Results from a ten-year study of 266,000 female factory workers in Shanghai, China, published Wednesday in the Journal of the National Cancer Institute, show the workers who performed self-exams regularly were no less likely to die from breast cancer than the women who never did the exams. Self-exam practitioners were more likely to detect benign breast anomalies than their peers, but there was no effect on the risk of death.
Does this mean we should all abandon our monthly self-exams? No. But it does mean we need to look at the practice with new, more reasonable expectations. And it also means that women who find the whole self-exam process to be more anxiety producing than reassuring can give themselves a break.
Doctors differ over how to address the issue of self-exams with patients. Rebecca Garcia, Ph.D., vice president of mission services at the Susan G. Komen Breast Cancer Foundation, believes self-exams still play an important role in maintaining breast health. "We realize there are limitations to individual screening options, including self-exam," she says. "That's why we advise women to use them — self-exam, doctor exams, mammograms — in concert." For Dr. Blake Cady, director of the Breast Health Center at Women & Infants Hospital of Rhode Island, however, the China study simply corroborates his long-held beliefs. "The idea of self-exams has been inculcated into the culture of cancer detection," he says, "but there's never been a study showing it works." Instead, Dr. Cady says, most women who find their own cancer (and that's a huge percentage of women who are diagnosed) locate it during normal, everyday activities, like showering, bathing or getting dressed.
Rather than telling women they absolutely must do exams, Dr. Cady believes doctors should concentrate their energies on mammography, which offers a far more sophisticated overview of breast tissue and can sometimes rule out the scary-feeling benign cysts that send so many self-examining women to their doctors' offices in a panic. "Women who do self-exams conscientiously and consistently should continue," he says. "Women who haven't yet started exams, I tell not to bother."
The key, says Dr. Cady, is to get a baseline mammogram — the American Cancer Society recommends women start getting mammograms at 40, or earlier if there is a strong family history of breast cancer. After the first screening, women should get mammograms every 2 years — or more or less often depending on a physician's recommendation.
But for women too young for mammograms, Dr. Garcia counters, the self-exam remains an excellent option. "We believe that taking control, learning about their bodies — what's normal, what's not — helps women take an active role in their health care." That's a goal no one can argue with.