Breast self-examination should no longer be promoted as an effective screening measure for breast cancer because it does more harm than good, new research says.
The bombshell, published in today's edition of the Canadian Medical Association Journal, reverses what physicians and women have been told for more than three decades.
"We all wanted to find that breast self-examination works, but it doesn't," Nancy Baxter, the lead author, said bluntly.
In fact, checking breasts monthly to detect lumps does not significantly reduce mortality and results in a lot of anxiety and unnecessary biopsies for benign breast lesions, she said.
"We'll save a lot more lives from breast cancer by doing mammography, by focusing our energies on proven screening measures and on promoting healthy lifestyles," Dr. Baxter said.
The formal recommendation is that physicians no longer routinely teach women aged 40 to 69 how to conduct breast self-examination. It has been adopted by the Canadian Task Force on Preventive Health Care, a body that counsels health-care providers on effective screening measures. (The under-40 and over-70 age groups were excluded because of a lack of data.)
The recommendation has angered some breast-cancer activists and physicians.
"This is devastating news because many women don't have any other defence against breast cancer," said Feather Janz, a breast-cancer survivor. "I'm alive today because I found a lump myself so I can't believe there are serious researchers out there saying this doesn't save lives."
Ms. Janz, from Abbotsford, B.C., dismissed the notion that finding benign lumps is harmful, arguing that a biopsy that finds nothing is a price well paid when there is a risk of cancer.
Ms. Janz said that instead of abandoning breast self-examination, public health officials should be stepping up education of physicians and women to ensure is it done more consistently and more effectively.
Barbara Kaminsky, chief executive officer of the B.C. division of the Canadian Cancer Society, said screening for breast cancer saves lives.
"The CCS continues to advocate that all women should do a monthly breast self-examination, have an annual physical exam which includes examination of the breasts by a trained health professional and that all women, between 50-69 years, have a mammogram every two years," Ms. Kaminsky said in a statement yesterday.
However, Dr. Baxter said the reality is that after 30 years of promoting the technique, only about one-third of women practice breast self-examination monthly, and even fewer do it properly.
While there is no doubt many women do detect breast tumours themselves, few do so during routine self-examinations. Instead, they find them while showering or during sexual relations, she said.
"We don't want women to ignore their breasts or problems with their breasts," Dr. Baxter said. But they shouldn't have a false sense of security because they perform breast self-examinations, she said.
Researchers focused on seven studies of women who performed breast self-exams in China, Russia, Britain and Canada. There was no significant difference in the outcomes of women who performed breast self-examinations and those who did not.
In a commentary also published in the CMA Journal, Larissa Nekhlyudov of Harvard Medical School said while there are uncertainties about the benefits and harms of breast self-examination, the recommendation to stop routinely teaching it to women is too hasty, because it is based on only five years of follow-up research.
"In screening, good science takes time," she wrote. Dr. Nekhlyudov said that if decisions had been made about mammographies or screening for colorectal cancer after only five years, both would have been declared detrimental.
More to the point, Dr. Nekhlyudov said the reality is that in Canada and the United States, breast self-examination is used as a screening tool in conjunction with mammography and clinical breast exams.
As a result, it is unlikely there is the high rate of unnecessary biopsies that were seen in the Chinese and Russian research.
But John Feightner, chairman of the Canadian Task Force on Preventive Health Care, said a review of the recent literature shows that mammography and clinical breast examination are far better screening methods.
"When one is looking at prevention activities, there needs to be evidence it's effective. We should focus on those that have proven effective," he said.
"Routine breast self-examination is not supported by the data."
Dr. Feightner stressed that while routine teaching is no longer recommended, women and physicians who are comfortable with breast self-examination should continue to use it, while being aware of its limitations.
"If an individual woman wants to pursue this method then, by all means, she should. But what is important is that she and her health-care provider be aware of the evidence and trained in proper technique," he said.
Breast cancer is the most frequently diagnosed cancer among Canadian women, and the second leading killer.
Research published last year revealed that one in five women over the age of 50 in Canada has never been screened for breast cancer, and that only about half of women in the age group had undergone a mammogram in the past two years.
The Canadian Cancer Society recommends that all women between the ages of 50 and 69 have a mammogram every two years in combination with a physical examination of the breasts by a trained health professional. It is also recommended that all women perform a breast self-examination at the same time each month.