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Breast Self Exam

Posted 3/6/2014

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  This is a nice example of "what goes around, comes around" or sometimes the older thing turns out to still be a very good thing. Most of us grew into adulthood with information about BSE/breast self-exam. We saw the posters and, hopefully, were taught by a doctor how to examine our own breasts and were told that doing so monthly would  likely enable us to find a cancer early.

  I took this advice seriously and practiced BSE regularly for years, for decades. When I was 44, I discovered the breast lump that turned out to be my first breast cancer--but not by BSE, by just stretching and slowly awakening in the morning. What the years of BSE had done for me, however, was teach me the natural landscape of my breasts, so that, when my fingers felt that lump, I immediately knew that it was new, and that it was bad. This turns out to be a pretty typical story. Many breast cancers are discovered by the woman herself, but most are felt sort of incidentally--in the shower, while getting dressed, etc. This fact should not discourage BSE--see above.

  This is relevant as there has been a lot of recent discussion/distress about the Candian study that once again casts doubt on the value of mammograms. Buried in that report was the fact that women (one arm of the study), who did not get regular screening mammograms, were taught to do BSE. And, guess, what, it turns out that the incidence of finding early cancers was just as good for those women as it was for those who did receive annual mammograms. I surely am not advocating that we dismiss mammograms (and, anyway, these studies are always about the general population, women who are screened, not about those of us who have had cancer), but I am suggesting that BSE should continue to be part of our health habits.

  Here is an article from The New York Times about this:

A Fresh Case for Breast Self-Exams

Scientists produced dismal news last week about mammograms. After tracking 90,000 women for 25
years, researchers in Canada found that those who received regular mammograms did not experience fewer
deaths from breast cancer or from all causes, compared with those who did not.
But buried in the news was a nugget of hope: The women who did not receive regular mammograms
were instead monitored with physical breast exams that proved effective. All of the participants were taught
to examine their own breasts once a month, and specially trained nurses examined women who were in their
50s. This low-tech approach, the researchers found, appeared to be as good as or better than regular
mammograms at locating the serious cancers that needed treatment.
The study authors are hesitant to draw any firm conclusions, because they did not set out to study
manual breast exams per se. But as the data came in, “I began to feel that what the trial was showing was
that clinical breast exam was effective and could substitute for mammography, if it was performed well and
was accompanied by the teaching of breast self-exam,” said Dr. Anthony B. Miller of the University of
Toronto, the study’s lead author.


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