Though you may not know it, since it's still promoted by doctors and some organizations, the monthly breast self-exam (or BSE) has been in the cross hairs for a while. The American Cancer Society's screening recommendations made it optional in 2003. The grass-roots group Susan G. Komen for the Cure promotes "breast self-awareness" rather than regular monthly exams. And this week, a review of existing research concludes what many doctors have been saying for years: There's no evidence that monthly self-exams reduce breast cancer deaths.
Though the data aren't new, the review, by the prestigious Cochrane Collaboration, and appearing in the Cochrane Library, is likely to add to the confusion many women have over this issue. How in the heck can something so common-sensical as a regular check for lumps in the breast be anything but good? If not the monthly exam, then what? And if you already have the exam habit, should you break it?
It's intuitive that monitoring the breasts for changes should lead to detecting cancer earlier and, therefore, to fewer deaths from the disease. Everyone has a story of a friend who found a lump—perhaps even one missed by a recent mammogram—that turned out to be treatable cancer. But there's a distinction, as fine as it may seem, between what longtime breast self-exam critic Susan Love calls "the formal, high church breast exam" and simply being familiar with your own body. The normal poking around that women (or their partners) do is good enough, says Love, a clinical professor of surgery at the University of California-Los Angeles medical school and president of the breast cancer-focused Dr. Susan Love Research Foundation. Following an exact, lengthy protocol on the same day of every month is no better and isn't necessary, she says. If you feel something unusual, however you find it, get it checked out.
That point is essential, says Eric Winer, director of the breast oncology center at Dana-Farber Cancer Institute and the chief scientific adviser to Susan G. Komen for the Cure. "This does not say that it's bad for a woman to detect her own cancer," he says. "What it says is that spending resources to teach women to learn how to do a BSE and then to encourage them to do it on a monthly basis is not going to solve the breast cancer problem."
The studies included in the latest review can't tell us why a formal BSE program doesn't work. As Love contends, a woman's nonregimented touching of her breasts may be just as good, so women find the same lumps whether or not they give themselves a monthly exam. It may also be that some forms of breast cancer grow so slowly that it doesn't matter if you find a tumor in January with BSE or two months later by some other method. Soon enough, after all, you'll probably feel something funny in the shower or get your yearly mammogram. And all current methods of early detection, explains Love, are better at finding these slower-growing cancers and not so great at finding the very fast-growing, deadlier ones.
Still, many doctors remain convinced that BSE is valuable, even if it's just a method for women to reach that "breast awareness" that they're supposed to have. "It's good to get to know what your body feels like routinely," says Amber Guth, a breast surgeon at New York University Langone Medical Center. Kelly Marcom, a breast oncologist at the Duke Comprehensive Cancer Center, agrees. "It's relatively easy, and, never to be overlooked in the modern era, it's free," he says. Both recommend BSE for their patients, who are all either people at heightened risk of cancer or survivors of the disease. The exception, say both doctors: Some women have such lumpy breasts that self-exams only produce anxiety. Most of those women are instead monitored by mammograms and other more sensitive imaging rather than manual exams.
The bottom line: If you are already in the BSE habit, you don't necessarily have to stop. But be aware that it may not provide an additional benefit above and beyond everyday touching of your breasts and that you may find more benign lumps that require a biopsy. If you are forever feeling guilty for not adhering to a regular breast exam schedule, you can stop. But don't avoid contact with your own breasts, and be aware of—and report to your doctor—any changes. That goes for every other part of you, too. "You need to be aware of not just your breasts but also your entire body," says Marcom.