Do you really need to do breast self-exams?

If you want to do a breast self-examination or if you're embarrassed to skip it for months at a time, do not worry. Large medical organizations no longer recommend BSE as a screening tool for early detection of breast cancer in women at average risk of contracting the disease.

But they make emphasize the "breast self-awareness". Essentially, this means getting acquainted with the usual appearance and feel of your breasts, so that you will be more likely to recognize something that comes out of the ordinary.

"I think the message at home for women is to be attentive to changes in their breasts," says Robert Smith, PhD, an epidemiologist and vice-president of cancer screening for cancer. American Cancer Society in Atlanta.

BSE was once considered a crucial tool for early detection of breast cancer, especially before mammography became the gold standard for breast cancer screening.

A thorough self-examination of the breasts involves several stages. A woman examines each breast and the surrounding tissues in a precise matrix using her fingers to look for any unusual masses or thickening tissue. He is played in a supine and standing position. The last step requires a mirror to observe any changes in the appearance of her breasts.

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Naturally, doctors assumed that teaching women BSE would save lives. However, evidence from two large clinical trials – one in China and the other in Russia – has shown no significant reduction in the number of breast cancer deaths among women who have learned the disease. compared to those who have not received such an instruction.

The experts acknowledged that there were problems with the studies. For example, women who learned to practice BSE did not follow it month after month or did not do it properly. In addition, studies have raised fears of unnecessary testing because women with BSE were undergoing more imaging procedures and biopsies.

After weighing the risk of false alerts versus lack of evidence of potential benefits, guidelines writing groups, including the US Task Force on Prevention Services, the American Cancer Society and the American College obstetricians and gynecologists (ACOG), began to go back. on the ESB.

In any case, some physicians and patient rights advocates continue to subscribe to self-examination as an important screening tool.

"For any individual, this may be the difference between less aggressive treatment and potentially longer survival," insists Marisa Weiss, MD, director of breast health awareness at Lankenau Medical Center. from Wynnewood, Pennsylvania, and Chief Medical Officer of Breastcancer.org, a non-profit educational outing.

Breastcancer.org recommends that all women perform these routine self-exams and have mammograms and clinical examinations of their doctor's breasts.

Lisa Jacobs, MD, an associate professor of breast cancer surgery at Baltimore's Johns Hopkins Medicine, says "should be a discussion about whether it's good for an individual."

"Frankly, mammography can miss between 10% and 20% of breast cancers," she adds. "And so, if the only screening test is mammography, … how are we going to find these cancers?"

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What does it mean to be self-conscious?

Mark Pearlman, MD, professor in the Department of Obstetrics and Gynecology at the Michigan Hospital and Health Systems in Ann Arbor, has been involved in writing the ACOG's guidelines on screening breast cancer, which reflect the risk of harm resulting from false positive test results of evidence of benefit.

Still, Dr. Pearlman notes that half of women over 50 and 70% of women under 50 are discovering their own breast cancer. "So, we can not really say, OK, just ignore your breasts." This gave birth to the concept of self-awareness of the breasts, he says.

What does it mean, exactly, to be self-aware? In reality, there is no standard definition.

The ACOG describes it as knowing what is normal for your breasts and paying attention to the changes you may be feeling.

Susan G. Komen, the national breast cancer research and advocacy group, defines it very broadly. Women need to know their risk of breast cancer, including their family history, he says. They must have regular mammograms and clinical examinations of the breasts. They must make healthy lifestyle choices and know what is normal for them.

"It's important to know the warning signs of breast cancer," said Susan Brown, Chief Nursing Officer, Director General of Health and Komen's Mission Program. Look for a size, a hard knot or a thickening in the chest; a change in shape or size of your chest; or signs such as swelling, redness, or nipple discharge, for example.

Dr. Pearlman advises average risk patients to be aware of all that is strange when they wear a bra, wash in the shower, or have an intimate relationship with a partner. "If something seems different, call your provider," he says. "It's a relatively simple message."

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