Q On Oct 9 2002, Wednesday, the newspapers reported some study which concludes that Self Breast Examination is useless? Please give me more information on the related subject.
Wynn, 11 Oct 2002 A The report that you might be referring to is perhaps the report of the final results of the Randomised Trial of Breast Self-Examination in Shanghai. This paper was published in the Journal of the National Cancer Institute, Vol 94, No 19, 1445-1457, October 2002. In the conclusion, the authors stated that intensive instruction in self breast examination did not reduce deaths from breast cancer. Programmes for self breast examination in the absence of mammography is unlikely to reduce breast cancer deaths. In our Breast Health website, the 3-prong strategy for breast health is encouraged. In other words, although at a younger age, we start to be aware of our breasts (through self breast examination – SBE), we add on a professional physical examination (by a doctor or nurse trained in breast examination) and finally once the woman reaches the right age group, mammography should be considered as it is the only method that can detect breast cancer before it can be felt by the hands. Please read our article on this. In evaluating any research/study paper on such/ a related topic, we should ask ourselves the following: - Was the technique being taught/used effective, taking into account the cultural and psychological environment? Did the women actually perform SBE despite the reminders?
- Was breast cancer being detected early by the participants in the study group?
- If detected early, did the women seek treatment at an early stage or did they delay them, preferring to seek traditional treatment first? Here we have to take into consideration the cultural and educational background of the women in the study.
- How many of the women in the study group already had a “silent” non-palpable cancer when they entered the study? This group may have had a higher incidence of breast cancer to start with, although this is a randomized selection.
If we do not detect breast cancer early, then, it is unlikely that we will affect the breast cancer death rate. If we detect breast cancer early - yet the patients delay their treatment, again, the breast cancer death rate will not improve.
It would be difficult to dismiss SBE because it helps a person to be “breast health aware”. Unless we are aware of our own breast texture, size, shape, colour, it will be difficult to detect unusual changes that should alert us to see the doctor immediately. To enable earlier detection of changes in the breasts (not necessarily a lump), one must perform the SBE with the correct technique. Many think that the cursory feel of the breasts while taking a shower is adequate and constitutes SBE. It is no wonder that even though they perform their SBE in the shower, there are still those who come in with lumps as large as 3 cm when discovered for the first time! Please read all about SBE Anyone not properly counseled on SBE may be overly anxious and it is true that it might lead to more breast biopsies as women may find the more common benign lesions in the breasts. Remember 90% of breast lumps are non-cancerous. However with the advent of imaging such as ultrasound and mammography, the need for biopsy can be properly assessed and the biopsy procedures are now less invasive and are often just office procedures done with a special needle. In Malaysia, such facilities are available in all the general hospitals, university hospitals and also in quite a few private centers. SBE can be practised by all and only needs to be done once a month on a regular basis. Although the principles must be adhered to, the practical ways in which each one performs SBE may differ based on personal preferences. Once you are in tune with your breasts, you will hopefully be able to detect changes. Otherwise, accidental discovery of breast lumps could mean these are already about 3cm in size. The size again depends on the size of the person’s breasts. In large breasts, lumps can go “hidden” until much larger, especially if the technique of SBE is suboptimal. Being breast aware should be the aim, not paranoia or anxiety, resulting in daily, non-systematic feeling of the breasts. Many women even forget to “look” at their breasts. At the end of the day, it is up to us to decide what steps we need to take to be pro-active about our own breast health. We do know that Early Detection Saves Lives – are your ready to want to detect breast cancer early? If you have detected some unusual change in your breast, are you ready to see your doctor to further evaluate this finding of yours or will you be passive and hope that the change will go away? Editor
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