Emotional hot buttons vs. evidence in the breast cancer screening debate

In the recent furor over the new mammogram recommendations, the issue of breast self-exam (BSE) sort of got lost in the shuffle.

The surprise: Like mammograms, BSE might be bad for your health.

On Good Morning America, a panel of doctors mentioned this briefly. They were aghast and baffled. And I have to agree with them on one point: Self-exam is empowering. It’s easily learned, it’s proactive, and it involves patients in the process of their health care. All good things.

But the evidence didn’t cooperate.

I’m not surprised that these mainstream doctors passionately voiced their emotional opinions about BSE. But I’m a little surprised that they apparently didn’t at least glance at the evidence.

Here’s all they had to do:

1) Go to the website for the Annals of Internal Medicine – easy
2) Find the Task Force Recommendation Statement – easy
3) Find the Breast Self-Examination section – easy
4) Click on the links that lead to two studies – easy
5) Read the abstracts for the studies – easy

That’s five “easys” and zero “hards.” And it took about seven minutes. So what’s the problem? Again – easy: The study results didn’t fit preconceived ideas about saving lives with BSE.

In one study, reported in the Journal of the National Cancer Institute, researchers recruited more than 266,000 women. After dividing them into two groups, one group was given BSE instruction. That was followed up with reinforcement sessions one year later, and again in three years. These women also received ongoing reminders to practice BSE monthly. The second group received no BSE instruction or information.

Results: After 10 years there were 135 breast cancer deaths in the BSE group, and 131 deaths in the control group.

BSE did not save lives. But the chance of having a benign breast biopsy was higher in the BSE group. A second study produced similar results.

Keep in mind that this evidence simply suggests a recommendation. Once you get in the examining room, BSE is an issue between you and your doctor. And now you’re both better equipped to make a decision. The new recommendations have made it clear to everyone that mammography and BSE results have to be very carefully reviewed to prevent unnecessary biopsies and treatments.

To Your Good Health,

Jenny Thompson

Sources:
“Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement” Annals of Internal Medicine, Vol. 151, No. 10, 11/17/09, annals.org
“Randomized Trial of Breast Self-Examination in Shanghai: Final Results” Journal of the National Cancer Institute, Vol. 94, No. 19, 2002, jnci.oxfordjournals.org