When it comes to breast cancer, some facts are not in dispute.
It’s the most common cancer in the United States and in women around the world. It’s the leading cause of premature death among U.S. women. Early detection can help prevent these deaths. Regular mammograms reduce breast cancer mortality by 20 to 40 percent in all age groups.
Those facts are straightforward, but the state of breast cancer recommendations is not. Take changing recommendations for the breast self exams, for example. These can be confusing for women who just want to know how to stay healthy.
For checking yourself, newer guidance centers on “breast self awareness” instead of self exams. But what does that mean for you?
Different groups, different guidance
In 2009, the U.S Preventive Services Task Force recommended against doctors teaching women about breast self examination. This shift was based on large studies out of Russia and China in the 1990s.
These studies reported that such exams, without mammography, do not reduce breast cancer deaths and may even cause harm by prompting unnecessary biopsies. But 67 percent of the women studied did not even perform self exams.
More recently, researchers presented a large study out of India at the San Antonio Breast Cancer Symposium. In this study, 150,000 women were randomized into two groups. Some had clinical breast exams plus self breast exams. Others simply received information on awareness. Neither group received mammograms.
In the study, women who developed breast cancer were diagnosed at an earlier stage if they had clinical and breast self exams.
I’ll add that in our practice, not a week goes by without a woman coming in having discovered her own lump that turns out to be cancerous. We do not see droves of women coming in with false findings. This is anecdotal, but it is common in many practices.
Also, not all major groups agree about self exams.
For example, the American Cancer Society no longer recommends either clinical breast exams or breast self exams. But the National Comprehensive Cancer Network (NCCN) does recommend clinical breast examination every one to three years from age 20-39, then annual clinical exams at 40.
The NCCN also advises that all women practice breast self awareness after age 25. They define self breast awareness as a woman:
- Being familiar with her breasts and reporting changes to her health care provider,
- Knowing her family history,
- Knowing her breast density, and
- Understanding her modifiable risk factors.
It’s more than just the self exam
If you wonder what self breast awareness really means, think about this: You can’t truly be aware
of your breasts without touching them.
In the past, many women have been scared they weren’t doing a self exam right. My advice is not to get too caught up in the details. Yes, there are good guidelines available
to get the best results — but the best thing you can do is just do it. Become familiar with your own body, and watch for changes. And when you find changes, talk to your doctor.
However, self breast awareness goes beyond the physical exam. You should know about the risk factors you can control, such as your weight and your alcohol consumption. If you’re at risk for breast cancer, talk to your doctor about plans to manage these risks.
Self breast awareness also means knowing your family history. If you know people in your family had breast cancer at an early age, for example, that’s a red flag to seek genetic counseling.
Still, with about 75 percent of diagnoses, the woman has no family history of breast cancer. So breast self awareness takes other risk factors into account, too.
For example, do you know your breast density
? If you don’t, ask next time you have a mammogram. Having dense breasts can make tumors more difficult to see on mammograms. In some cases, it raises the risk of cancer. These risks may lead to the need for added screening.
In other words, the more you know about your own breasts, the better.
In the end, recommendations are just that — recommendations. Women should learn about their breasts and make decisions accordingly. Many might be willing to accept the benefit of finding cancer early at the risk of the anxiety of a false positive. And sometimes it helps just to find out that a lump you discovered is not cancerous.