Self Breast Exam - Should I Be Doing Them?

The self breast exam is one form of breast cancer screening which can potentially lead to an earlier diagnosis of this disease. It is the regular, manual examination of the breast by the woman herself. The reason that screening for common forms of cancer are important is that most cancers have the best chance for successful treatment if they are caught in an early stage. Screening in asymptomatic individuals helps to catch early cancers while they are small and less advanced and therefore easier to treat.

For breast cancer, mammography is the most effective way to detect early cancers. However, mammography is not recommended routinely at present until after 50 years of age, every other year. There is even more controversy about the ideal recommendations for self breast exam. Although self exam has been recommended for years as a way to help screen for breast cancer in young and old women alike, the recent findings of the US Preventive Services Task Force suggested that self exams do not help save lives.

So what is a woman to do? Like most of our health care decision, each woman must weigh the options to decide what is best for themselves and what they feel most comfortable with. In some cases the answer is fairly obvious. Women who have a personal or strong family history of breast cancer (particularly if they carry the breast cancer genes, BRCA1 or BRCA2) will often opt for earlier and more aggressive screening. They will often start regular mammograms earlier and opt for frequent self and doctor exams. However, women without any of these risk factors have to weigh the options and decide what they, and their doctors, feel most comfortable with.

The Self Breast Exam: What are the pro's and con's?

Pro's: As discussed above, screening has the advantage of potentially catching cancers earlier when they can be treated more effectively. In fact, caught early, most breast cancers can be treated with a high level of success today. So, in theory, any screening method which can potentially expose a cancer early, before other screening or symptoms reveal the disease, is a good thing.

Con's: On the contrary, a screening test is not necessarily a good thing if the results it gives are inaccurate or confusing in any way. In the case of self exams for breast cancer, not all women perform the exam accurately and may miss lumps (a "false negative" test), giving them a false sense of security and possibly dissuading them from persuing more effective means of screening (such as regular mammograms and doctor visits). Additionally, some women may discover lumps which are not cancer. In fact many women have cystic or otherwise lump breast tissue which can be confusing and hard to examine without extensive experience. These "false positives" can lead to a scare that results in the woman receiving a full work-up, including invasive tests such as a needle biopsy or lumpectomy. If these do not turn out to be cancer, they may have been unwarranted.

Now, with all screening tests, some degree of "false positives" and "false negatives" are expected. But the more they occur, the more potential for harm, either in missing the diagnosis or in making a false diagnosis which leads to unneccessary procedures. These procedures have their own risks associated with them.