October is Breast Cancer Awareness Month

Early Detection and Screening:

The Self Breast ExamBreast self-exam is a screening method that is intended to find early tumors, particularly those that develop in the time between annual mammograms and clinical breast exams. By doing breast self-exams once a month, women can become familiar with the way their breasts look and feel normally and thus may be able to recognize changes, such as thickening, lumps, spontaneous nipple discharge or skin changes, such as dimpling or puckering.

When doing breast self-exams, many women may find that their breasts feel lumpy, because breast tissue naturally has a bumpy texture. There is also a great deal of individual variation, so that for some women, the lumpiness is more pronounced than for others. In most cases, this lumpiness is no cause to worry. If the lumpiness can be felt throughout the breast, then it is probably just the normal breast tissue. The kinds of lumps that are of concern are ones that are firmer than the rest of the breast. When such a lump is found, there is more of a risk that it may be cancer, although cysts and fibroadenomas can cause similar lumps. Any time a woman discovers a new lump that feels different from the rest of the breast or one that is different from what she has felt before, she should have it checked by a health care provider.

The Susan G. Komen Breast Cancer Foundation recommends a 3-step approach to breast cancer screening that includes, depending upon a woman’s age, a combination of mammography, clinical breast exams and breast self-exams.

• Monthly breast self-exam beginning by age 20.
• Clinical breast exam at least every 3 years beginning at age 20, and annually from age 40 on.
• Annual screening mammograms beginning at age 40.

Women with a family history of breast cancer or other concerns about their personal risk should consult with a health care provider. Screening tests may need to be done more often and/or started earlier than usual.

As part of a total approach to breast health, it is also important that women become familiar with their own bodies; play an active role in their own health; and develop a close partnership with their health care providers.

Learning how to do breast self-Exam
• To find out how to do breast self-exam, ask a health care provider, call the Foundation’s National Toll-Free Breast Care Helpline, 1.800.I’M AWARE® (1.800.462.9273) or click here.

What’s the Evidence for Breast Self-Exam?
Intuitively, breast self-exam seems like an ideal method of early detection, because it is something all women can do on their own. Unfortunately, it is still unclear whether breast self-exam is a useful way for the majority of women to detect early stage tumors and improve their chances for survival, and there has been some controversy about whether it should even be included in screening recommendations. Breast self-exam is the screening test that has the least scientific support. Women who practice it should be sure that they also get the recommended mammogram and clinical breast exam and not substitute breast self-exam for other recommended screening tests.

Admittedly, breast self-exam seemed promising when it was first introduced, and it has been widely advocated, but the evidence that it actually provides a benefit is not conclusive. Results of studies on its effectiveness have been mixed, with some supporting its value and others not.

A study in China, one of the largest done so far, did not find a difference in mortality after ten years between women who were practicing regular breast self-exam and women who were not. On top of this, the study also found that the self-exam group had nearly twice the number of benign breast lesions diagnosed as the other group, which means that breast self-exam caused many women to endure unnecessary follow-up biopsies.

Despite the disappointing results of this study, the researchers did not rule out the possibility of a modest survival benefit if women practiced self-exams regularly and proficiently. The researchers saw no reason to discourage women from practicing breast self-exams, as long as women were aware that the practice had no proven survival benefit and could be increasing their chances of having an unnecessary breast biopsy.

Despite the open question about its overall benefit, breast self-exam does provide an opportunity for women to become more aware of their own bodies and the fact that they can play active roles in their health. The Komen Foundation currently recommends that all women age 20 and over perform monthly breast self-exams in addition to other appropriate breast cancer screening tests.

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