Dear Dr. B: I have been doing breast self-examination (BSE) for many years. But recent recommendation by the Canadian Task Force on Preventive Health Care has confused me. Can you please tell me whether I should continue to do BSE? And what is the Task Forces exact recommendation? Yours, Ms. Confused.
Dear Ms. Confused: My recommendation would be to continue to do breast self-examination. If we are going to ask women to discontinue with BSE then we should ask the public to stop having rectal examination for detection of rectal and prostate cancer, we should stop doing PSA tests, we should stop checking moles, we should ask men not to examining their testicles for tumour well I can go on and on.
Unfortunately, medicine is not a perfect science. That is why evidence based medicine is not popular with physicians who have to deal with sick and anxious patients face to face. Common sense and sense of responsibility dictates that we should continue to examine and check our bodies for any obvious abnormalities.
Of course, conducting unnecessary invasive tests without adequate clinical indication is not acceptable. But BSE is inexpensive and non-invasive test requiring no high tech machinery.
What did the Task Force recommend?
1. Women aged 40-69 years should not do BSE, as there is a fair evidence of harm and no evidence that it saves lives.
2. Women younger than 40 and older than 70 no recommendation was made as there is lack of sufficient evidence to evaluate the effectiveness of BSE in this age group.
What are the recommendations based on?
The Task Force reviewed several large studies and failed to find any evidence that BSE prevents death from breast cancer. In fact, the studies show that women who do BSE visit doctors more often for evaluation of benign breast disease, and have higher rates of benign breast biopsy results. This inflicts anxiety and pain not only to patients but to their families as well.
Is this a big price to pay to rule out breast cancer?
Breast cancer is the most frequently diagnosed cancer among Canadian women. Breast cancer accounts for 30 percent of all new cancer cases diagnosed each year, says the Task Force article in the Canadian Medical Association Journal. Each year, 25 percent of women with diagnoses of breast cancer die.
Well, you be the judge. Each woman has to decide what is important for her. It is your body and you should have full control over it. If you are going to do regular BSE then make sure that you learn the right technique. Information pamphlets and videos are available at the Canadian Cancer Society office (Phone: 529-8015).
Early detection of breast cancer requires three tests: BSE, clinical examination of the breasts by a physician or a trained nurse, and mammography. None of these tests are hundred percent accurate in detecting early breast cancer. Therefore, many physicians, including myself will follow the dictum that a breast lump is malignant until proven otherwise. I would rather remove a benign lump then miss a breast cancer!
Ms. Concerned, I hope this answers your question. If you are going to continue to do BSE then make sure that your technique is correct.
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