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HomeHealth & FitnessTips | Why do doctors no longer recommend breast self-examination?

Tips | Why do doctors no longer recommend breast self-examination?

Tips |  Why do doctors no longer recommend breast self-examination?

Q: Should I do a breast self-exam? Why are they not recommended now?

TO: You should alert your doctor if you notice new changes in your breasts, such as dimpling, rash, or a lump. But teaching breast self-examinations is no longer recommended because it has not been proven to prevent breast cancer deaths.

In 2009, the United States Preventive Services Task Force (USPSTF) officially recommended against teaching breast self-examinations, a practice that had been widely promoted in public health campaigns for years before the guidelines. Those decades-old campaigns are ingrained in many of our memories. I remember cards in the gym locker room when I was a child instructing women on the technique of breast self-examination.

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So it may come as a surprise that they are no longer recommended.

This doesn’t mean that women (and men) shouldn’t become familiar with their breasts, even if teaching regular breast self-examination has not been shown to affect mortality.

It is important to recognize important breast changes that people may notice in their routine life while showering, shaving, applying deodorant, or putting on a bra. About 1 in 5 breast cancer survivors say they discovered their breast cancer “by accident” this way.

Why isn’t it better to check it periodically?

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The 2009 USPSTF recommendation was based in part on two large randomized controlled trials of breast self-examination of thousands of women published in 2002 and 2003.

In both studies, there was no reduction in mortality rates among groups randomly assigned to a breast self-examination educational program, but there was evidence of harm. That is, patients who were randomly assigned to perform breast self-examinations were significantly more likely to undergo invasive breast biopsies to detect benign lesions.

Undergoing these additional and unnecessary procedures can take a toll, both financially and on the patient’s psychological well-being. The 2003 study did note that both malignant and benign tumors were found more frequently among those in the self-examination group, but that did not affect mortality.

What that means is that finding a tumor in the breast (because you’re actively looking for it during a regular self-exam) or finding it by accident (when you shower or get dressed) has the same outcome in terms of possibilities. to survive cancer.

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Ask a Doctor: Do you have any health questions? We will find the right expert to answer it.

Those studies on breast self-examination were done in countries where at the time there were no large screening mammography programs like in the U.S. Here, we do They recommend screening mammograms for women every two years starting at age 40. (This advice is recent; previously the recommendation was to start at age 50). Unlike breast self-examinations, mammography has been shown to reduce mortality in multiple randomized controlled trials over the years. .

Scientists and doctors recognize that this still leaves a worrying gap for cases that occur before the age of 40. Overall, the incidence of breast cancer in women under 40 is low: around 25 cases per 100,000 women in 2019. In comparison, there were around 229 cases per 100,000 women in the 40-64 age group. and 462 per 100,000 in women aged 65 to 74 years.

How to best identify and evaluate younger people at highest risk (most of those cases are not genetic) is an important source of ongoing discussion and research.

We don’t have all of those answers yet, but experts tend to agree that becoming familiar with your breasts and recognizing important changes is still essential, even if teaching regular breast self-examinations is no longer recommended.

So how can I reduce my risk of breast cancer?

Some risk factors are not under your control, such as those related to the age at which your period started, pregnancy, and menopause. Having dense breasts, which is more common among black women, also increases the risk of breast cancer. But some risk factors you can change include quitting smoking, becoming more physically active, and reducing alcohol consumption.

It’s also important to ask your family members about their medical history, especially if first-degree relatives have breast or ovarian cancer, as this can increase your own risk.

What I want my patients to know

It’s scary to hear about rising cancer rates among young people, and you may know people in your own life who have been diagnosed early. It is important to understand that guidelines are developed through a systematic process based on population-wide risks and benefits. Experts try to make recommendations of the highest quality possible to benefit the greatest number of people and harm the smallest number of people. That math can be very complicated.

However, don’t wait until you’re 40 to discuss breast health with your doctor. Each person has individual risk factors that are important to discuss individually with your own doctor to determine if there is any reason that may warrant early evaluation.

Trisha Pasricha is a physician at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School.

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