Why Women Must Still Examine Their Breasts
July 22, 2008— -- A report last week by a panel of experts evaluating the pros and cons of breast self-examination and clinical breast examination by a trained practitioner stirred up a lot of controversy.
Wonderfully angry responses by women (and their men for that matter) fueled the controversy, arguing that it is absurd to tell women not to examine their breasts. Many of these women found their breast cancers as a result of their own breast exams.
So what is the fuss? A group of experts convened to assess the evidence for the pros and cons of both breast self-exam and clinical breast examination by a trained practitioner. After reviewing two large randomized controlled studies from China and Russia, they concluded that women assigned to do regular breast self-examinations were almost twice as likely to undergo a biopsy of the breast than women in the control group. They found no difference in the number of cancers diagnosed overall.
The researchers found only one large population-based clinical trial evaluating the effectiveness of a clinical breast examination by trained practitioners. This study was ended early, and there were no conclusions because of poor compliance with followup. I am curious to know more about this study and how much better (or worse, according to this panel of experts) doctors perform than women in finding subtle but potentially serious breast changes.
It is interesting to me that no one picked up on this part of the study. I doubt anyone would suggest that clinical breast examination by a practitioner may also be harmful and could lead to more unnecessary biopsies.
Think about this for a minute. Women in the self-exam group knew they were part of a study that was "testing" or "grading" their ability to find possible breast cancers early. It stands to reason that these women would have been extra vigilant as a result and may have reported findings or concerns that they would not have otherwise mentioned to a physician had they not been enrolled in a study.
