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Dr. Kate: Is Breast Self-Exam Best?

Thu, Mar 5, 2009

Advice, What's Up Doc?

breastsphoto by Caitlinator

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City who answers your medical questions here once a week. To ask her your own question, click here.

Many of my patients have come in lately for their yearly check-ups, and as I do their breast exam, they confess that they haven’t been checking themselves as regularly as they ought to. But there isn’t really a clear answer as to whether or not women “should” perform breast self-exam (or BSE) on a regular basis. There are doctors on both sides of the debate, and if you search the web you’ll find a plethora of opinions. I tell my patients that there are two arguments to be made:

Reasons to perform routine BSE:

  • Most lumps that turn out to be cancer are found by the woman herself.
  • Knowing your own breasts — how they normally feel, what they normally look like — is essential for knowing when something doesn’t seem right.
  • Many doctors, unfortunately, don’t perform a thorough breast exam at your annual exam (how long did your doctor spend on your girls the last time you were there?).

Reasons NOT to perform BSE:

  • Many young women have “lumpy” breasts, and have a hard time distinguishing a “bad” lump from normal breast tissue.
  • There’s no study that shows that routine self-exam is any better at detecting breast cancer than occasional exams (by you or your partner) or preventing breast cancer deaths.
  • Routine exams, in fact, may increase the number of unnecessary biopsies that are performed for benign lumps.
  • It may make you more afraid, to be thinking about cancer so regularly, and not actually be helping you feel better about your body.
  • It’s one more thing to feel guilty about not doing (and you already feel guilty about not flossing, right?).

In the end, I support what each of my patients wants to do. If she doesn’t want to do BSE, no problem — I make sure she gets an annual exam from me. And if she does want to check herself regularly, I make sure she knows how to perform BSE and what to look for. There are many different resources available about how to properly perform a breast self-exam. Either way, you should know your body — but not approach it with worry.

Do you perform regular self-exams?

– Dr. Kate
Gyotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

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4 Responses to “Dr. Kate: Is Breast Self-Exam Best?”

  1. Antonio Says:

    I don’t have breasts, but I do perform regular testicular exams, guided by a pamphlet I found at a local hospital.

  2. AJ Says:

    My wife has had both breasts removed because of cancer. Soon after she started chemo I was talking to some friends about the preventative measures she had taken because she had a strong family history. One woman went home and told her husband that she had not done a self exam in a long time. They both did an exam and her husband asked about a lump he felt. Within two weeks a biopsy found a malignant lump and she eventually had the breat removed with no chemo required. She was so thankful that was willing to talk so directly about the subject.

    I would recommend that women who have a family history of breast cancer be more vigilent.

    It has been over 5 years since my wife’s diagnosis and she doing fine and is as beautiful as ever.

    AJ

  3. Cheating Says:

    Is there a way to locate someone locally to try this?

  4. Natalie Says:

    I started to have a professional exam with a breast cancer physician at 45 – breast exams are not recommended earlier than that as they often lead to biopsies.
    Self-examination has been totally discredited and my Dr says it’s better to be “breast aware” – to take note of shape, look and colour when you’re drying yourself after a shower.
    I think the emphasis on cancer is a bit unhealthy – I try to keep it all in perspective.
    We don’t have routine gyn exams in my country and pap smears are “offered” from age 30 and then 5 yearly until 50,55 or 60 (depending on past results and risk profile) No woman is forced or pressured to have smears – they have risks, so it must be YOUR decision.
    Women are given clear risk information and there are no scare campaigns.
    As a very low risk woman, I was told that I’d be unlikely to benefit, but if I wanted them, I was likely to face at least one false positive and biopsies in my lifetime. (55% of Finnish women face biopsies (only a very small number have any sign of malignancy) – in the States it’s a whopping 95%)
    I made an informed decision not to have screening. (I will also decline breast screening – the evidence against them is very strong – new research suggests they may INCREASE the risk of cancer because of the radiation and bruising of the breast tissue)
    If you have mammograms, be very careful before age 50 – they are VERY likely to lead to biopsies in women under 50.
    I was a bit shocked to read of all the invasive exams that are recommended annually for US women.
    In my country, our doctors are opposed to over-examining and over-screening as it leads to over-treatment and harm.
    It also means you lead lives focused on cancer and medicalized to a high degree….
    I think the healthiest approach is to adopt a balanced view – one that gives YOU the best protection without becoming a permanent patient.
    Womanhood isn’t a disease.


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