NEWS

Breast Self-Examination: A Mixed Message

Andrea Walker Gehrke

It’s a message that most women know well—perform a monthly breast self-examination. Women are encouraged and reminded by sisters, friends, monthly e-mail messages, and shower cards. Now there are products available that are supposed to make the process easier. Yet, leading cancer research organizations are increasingly backing away from this recommendation to perform breast self-exams.

The National Cancer Institute no longer prints a breast self-examination guide in its breast cancer booklet. "We have summarized the evidence, and at this point no studies have clearly shown a benefit of using breast self-examination," said Barnett Kramer, M.D., director of the Office of Medical Applications of Research at the National Institutes of Health.

And, although the American Cancer Society still includes monthly breast self-exams in its recommendations for the early detection of breast cancer, it is in the process of eliminating materials that focus only on breast self-examination.

"We can’t say a breast self-exam alone can save your life. We just don’t know that," said Terri Ades, health content and nursing staff director at ACS. "Therefore, we are choosing to include breast self-examination as part of a three-prong message, emphasizing [breast self-exams] only as the third part in that message."

For the most part, this quiet change in promotional efforts has gone unnoticed.

But it does not mean that women are any clearer on whether they should be performing the exams. Even the scientific community has yet to come to an agreement on the appropriate message.

A Difference in Opinion

Not all specialists in the field would agree that downplaying the role of breast self-examination is a step in the right direction. "I think we are doing a disservice to women to minimize our emphasis on [breast self-examination]," said Nan Leslie, Ph.D., associate professor of the School of Nursing at West Virginia University. "We each have just one body, and certainly ought to know it better than any health care provider on earth. I truly feel we need to encourage women to at least feel and look for changes in the breast, so if there is a difference they can report it to their health care provider."

Other authorities agree with Leslie. More noticeably, physicians and advocacy organizations, from whom women seek guidance, continue to promote and encourage breast self-exams. The Susan G. Komen Breast Cancer Foundation is one such organization, saying breast self-examination is a major message of the foundation.

"We are trying to at least provide a consistent message," said Wendy Potts, Helpline manager of the Komen Foundation. "We receive calls from women all the time on our hotline wondering what methods of early detection they should be involved in. Some of their doctors are telling them it is very important, others are saying it isn’t so. There is definitely a mixed message out there."

Examination Aids

At least one company has a commercial interest in promoting breast self-examinations. Becton Dickinson and Co. put its Sensability breast self-examination aid on the market in July 1999. The product, which sells for about $30, is a thin plastic pad filled with liquid that is meant to enhance breast self-exams. Although marketing analyst Debra Sidney turned down a request to provide sales figures of Sensability, she did comment that sales have been slow in the consumer arena. They are now focusing more on selling the product to professionals, hoping they will recommend the product to their patients.

What Is Being Done?

Although there are no clear-cut answers, the issue is not being ignored. "A lot of women are told to practice breast self-examinations and a lot of expense has gone into teaching women breast self-examination," said David Thomas, M.D., Dr.P.H., head of the epidemiology program at the Fred Hutchinson Cancer Research Center, Seattle. "We’d like to know if it’s doing any good or not." Thomas is heading a randomized trial of breast self-examination in 435 factories in Shanghai. Preliminary results in 1997 showed little benefit. Final results are due next year.



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Dr. David Thomas

 
The Canadian Task Force on Preventive Health Care is doing an evidence-based review of breast self-examination and of clinical practice guidelines. The results are expected by the end of summer.

Experts at both NCI and ACS are concerned that women could consider breast self-examinations a substitute for screening practices that have a proven benefit, such as mammograms. This, they fear, could put women at an even greater risk. "Women should not think that by doing breast self-exams, they are no longer in need of mammograms," Thomas said. "That would be a terrible mistake."

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The above information is from a shower hanger card produced by the American Cancer Society; however, it is no longer actively distributed. Other brochures on breast self-exams are available from ACS upon request.

 


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