You know those questions from folks in white coats -- "How often do you floss?" "How much exercise do you get?" "How often do you brush your dog's teeth?" -- that always seem to make you feel guilty for not doing enough, no matter what your answer is? For women, "Do you do regular breast self-exams?" can be right up there. So I was relieved to see Debbie Saslow, director of breast and gynecological cancer for the American Cancer Society, offering absolution in Time magazine: "Women who don't want to do breast self-exams shouldn't feel guilty about it," she says. Hallelujah!
After reviewing two previously published studies on the effectiveness of breast self-examination, researchers from the Cochrane Collaboration concluded that self-exams provide no measurable benefit and may even do more harm than good. Women who died of breast cancer over the course of the study were just as likely to have done self-exams as not, but among all the women studied, those who did self-exams were nearly twice as likely to have undergone biopsies with benign results -- i.e., ultimately unnecessary procedures.
This would seem like pretty strong evidence that breast self-exams aren't worth the effort, if not for other studies that show a large number of breast cancer patients -- 35 percent, in one study -- discovered their own lumps. That research doesn't tell us whether they found the lumps during the course of proper self-exams or by accident, but it still makes a good argument for a better-safe-than-sorry approach. Isn't risking an unnecessary biopsy preferable to missing a malignancy? Maybe, maybe not. "Dr. Peter Gotzsche, director of the Nordic Cochrane Centre in Denmark and a co-author of the [Cochrane Collaboration] review, says biopsies are often the first step on the path toward further testing and increasingly invasive diagnostic tests. The report cites studies suggesting that women who travel that route often emerge with scars, breast deformities and emotional wounds." Those might seem like small sacrifices if your vigilance eventually turns up a malignant tumor at an early stage, but what if it never does?
Thus the American Cancer Society's recommendation that women do self-exams if they want to and ditch the guilt if they don't. The best available research simply can't tell us whether self-exams are more likely to lead to spotting cancer early or to a series of invasive, potentially disfiguring medical procedures and ongoing jacked-up anxiety. On second thought, scratch that "Hallelujah."