Breast Self Exams: don't cut death rate from breast cancer
Subject: a study of 26,000 women who did breast self exams did not reduce
the risk of dying of breast cancer.
A few years back when we were lobbying the Colorado State Legislature to
pass a bill regulating the naturopathic medical profession we had to spend
many hours meeting with representatives of the Colorado Medical Society and
other medical groups defending our profession. The mantra which the
medical doctors always hammered us with was the phrase, "untested and
unproven therapies" to imply that naturopathic therapies which had hundreds
of years of historical use could not work unless proven to do so by the
modern rigorous scientific method. No matter that the vast majority of
things we do prescribe have been subjected to modern examination, the
phrase was a good one-liner when playing politics. Since then I have
become very sensitive to stories which point out modern medical practices
which not only don't have evidence supporting their use but which have
clear evidence that they are ineffective.
Earlier this year a study called into question whether routine mammograms
were of any benefit in reducing breast cancer deaths. Now today's Journal
of the National Cancer Institute has asked the same question about breast
Here's the news release the National Cancer Institute put out this morning:
Press Release from the Journal of the National Cancer Institute Vol 94, No
19, October 2, 2002
Study Finds No Evidence That Teaching Breast Self-Examination Saves Lives
Linda Wang, Assistant News Editor, Katherine Arnold, News Editor
Teaching women breast self-examination (BSE) does not appear to decrease
the number of deaths from breast cancer, according to a study in the
October 2 issue of the Journal of the National Cancer Institute. However,
intensive teaching of BSE was found to increase the rate of benign breast
biopsies, potentially adding to health care costs without benefits.
Evidence from non-randomized observational studies had not been consistent.
Given such evidence, the U.S. Preventive Health Services Task Force
currently does not recommend for or against the teaching of BSE.
To address this issue directly, David B. Thomas, M.D., Dr.P.H., of the Fred
Hutchinson Cancer Research Center in Seattle, and his colleagues randomly
assigned 266,064 female factory workers in Shanghai to either a BSE
instruction group or a control group. Women in the BSE group were taught
how to perform BSE and participated in reinforcement sessions 1 and 3 years
later. The women also received regular reminders to practice BSE monthly
and practiced BSE under medical supervision every 6 months for 5 years. The
control group received no information on breast cancer screening.
After 10 to 11 years, there was no difference in breast cancer mortality
between the BSE and control groups. There was also little evidence that
cancers were detected at an earlier stage in the BSE group. However, women
taught BSE found more benign breast lesions than women in the control group
did during every year of the trial.
"In developing countries, where mammographic screening is not available, it
would not seem to be a good use of the limited funds available for
preventive services to promote practice of BSE," the authors write. For
women with access to mammographic screening, the authors say that the
results make clear that BSE is not a substitute for regular screening by
mammography. They also point out that the implications of these results for
women who do receive regular mammograms are unclear.
They note, however, that it is possible that highly motivated women could
be taught to detect cancers that develop between regular screenings, and
that the diligent practice of BSE might enhance the benefit of a
mammographic screening program. They suggest that future studies look into
In an accompanying editorial, Russell Harris, M.D., and Linda S. Kinsinger,
M.D., of the University of North Carolina School of Medicine, point out
that while teaching BSE seems like a good idea, BSE is more expensive than
it first appears, is difficult to learn to do well, and is difficult to do
They say that the new findings should lead to a change in clinical
practice. Rather than spending time teaching BSE, physicians should find
ways to educate women about breast cancer symptoms and spend a little
longer on the clinical breast exam, they say.
"Routinely teaching BSE may be dead, but giving women information-and
continuing research on the effectiveness of excellent physical
examination-should live on," the editorialists write.