January 21, 2018
woman performing self breast examination

Re-examining the Breast Self-Exam

by Berkeley Wellness  

For the past half century, women have been encouraged to perform a monthly breast self-exam—and may feel remiss or even guilty if they don’t do it faithfully. You may have been given pamphlets to read, videos to watch, and a card to hang in the shower—or even hands-on instruction courtesy of a silicone breast model with hidden lumps to feel for.

But what’s the evidence that this monthly ritual helps in early breast cancer detection and actually saves lives? You may be surprised to know it’s actually slim to nil.

Where’s the proof?

In its last update in 2009, the U.S. Preventive Services Task Force—an independent panel of experts that makes evidence-based health recommendations for the government—advised against clinicians teaching breast self-examination. It cited evidence suggesting that the exams do not reduce breast cancer deaths and some evidence that they cause harm. The harm includes false alarms, which can lead to unnecessary procedures (notably more biopsies of benign lesions) and extra worry.

For example, a large U.S. study in the Journal of Cancer Education in 2006 found that women who did breast self-exams had more unnecessary diagnostic mammograms; and for those diagnosed with breast cancer, breast self-exam performance did not correlate with reduced severity of the disease. Breast self-exam “did not show any advantages with respect to tumor outcomes,” the authors concluded.

The Canadian Task Force on Preventive Health Care similarly recommends against breast self-exams (a reversal of its earlier position), additionally citing evidence linking it to increased anxiety and depression. Some other health authorities, including the American Cancer Society, have taken a more neutral position, saying that women can choose to do breast self-exams occasionally or not at all, after being informed of the benefits and limitations.

Raising awareness

Instead of formal step-by-step breast self-exams in which you regularly and methodically search for lumps, the shift of late has been toward “breast self-awareness.” This approach simply encourages women to be mindful of what their breasts normally look and feel like so they can inform their health care providers if they detect any changes. Favored by the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network, this can be done by checking your breasts as you go about your normal activities, such as when showering or dressing—but it doesn’t have to be done in any specific way or at any specific time of the month.

Some women may feel more comfortable with this more relaxed style—but it is not without criticism either. First, it’s not really clear how a woman is supposed to develop “self-awareness” without doing a lot of feeling around, as she would with a formal breast self-exam. In fact, some organizations say women can include breast self-exams as part of breast self-awareness.

And though breast self-awareness is meant to empower women to take charge of their own health, a commentary in Obstetrics & Gynecology in 2014 concluded that “much like its more clearly defined predecessor, breast self-examination, breast self-awareness is being implemented and promoted without any evidence or known benefits.”

Getting clinical

If this leaves you befuddled about what to do, you’re not alone. Even health care providers vary in their views and practices. A survey in the Journal of Healthcare Quality in 2013 reported that more than half of OB-GYNs did not know that there were recommendations against teaching routine breast self-exams. And about half said they would recommend such exams to most women in their practices and would teach a specific technique.

Keep in mind also that the recommendations regarding breast self-exams have nothing to do with clinical breast exams done by health care providers as part of most women’s routine checkups. Even here, though, there is no universal agreement. The U.S. Task Force says the effectiveness of clinical breast exams has not been adequately proven, but many organizations recommend them (with varying schedules).

The general consensus is that clinical breast exams are an option, but should not replace mammography, which, despite its own shortfalls, remains the best breast cancer screening tool available. Some research shows that combining mammography with clinical breast exams detects more cancers than mammography alone.

It’s your choice

When it comes to keeping abreast of your breasts, do whatever you feel most comfortable with—whether that means doing regular step-by-step self-exams or simply practicing breast self-awareness. If you choose to do breast self-exams, be sure to get proper instruction from a qualified health care provider. Two good online resources are the American Cancer Society and BreastCancer.org.

What’s most important is to promptly notify your health care provider if you notice any changes in your breasts. That includes any reddening, darkening, or swelling of the breast, puckering of the skin, scaliness or sores on the nipple, new pain in one spot that persists, nipple discharge or inversion, or, of course, any lump or thickening in the breast or armpit.

If you want to forgo any kind of self-examination, that’s okay too, as long as you get regular clinical exams—which we think all women should have, whether they do self-exams or not. Also key is to discuss other breast cancer screening methods—notably mammography—with your health care provider. Keep in mind that screening recommendations for women at increased breast cancer risk (because of family history, for instance) differ from those for women at average risk.