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Controversy Over Breast Self-Examination

August 2008 - A review by the Nordic Cochrane Centre published in The Cochrane Library into the effectiveness of regular breast self-examination concludes that despite its promotion in health advice to women there is no evidence that it has contributed to a reduction in breast cancer deaths. Indeed, it has resulted in twice as many negative biopsies.

Researchers analysed data from two large studies of 388 535 women in Russia and China. Women who used breast self-examination had 3406 biopsies compared with 1856 biopsies in those who did not. There was no significant difference in breast cancer deaths between the two groups. Treatment protocols included in the Chinese study found similar rates of mastectomy and breast-conserving surgery such as lumpectomy in both groups.

Jan Peter Kosters, Ph.D. and Peter Gotzsche, Ph.D. concluded:

"At present, screening by breast self-examination or physical examination [by a trained health worker] cannot be recommended."

The authors nonetheless acknowledge that some will choose to continue the practice.

Carolyn Runowicz, director of The Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center, supports breast self-examination by women comfortable with the practice, noting that 50 to 60 per cent of breast masses are found by women themselves.

Carolyn Runowicz commented:

"I think what we are seeing is that women are familiar with their breast through breast self-exam and when there is a lump, they notice the difference."

Jan Peter Kosters added:

"Women should always seek medical advice if they detect any change in their breasts that might be breast cancer. We suggest that the lack of supporting evidence…should be discussed with these women to enable them to make an informed decision."

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