Breast self-exams are no longer recommended. Here’s why and what to do instead

I was in the shower, rushing to work, daydreaming about an upcoming vacation, when I felt it: the tiny pebble was firmly planted in my right breast. I stood there, not breathing, underwater. Would I lose my breasts? Would I be able to see my daughter grow up? Finally, after dreading it for so long—knowing the history of breast cancer on both sides of my family, being hyperaware of the 1 in 8 risk for all women—I knew it was my turn.

After a battery of tests, a diagnosis and many decisions, I ended up having a double mastectomy. But at least I had caught the cancer early. Because the mammogram I had done on my dense breasts less than a year ago hadn’t.

So I was surprised to learn, then, only recently, that breast self-exams are no longer recommended as a screening tool by most experts, including the National Cancer Institute, the National Cancer Network, the American Cancer Society, and the United States. The Preventive Services Task Force (USPSTF), the volunteer task force that makes recommendations to Congress, first urged “against the teaching of breast self-examination (BSE)” back in 2009 and does not mention BSE in its current recommendations.

However, while I technically found my own nodule by accident, as do 18% of women diagnosed with breast cancer, many others—between 25% and 75% of all diagnoses, depending on the study—of which there are more—discovered their cancer while consciously performing a breast self-examination. So what gives?

No benefit in reducing mortality

Research shows that BSE does not offer the early detection and survival benefits of other screening tests such as mammograms. According to a meta-analysis of large controlled trials comparing women who did routine breast self-exams with those who didn’t, there was actually no difference in breast cancer survival . Furthermore, women who had BSE had more false-positive results, resulting in almost twice as many non-cancerous breast biopsies.

“Is it absolutely true that some women find their own lumps even though they have breast screenings with mammograms? The answer is absolutely yes. We all have anecdotes,” says Dr. Larry Norton, an oncologist at Memorial Sloan Kettering Cancer Center in New York.

he says wealth that it is important to put official recommendations in context.

“These sources are not saying it shouldn’t be done,” he notes. “They say they can’t find prospective randomized evidence (the gold standard for effective research) that it helps, and that’s a very different claim.” This is partly because mammograms and other screening techniques, including sonograms and MRIs (both of which are recommended for the large number of women with dense breasts), are so effective at finding “very, very small lesions” that cannot be felt – and that they have clearly demonstrated that they make a difference, both in terms of survival and outcome.

“So in that context,” Norton explains, “the incremental benefit of breast self-examination is very hard to demonstrate… And the rules of the game are, if you can’t demonstrate it in prospective, randomized trials, you can” I don’t recommend it.”

A quick history of breast self-exams

The idea of ​​a breast self-exam first came from the theory, popularized by an American surgeon in the early 1900s, that breast cancer begins as a localized disease that is more curable if caught early, according to an article in Journal of the Canadian Medical Association. One of its earliest proponents was a New York physician who in 1929—more than 30 years before mammograms were popularized as a screening tool in the U.S.—wrote that “waiting for a lump to appear had no sense”, propelling the idea of ​​BSE. across the US, Canada and Europe, despite a lack of data to support them.

A 1950 educational film on the subject, Breast self-examination, from the American Cancer Society and the National Cancer Institute, would eventually be seen by more than 13 million women; Accompanying material stated that BSE’s finding of smaller cancers dramatically improved a woman’s chances of survival.

It also put the onus on women—which some saw as empowering and others as a burden—and women began to talk about how self-exams saved their lives. The practice gained more momentum in the 1970s as a way for women to become less dependent on the medical system.

However, evidence that BSE decreased breast cancer mortality remained insufficient. And while moving away from it has remained controversial over the years — especially among some breast cancer survivors who believe they would have died without it — the recommendations have changed.

Transitioning to breast self-awareness

Encouraging patients to be aware of how their bodies feel so they can easily detect change is the USPSTF’s current recommendation as of 2016, when it noted support for “all patients to be aware of changes in their bodies and to discuss these changes with the clinicians. ” It is what is mostly called cultivating “breast self-awareness”.

“I strongly believe that people should know how their bodies feel, men and women, and if they notice anything out of the ordinary, they should bring it to the attention of a health professional,” says Norton. “So that’s what I tell my patients.”

If they ask for further instructions, he refers them to the indications for BSE on the Memorial Sloan Ketterings website, which notes, “MSK does not recommend performing a BSE as part of routine breast cancer screening. That’s because studies show it doesn’t help find breast cancer, nor does it help people live longer. However, you may choose to do a BSE as a way to familiarize yourself with your breasts. You can do a BSE once a month, once in a while or not at all.”

The Susan G. Komen organization, which powers breast cancer research, focuses its messages “on the importance of knowing what’s normal for you and then reporting any changes to your doctor,” says Erica Kuhn, director of health information and publications. . While the organization sees “no real harm” in doing a BSE, Komen, “as an evidence-based organization, would not promote this behavior,” she says.

However, not everyone has completely abandoned the idea of ​​BSE as a line of defense.

“We didn’t budge that much — and we’re still handing out the shower cards (with self-exam instructions),” says Ashley Miller, a spokeswoman for the National Breast Cancer Foundation — whose founder found her own breast cancer through a self-examination. However, “It’s not just about doing a breast self-exam, although we encourage that. Educate women – and men – about the need to know what your breasts look like,” Miller points out.

“I personally have never met someone who has had a breast exam and regretted it,” says Dr. Kiarra King, OB/GYN. wealth. And while she wouldn’t necessarily direct anyone to get a BSE every month, because she understands the rationale of not causing harm through anxiety and unnecessary biopsies, “I’ll never say ‘No!’ It’s stupid,” says King. “People need to be comfortable with the decisions they make about their bodies.”

That idea resonates strongly with Abigail Glavy, 34, of Dallas, who says wealth about how she was vigilant, even at 32, because of her family history of breast cancer. Then he was in the shower doing a self-examination. “I felt a lump on my right side – and immediately felt a strong sense of panic,” she recalls.

What Glavy found turned out to be DCIS—ductal carcinoma in situ, also called stage 0 breast cancer, news she received in a phone call from the doctor who reviewed her mammogram and ultrasound results, because dense breasts.

She tested positive for a genetic mutation that made her more at risk for breast and other cancers and ended up with a bilateral mastectomy with reconstruction. And she feels grateful that she found the cancer when she did, especially since the recommended age for her first mammogram, 40, was many years away, despite breast cancer rates steadily rising in younger women.

“It can be scary to do a breast self-exam, and you might feel something that looks scary or might cause panic or anxiety,” she says, even if it’s not cancer. “Of course, in this case, I felt something and it ended up being cancerous, but I got through it.” Whether you want to do self-exams or not, she stresses, it’s important to know your body and support yourself.

“No one is going to care more about you and your health,” she says.

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