Breast self-exams may not help save lives

HACKENSACK, N.J. – Breast self-exams may not help save women’s lives and may even do more harm than good, an influential research group said in a report that’s fueling an ongoing debate about the screenings.

The researchers said the monthly breast self-exams that doctors have been recommending for years have not lowered the death rate. They have, however, led to many unnecessary biopsies, according to the report, which looked at studies of nearly 400,000 women for the Cochrane Collaboration.

But several breast surgeons and gynecologists say they still recommend the checks.

“The articles say there’s no evidence of a benefit from a statistical analysis, but we still see women finding their cancers,” said Dr. Fred F. Rezvani, director of obstetrics and gynecology at The Valley Hospital in Ridgewood, N.J. “In the trenches, I still advise breast self-exam.”

Regular checks help women become familiar with changes in their body – what Dr. Erika Brinkmann calls “breast familiarity.”

“About 20 percent of cancers are found by women themselves,” said Brinkmann, director of Breast Surgery at Holy Name Hospital in Teaneck, N.J. “I’m an advocate of breast self-exam for this reason.”

The new studies were based on women in China and Russia who were taught to check their breasts monthly for tumors and lumps. Those that checked their breasts were found to have no advantage in survival rates compared with a group that was not performing breast self-exams.

Other research has also raised questions about the effectiveness of policies that call for women to regularly monitor their breasts. In fact, other studies have shown that breast-self exams may be harmful because they lead to unnecessary biopsies and anxiety that haunts women for months afterward.

As the evidence mounted five years ago, the American Cancer Society quietly stopped recommending that all women do monthly breast self-exams. The society instead called for optional checks. However, routine checks for lumps, dimpling and other problems that can signal cancer may make sense for women who have known cancer risks, the society concluded.

Some physicians have changed their recommendations based on the emerging data.

“I’m not proactive the way I used to be five years ago encouraging breast self-exam,” said Dr. Steven W. Domnitz, chairman of the OB-GYN department at Chilton Memorial Hospital in Pompton Plains, N.J.

“If a woman has a breast cancer and it’s in the 90 percent that’s picked up by mammography, the mammogram will pick it up long before you or I would ever be able to feel it,” he said.

Domnitz said he has found that many patients who have not been checking their breasts monthly feel relieved when he tells them it’s not necessary.

“If you’re not doing it, you’re not missing anything,” he advises patients. He stressed he doesn’t discourage the practice for patients who are checking their breasts regularly.

The studies seem to contradict conventional wisdom that checking for lumps is vital to good health. Countless women have discovered their own tumors because they learned what’s normal and what’s not for their body.

And hospitals and advocacy groups, including the Susan Komen Race for the Cure, still hand out plastic cards to hang in the shower to remind women to check their breasts each month for any changes.

Dr. V. Merle Mcintosh, chief of breast services at Englewood Hospital and Medical Center, said the studies haven’t concluded that a woman shouldn’t examine her breasts. Rather, the studies have determined there’s no statistically significant advantage for doing so. But statistics aren’t the only factor in determining best practices.

“If you are the one woman that examines herself and finds a cancer early, it makes a big difference,” she said. She said she has treated patients who found tiny nodules that were Stage 1 that required no chemotherapy – a cure rate that’s 95 percent.

“We temper all of our judgments based on our experience,” she said. “That’s why I encourage self-exam.”