What about Breast Self Exams?
A review of studies regarding the value of monthly breast self exams concludes that they make no difference in survival. That is, women's lives are not saved by this long-recommended practice. Indeed twice as many women who do BSE undergo biopsies (with all their associated risks) that turn out not to be cancer as do women who have not been examining themselves regularly. The National Breast Cancer Coalition has been saying for years that "there is currently no scientific evidence from randomized trials that breast self exam finds breast cancer in earlier stages." And don't we all know that finding breast cancer earlier rather than later is a good thing?
Since we have all been educated (preached at? directed to? ordered?) to carefully perform BSE at the same time each month (younger women have been told to do so right after their periods, and older women have been told to pick a day each month that is easy to remember) with the seeming promise that this might help us save our own lives, how are we to understand this information? And, since it appears that the medical community has known for quite a while that BSE does not save lives, how come we have still been told to do it?
I certainly don't know the definitive answers, but I do have some thoughts about this. First, most breast lumps are discovered by the individual woman or her partner. The reality that these lumps are more likely palpated during a shower or dressing or love-making does not seem to eliminate the potential value of BSE. I found my own first breast cancer in 1993 while stretching in the morning. I did and do BSE, but had not felt it on a recent self exam. The fact, however, that I had examined myself regularly meant that I immediately recognized this lump as different. One absolute value of BSE is becoming familiar with the landscape of your breasts. When something is new or different, no matter how you find it, you will recognize it as a change.
Since most breast cancers grow very slowly and are likely to have been present for years before discovery, part of the thinking is that a few months more until a doctor finds it or a mammogram indicates a problem (and remember that not all cancers are seen on mammogram; my 1993 breast cancer never was seen, even after my doctor and I could feel it) won't matter. That is probably true, but it certainly won't hurt to find it a bit sooner. My second breast cancer, in 2005, was found on a mammogram before anyone could palpate it; I was grateful for this earlier detection.
We also know, unfortunately, that some breast cancers are lethal from the beginning. A woman who has the very bad luck to have a particularly virulent and nasty form of breast cancer may well die whenever it is found and whatever treatment she receives. Early detection and the right treatment cannot guarantee survival. We delude ourselves if we think that all breast cancers, if found early enough, will be cured. A major challenge in cancer research today is identifying which cancers need treatment, what the most effective treatment would be, and which cancers are unlikely to ever spread and can be cured by surgery and radiation therapy. The field of targeted therapies is growing quickly and certain to be more and more helpful in making treatment decisions in the future.
Since we sadly know that there is no screening tool or treatment that is guaranteed to cure every breast cancer, we still need to use everything we have to improve our chances of survival. Chemotherapy does not always prevent recurrence. It does improve the odds of staying well and, in many situations, is worth the risks. Mastectomies do not eliminate the possible recurrence of a local breast cancer, but they bring that risk down to about 1%. Radiation cannot promise that a breast cancer will not recur in that breast, but it makes it much less likely to happen. Hormonal therapies do not insure that an estrogen-receptor-positive breast cancer will never recur, but they are often more helpful than even chemotherapy in reducing that risk.
For screening, we know that mammograms sometimes miss cancers (especially in women who are still mensturating and have dense breast tissue), and that breast MRIs are exquisitely sensitive and may result in more biopsies that turn out not to be cancer. We know that even a surgeon's skilled hands cannot be certain that a lump is benign or malignant or whether axillary lymph nodes will turn out to be positive or negative. I would put BSE in this same group. It is an imperfect tool; regular BSE cannot guarantee that we will not die of breast cancer. However, by knowing our own breasts well, we are primed to recognize change. And early detection, while not a promise, is our best shot at staying well.