Breast Self-Exams Don’t Work So Well
Today’s mantra for women and breast self-examinations is know your breasts. Self-examination won’t hurt but it can be anxiety producing.
Illustration by Raisa M. Yavneh
If you’re like many women, you grew up on a doctor’s office diet of routine breast self-exams, or the SBE. For generations, women, usually starting at their first menstrual period, were taught to carefully check their breasts monthly for lumps, bumps, or unusual changes.
Lift your arm over your head, using the opposite hand to check that breast. Press around the entire breast in a circular pattern, start to finish. Palpate up the side of the breast from the armpit to cover the lymph nodes. Pay attention to the nipples. Do it standing in front of the mirror. Do it lying down. In the shower. In the bath. Every period should be a reminder.
And so it went, for millions of females. Women were urged, encouraged, educated — by nurses, doctors, pamphlets, videos, and each other. Until the last few years.
The breast self-exam landscape has changed with solid research showing it has little benefit in detecting cancer or extending life. Studies also indicate that breast self-exams lead to unnecessary medical procedures such as biopsies. They also cause worry. The majority of breast cancers are detected through mammogram.
Many doctors, and indeed, the American Cancer Society, the National Breast Cancer Coalition, and the Susan B. Komen Foundation no longer recommend regular breast self-exams. This leaves some experts on the fence about what to instruct women. Most people know at least one woman who found cancer by examining her breasts.
Some providers still advocate for breast self-exams such as the National Breast Cancer Foundation Inc., a patient support and education group. Recently retired Kaiser Permanente breast surgeon and cancer expert Susan Kutner said the Kaiser medical plan still recommends routine self-exams, as part of a comprehensive approach to breast self-awareness.
At least one strong consensus has emerged from this evolving discussion: Know your breasts.
Breast familiarity, as a part of casual, everyday living, has largely replaced regulated self-exams as the best home approach to cancer detection. Even the few exam holdouts agree that women who know the feel and look of their breasts though regular activities such as dressing, showering, or sex can notice changes such as a lump, discharge, or swelling, and seek medical advice.
If knowing your breasts includes regular self-exams, no medical provider is likely to ask you to stop. But what was once a stern message to women is much softer today.
“It heightened anxiety; it wasn’t adding value. If it really were something that was making a big difference in survival, it would make sense to do it. In the absence of finding that, it made sense to back off,” said Heather Huddleston, an ob-gyn at UCSF Medical Center.
“A lot of women would say to me, ‘I hate examining my breasts or I dread it,’ ” Huddleston said. “They’d feel like the whole reason they did it is to find a cancer, and no one wants to think of that. And breasts are hard to examine.”
On the other hand, she added: “If you have a patient who feels strongly about it, and they know their bodies and want to advocate for themselves, it’s not, on an individual basis, going to cause them harm. On a population basis, it’s not leading to any benefits.”
The national breast coalition, a driver of evidence-based advice for the public, was one of the first major organizations to steer policy away from self-exams, about six years ago. It was among the first organizations to advocate for replacing self-breast exams with breast familiarity.
Women need to know the pros and cons of self-exams, the coalition stresses. The American Cancer Society followed suit a few years later.
“Breast exams are no longer a part of the screening recommendations because research does not show they provide a clear benefit. Still, the American Cancer Society says all women should be familiar with how their breasts normally look and feel and report any changes to their health care provider right away,” states the society’s website.
Even clinical breast exams in the doctor’s office by trained providers are no longer recommended for most women by many experts, including by the American Cancer Society.
Kutner, the retired Kaiser breast surgeon, said she respects the data that breast self-exams don’t significantly increase the chances of finding cancer or saving lives. “That being said doesn’t mean that self-breast exam doesn’t have an important value,” Kutner said. She said they’re useful for developing breast self-awareness and therefore worth recommending.
“Unlike other tests, breast self-exam doesn’t have a cost to it, doesn’t have exposures that are negative; we still do recommend that our patients know their bodies and do self-breast exams,” she said. Women are advised to see their primary care physician for a full evaluation if they notice anything abnormal.
But Kutner stressed that breast self-exam is just one piece of what should be a multi-pronged approach to cancer screening and prevention. “We couple this with other conversations. We don’t approach it as if it’s going to be the one and only thing that will detect their cancer at an early stage.”
Mammograms for older or high-risk patients, and a healthy lifestyle including regular exercise, weight management, and avoiding smoking are important to Kaiser’s message, Kutner said.
Mammograms are the gold standard for cancer screening for most women, even with controversy around when they should start and how often they should occur. “It is the best overall test for early detection of breast cancer,” Kutner said.
Different groups weigh in with slight differences, but the current recommendation is for women with an average breast cancer risk to start getting regular mammograms between ages 40 and 50 and continue every one or two years, with consultation with a doctor.
Earlier and more frequent mammogram is recommended for women at higher risk for breast cancer due to family history or genetic profile. Higher-risk women may also be advised to get other kinds of tests and screening.
Medical histories are different, genetic profiles are different, breasts are different, cancers are different, and so is access to health care. Age is also a risk factor for breast cancer.
There’s little disagreement that the optimal approach to breast cancer screening is individual or personal and should include talking with a doctor, mammograms at the suggested age and interval, and developing a sense of your breasts, how they look and feel to the touch, with the knowledge that few cancers are found this way and most lumps and bumps are normal.