Should women do self breast-exams? An ob-gyn’s opinion.

I’ve asked ob-gyn Susan Warhus, M.D., one of our editorial-board members, to comment on whether women should still be doing breast exams, and she’s kindly obliged. She’s author of Fertility Demystified, Countdown to Baby and Darn Good Advice—Pregnancy.
—James Hubbard, M.D., M.P.H.

by Susan Warhus, M.D.

I just read an article about the Cochrane study concluding that monthly breast self-exams (SBE) are falling out of favor because there’s no real evidence they save lives.

As a physician and a woman, the implications here do not make me happy. I’m concerned that it sends the wrong message to women—like relax and don’t worry about “the girls” getting cancer because there’s nothing you can do about it anyway. I don’t agree!

The study says that women who find abnormalities during their SBE often end up having biopsies, which usually turn out to be benign. So they conclude that these women underwent unnecessary surgical procedures. Well, the Cochrane group makes their conclusions from research conducted in China and Russia. I’m not convinced that you can translate these same conditions to women being treated in the U.S. health-care system. In the U.S., finding a lump in your breast does not necessarily mean that you must undergo a biopsy. With our medical expertise and excellent imaging centers, oftentimes a biopsy can be avoided completely.

Furthermore, while I agree you may not have to perform your SBE with obsessive compulsive precision, I think it’s critical that you know how your breasts normally look and feel so you can report any changes to your doctor. If you don’t—who will?

I tend to take a practical approach to SBE. I think it’s important for you to take age and your own risk factors into consideration. If you have a strong family history of breast cancer or other risk factors, then by all means, do a monthly SBE and everything else within your power to reduce your risks or at least detect problems early. On the other hand, if you are in your 20s or 30s and don’t have any risk factors, I don’t think you need to panic about missing a month or so of the “circle, line, or wedge method.” That’s because women in this age group rarely get breast cancer. This age group also tends to have more fibrous breast tissue and lumps and bumps anyway. However, once you are in your 40s, 50s, and beyond, it becomes more critical to keep close tabs on “the girls” and notice changes in their appearance or feel. This time frame also coincides with mammogram screening. That’s because advancing age is a major risk factor for breast cancer.

I looked on the American College of Obstetricians and Gynecologists (ACOG) website and could not find a recent comment from them regarding this study. However as of 2003 they recognized a “lack of definitive data for or against SBE,” but still recommended it because “it has the potential to detect palpable breast cancer.”

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2 Responses to “Should women do self breast-exams? An ob-gyn’s opinion.”

  1. James Hubbard, M.D., M.P.H Says:

    Excellent advice. I have read that women, as they age, become less concerned detecting breast cancer, when they really should be more.

    I have also read that around 35 percent of breast cancers are detected at home.

    Thanks, Dr. Warhus

  2. James Hubbard’s My Family Doctor Blog » Blog Archive » Should women do breast self-exams? A family doctor’s view. Says:

    [...] Home » Blogs « Lidocaine gel helps discomfort, pain from mammograms Should women do self breast-exams? An ob-gyn’s opinion. [...]

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