Monday, October 07, 2002

Doctors stand fast on value of breast self-exams

By Peggy O'Farrell
The Cincinnati Enquirer

        Self-exams are still an important component of breast health, Tristate breast cancer experts say, despite a new study that says teaching patients to check their own breasts for lumps is a bad investment of health-care dollars.

        The study from the Fred Hutchinson Cancer Research Center in Seattle followed more than a quarter-million Chinese factory workers for more than 10 years. Half learned to perform self-exams, and the other half did not. There was no difference in breast cancer deaths between the two groups, and the women who did self-exams didn't find any more malignancies than the other group - but they did find more benign lesions, which led to more intensive testing.

        Dr. David Thomas, lead author of the study and a cancer epidemiology researcher, said in an interview with the Seattle Post-Intelligencer that self-exams should not be used as a substitute for regular mammograms. He also said the study concluded that funding for cancer prevention could be better invested in developing countries. Breast cancer is uncommon in Asia, and mammography and ultrasound are not widely available in China.

        But local clinicians say self-exams are a valuable tool and they've treated many patients who came in because they found lumps that turned out to be cancer during routine self-exams.

        “Who is more likely to know if there's a change in your breast, you who are checking every month or the doctor you see once a year?” asks Dr. Jackie Sweeney, a radiologist with Radiology Associates of Northern Kentucky in Edgewood.

        Self-exams are especially useful for women in their 20s and 30s who are too young to get routine screening mammograms, which should begin at age 40. And mammograms might miss some lesions in younger women because breast tissue is much denser in younger women.

        “We've seen women in their 20s with breast cancers. To discourage self-exams, when would they have found that?” Dr. Sweeney asks.

        “There are lesions, and they're not going to be common, that you're only going to pick up on a self-exam and they're going to bring women into the clinician's office,” says Dr. Susan Weinberg. “Some of those obviously are going to be benign. But I've had patients who've found lumps that turn out to be cancer. It's not common. It happens, particularly in younger patients who are not mammography age, to pick up things on a self-exam that turn out to be cancerous.”

        Dr. Weinberg, the medical director of the Bethesda North Center for Breast Care, says self-exams are an important component of what she calls the “triad” of breast care: Self-exam, physical exam by a doctor or nurse and screening mammogram.

        “To take one out of context is not in anyone's best interest. You need to learn all three and practice all three,” Dr. Weinberg says.

        The Seattle study isn't the first to question the value of self-exams, says Dr. Elizabeth Shaugnessy, a surgical oncologist specializing in breast cancer at the Barrett Cancer Center.

        “There've been a number of previous studies that would suggest that women did not find masses as readily as medical professionals would find them,” Dr. Shaugnessy says. “I can tell you from personal experience that learning to do a breast exam took a long time. The texture changes and there are different textures when you're pregnant and when you're pre-menopausal and post-menopausal. It's very confusing.”

        But self-exams are still important and women should continue performing them, she says.

        “Obviously something's being found and women are finding it during self-exams,” she says.

        The study suggests that self-exams have no impact on the outcome, or successful treatment, of breast cancer. “That says something about how fast breast cancer grows as well,” Dr. Shaugnessy says. “It does not grow very quickly for most people. For some women, finding something on self-exam might be helpful in treating it more quickly. And it might be that by waiting a couple of more months and having a clinical exam done by a professional that the mass might not have changed.”

        Dr. Sweeney says she's especially concerned that women who are already scared of what a breast exam might reveal will use the study, published in Wednesday's Journal of the National Cancer Institute, as an excuse to give up on breast checks entirely.

        “It's just one more disincentive to women accessing breast care,” Dr. Sweeney says.


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