trouble, change in appetite, and a general malaise fueled by thoughts of breast cancer." By encouraging SBEs, are providers are actually increasing the likelihood that patients will have unnecessary procedures, resulting in both literal and emotional scarring?
This is where things get confusing. The truth is that women do, in some cases, detect dangerous breast lumps through self-examination. Substantial anecdotal evidence supports such findings. At least one published Australian study found that 35 percent of malignant lumps are identified by patients themselves. Also, in the absence of family history of breast cancer, yearly mammograms are recommended only for women over age 40. For women under 40 years old who will not be reimbursed by their health insurance plans for mammograms, SBE may be the only screening tool available to assess breast tissue for lumps.
Perhaps the wisest approach to the under-40 crowd is to provide thorough education about the limitations and risks of SBEs and to allow women to make their own decisions about it. Women should be told that normal breast tissue is often bumpy and irregular, and that better-to-be-safe-than-sorry follow-up biopsies are likely to be negative for malignancies. Some, given this information, may wish to continue performing SBEs. That's okay. We should not, however, make women feel guilty if they elect to discontinue SBEs. Simply put, it is not an evidence-based practice.
Copyright 2013- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved
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Liz Di Bernardo