Breast self exams

File this one under the "Sure to be controversial" file. This news release is based upon a Cochrane database review of the efficacy of breast self exam in preventing deaths from breast cancer. According to the article, the authors were able to find "two large population-based studies involving 388,535 women who compared breast self-examination with no intervention", one out of China and one out of Russia. Women who were randomized to the breast self exam were more likely to have breast biopsies of benign disease, and there was no benefit in terms of earlier detection of breast cancer or overall survival. There are many limitations with both of these studies, including imbalances in the overall mortality between arms in the China study suggesting there is a bias present. The ongoing studies that may also help answer the question are being done in Egypt and India. I would argue that all of these populations may not be applicable to the United States where we have mammography and clinical exams also available to us. However, the weight of the evidence, even with the problems with the above studies noted, is such that I doubt we will ever need to recommend breast self exams as an early detection method. The American Cancer Society may disagree with me. I suspect many breast cancer advocates may beg to differ as well. In any case, this review also made me remember back in college when I was a resident advisor in the dorms. I was asked to hang up laminated cards in the women's showers explaining how to do a breast self exam and replace them if anyone took a copy for their own use. I did this job joyfully thinking maybe I was helping just one person get a lump evaluated by their doctor. It never occurred to me to question whether the exams were helpful, they just seemed so benign at the time.