Breast self-exam

In June, 2001, the journal of the Canadian Medical Association, which represents physicians in Canada, published the results of a study that came to the conclusion that regular breast self-exam (BSE) by women does not reduce the risk of dying of breast cancer.

This unleashed a storm of anger from breast cancer survivors and doctors alike. The American and Canadian Cancer Societies had been recommending monthly BSE for women since the early 1950s! Many breast cancer survivors had discovered their cancer themselves and gave vigilance with BSE as the reason that they were still alive. Nevertheless, the Canadian Cancer Society stopped recommending monthly breast self-examination.

The report that garnered so much attention had analyzed many studies related to BSE and death due to breast cancer - this is called a meta-analysis - and discovered that although BSE appears to be a simple and low-cost method of catching cancer early, it is not. It is difficult to learn to do well and to perform consistently. There was also some evidence that it caused more medical interventions, when a non-malignant "lump" was discovered and investigated. It was reasoned that this would lead to an increased cost burden to the health care system and needless worry by women without a corresponding benefit in saved lives.

Given this controversy, what are the current guidelines? The latest breast cancer screening guidelines from the Canadian Task Force on Preventive Health Care, which apply to average-risk women aged 40 to 74, recommend against routine breast self-examination. Rather than monthly breast self-exams, the Canadian Cancer Society recommends that women become familiar with the usual look and feel of their breasts and report any changes to their doctor.

Mammograms

Mammograms are low-dose X-rays of the breast that are used to detect breast cancer. Mammograms are used for screening and diagnostic purposes. Screening mammograms look for breast cancer signs that may be developing, even if you are not experiencing symptoms. Diagnostic mammograms are used if you have a lump in your breast or other symptom that needs further investigation.

The controversy over mammograms is focused on whether regular screening mammograms should be recommended for women under the age of 50. For women over 50, there is general consensus in the medical community that regular screening mammograms after menopause find breast cancers at an early stage, when treatment is most likely to be successful. However, younger women's breasts are dense, making the abnormalities that signal breast cancer hard to detect. It is sometimes referred to as "trying to find a polar bear in a snowstorm."

So what's a girl to do?
In Canada, the most recent guidelines recommend that women between 50 and 74 should have a mammogram every 2 to 3 years to screen for breast cancer.

Women at higher risk for breast cancer may need to start earlier. It's best to talk to your doctor about when to start getting regular mammograms.