You Don’t Need to Do a Monthly Breast Self-Exam
This year I switched to a new obstetrician / gynecologist due to changes in my health insurance plan under the Affordable Care Act. When I went to my annual Well Woman check-up, my new doctor told me that the manual breast exams that I had at every previous Obstetrician / Gynecologist appointment were no longer recommended.
Since I was the type of person doing breast self-examinations at home when I remembered (and then set a recurring calendar reminder to make sure I remember), I was very curious to know why this recommendation changed.
Here’s the short answer: Current research shows that traditional breast examinations – one arm overhead with the other hand probing the breast for potential abnormalities – is not an effective method for early detection of breast cancer.
As the American Cancer Society explains:
Research has shown no clear benefit to having regular physical breast examinations done by a health professional (clinical breast exam) or by you (breast self-exam). There is very little evidence that these tests help detect breast cancer early when women also have screening mammograms. Most often, when breast cancer is detected due to symptoms (such as a lump), the woman finds the symptom during routine activities such as bathing or dressing. Women should know how their breasts usually look and feel and report any changes to their doctor right away.
(Although the American Cancer Society uses the term “woman,” it’s important to remember that people of either sex can develop breast cancer, and we should all be familiar with how this area of our body usually looks and feels.)
I wanted a more detailed answer, so I spoke with Dr. Otis Brawley, chief medical officer of the American Cancer Society.
“The guidelines changed in the late 1990s,” Dr. Brawley told me. Two well-designed clinical trials have shown that self-examination the breast is more likely to make people worry about whether they have breast cancer. This has led to an increase in doctor visits, unnecessary examinations, and so on.
Brawley noted that most people did not properly self-examine their breasts anyway. “If you did it right, you would spend a good 45 minutes exploring your breasts and looking for lumps.” (I don’t know about you, but my introspection usually took about 45 seconds.)
When people find low stage breast cancer, they tend to find it during their daily activities, such as taking a shower or getting dressed. “Not in this monthly 45-minute obsession.”
Although this study is twenty years old, the recommendation for monthly breast self-examinations remains widespread. As Dr. Brawley said, “It is very difficult to get doctors to change their habits.” All my previous obstetricians-gynecologists have performed breast examinations and advised me to continue self-examinations between visits. The popular Clue period tracking app includes a Breast Self Examination Reminder. October is Breast Cancer Awareness Month, which means that many newspapers and online publications are now publishing articles on how to do breast self-examinations.
If you already have a habit of regularly checking your breasts for anything unusual, continuing to do your own breast self-exam is unlikely to harm you, although, as noted above, it can also cause some unnecessary anxiety.
If you’re worried about whether or not you should be doing breast self-examinations correctly, you may feel comfortable knowing that skipping your monthly exam is not against your doctor’s recommendations.
What should we do instead?
“Women need to know about their breasts,” said Dr. Brawley. “If they find any changes, women should seek medical attention.”
Many of us will also need regular mammograms starting at age 40; If you are at high risk for breast cancer, you should talk with your doctor about additional screening recommendations.