Breast self examination – more harm than help

It  seems so sensible to try and find breast cancers early. Yet the truth in medicine is often counterintuitive, and this is one such example.  

The headlines today are about breast self examination – regular exams done by women themselves looking for lumps – being ineffective to reduce deaths from breast cancer. 

One of the things I was taught at medical school was that I should show women how to examine their breasts a quarter at a time. I was horrified when I was later told to demonstrate breast self examination in a spiral fashion – apparently I had been doing it all wrong! It took me a while longer to realise that there was no evidence for any of this. Worse, by telling women to do regular breast self exams, I was doing harm.

This paper generating the headlines is published by the Cochrane Collaboration and is available here. In fact, this builds on previous research  which I wrote about a while ago, here.

How can something as seemingly benign as advising women to do breast self examinations cause harm? Women doing breast self examinations seem to be more likely to feel lumps,  which end up needing to be biopsied. The argument here is usually: better safe than sorry! But this misses the point. Since there was no extra benefit to be had from doing regular breast self examinations, there was no extra ‘safety’ to gain from these women having an increased rate of biopsies being done.

That said, most women find breast cancers themselves. The important thing remains: breast lumps are still going to need a doctor and a diagnosis. But two things; women who feel guilty -or even in some way responsible – for their breast cancer because they didn’t do regular self examinations can stop doing so. And doctors should have good evidence of benefit before recommending things to patients – even seemingly sensible things can end up doing harm.

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