Breast Self-Exam Gets Thumbs Down in Systematic Review

By Charles Bankhead
COPENHAGEN, 17 july 2008 -- Breast self-examination does not reduce breast cancer mortality and may cause harm by prompting unnecessary biopsies, according to data on almost 400,000 women.
Women who performed self-examination had virtually identical breast cancer mortality rates as women who did not examine their breasts, Jan Peter Kosters, Ph.D., and Peter C. Gotzsche, Ph.D., of the Nordic Cochrane Center here, reported in a Cochrane Review.
What's more, women who did breast self-examination had almost twice as many negative breast biopsies as women who did not perform self-exams.
"At present, screening by breast self-examination or physical examination [by trained healthcare personnel] cannot be recommended," the authors said.
The results updated and confirmed those from a 2003 review that reached similar conclusions.
Debbie Saslow, Ph.D., a spokesperson for the American Cancer Society, said the organization revised its recommendations for breast self-examination more than five years ago in response to emerging evidence of a lack of benefit. Monthly breast self-exams remain optional, however.
"We are advising that women should be aware of what is normal for how their breasts looked and felt, and to promptly report any changes to their healthcare provider," said Dr. Saslow. "Women who want to, should keep doing breast self-exams, and women who don't want to, don't need to."
In their current review, Drs. Kosters and Gotzsche analyzed data on 388,535 women involved in population-based studies in Russia and Shanghai. Objectives of both studies included a comparison of breast self-examination and no examination.
The comparison showed no significant difference in breast cancer mortality between the two groups (RR 1.05, 95% CI 0.90 to 1.24).
In the Russian study, women who performed breast self-exams identified more cancers (RR 1.24, 95% CI 1.09 to 1.41), but the Shanghai study demonstrated no difference in detection rates (RR 0.97, 95% CI 0.88 to 1.06).
Breast self-examination led to 3,406 negative breast biopsies, compared with 1,856 in the control group (RR 1.88, 95% CI 1.77 to 1.99).
"Data from two large trials do not suggest a beneficial effect of screening by breast self-examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed," the authors concluded.
Drs. Kosters and Gotzsche reported no disclosures.
Primary source: Cochrane Database of Systematic ReviewsSource reference:Kosters JP, Gotzschke P "Regular self-examination or clinical examination for early detection of breast cancer (Review)" Cochrane Database Syst Rev 2008; 3:DOI: 10.1002/14651858.CD003373.