ENCOURAGING women to systematically examine themselves for signs of breast cancer does not reduce deaths from the disease, a major review of the evidence showed yesterday.
Many women practise a rigid routine of checking their breasts on a regular basis to see if there are any lumps that might indicate they have cancer.
But the review by researchers at the Cochrane Collaboration – an international body that assesses
the combined results of medical studies – has concluded there is no evidence that systematic self-exams actually reduce breast cancer deaths. They also said the common practice could do more harm than good, with more women having to undergo biopsies on lumps that do not turn out to be cancer.
Cancer charities said they encouraged women to be "breast aware", as opposed to carrying out systematic self-exams, and to report any worrying changes to their doctors. This is also the government's guidance.
The latest Cochrane review of research on self-examination included two large studies involving nearly 400,000 women in Russia and China.
In these studies, 3,406 women who carried out self-examination of their breasts had to have biopsies to see if they had cancer. Among those women not carrying out the checks, only 1,856 had the biopsies.
However, the researchers found no significant difference in deaths between the groups.
Researcher Jan Peter Kosters, from the Nordic Cochrane Centre in Copenhagen, said: "At present, screening by breast self-examination or physical examin-ation (by a trained health worker] cannot be recommended."
He said researchers recognised some women would want to continue to self-examine and they should always seek medical advice if they found changes in their breasts. He went on: "We suggest that the lack of supporting evidence…should be discussed with these women to enable them to make an informed decision."
In the UK, women are advised to be "breast aware", rather than to carry out strictly regimented breast exams. This means they should be aware of how their breasts feel and report any lumps they find to their doctor.
Systematic breast self-examination involves a regular routine of checking the breast, usually about once a month, feeling the whole breast, nipple and arm-pit area for lumps and other changes. Women are also encouraged to look at their breasts in a mirror to check for changes in appearance.
Many websites and medical books include details of how women can carry out systematic breast checks. As women grow increasingly worried about breast cancer, more and more are turning to the internet and other sources of advice to learn how to make sure they can catch the disease early.
Carolyn Runowicz, of the University of Connecticut Health Centre in the United States, said they encouraged women to do self-exams if they felt comfortable doing so. She said that 50 to 60 per cent of women detected their own breast lumps.
"I think what we are seeing is that women are familiar with their breasts through breast self-exam and when there is a lump, they notice the difference," she said.
In the 1980s, doctors in the UK started encouraging women to self-examine their breasts for lumps rather than visiting their GP for regular checks.
Then, in 1991, the UK abandoned systematic breast self-examination and replaced it with advice to be breast aware; this was because of a lack of evidence about a formally taught, ritual self-examination.
But charities said women were still confused about the differences between being breast aware and carrying out formal checks. This means that many women still follow a set regime, as described on many health websites and in medical dictionaries.
Karsten Juhl Jorgensen, from the Nordic Cochrane Centre, said the latest review had looked at the more regimented forms of breast examination.
"Women in many countries are now encouraged to be breast aware rather than carry out strict testing regimes to check for lumps," he said. "It is still important that women who find any lumps go to see a doctor."
Arlene Wilkie, director of research and policy at the Breast Cancer Campaign, said: "This is an interesting study, but we would advise women to remain breast aware at all times, not just once a month.
"The earlier breast cancer is detected, the greater the chances of survival.
"It is vital that women remain breast aware to reduce their risk of breast cancer, know what is normal, what changes to look for and report any changes to the doctor without delay. Remember to attend breast screening if you are over 50."
Dr Sarah Cant, policy manager at the charity Breakthrough Breast Cancer, said breast self-examination was widely practised in the United States and was a strict routine that women were taught in order to check their breasts.
But she said breast cancer charities and health officials in the UK recommended that women needed only to be breast aware.
"Being breast aware does not mean following a fancy routine – you just need to know what your breasts look and feel like normally, in any way you feel comfortable," she said.
"If you notice any unusual changes or have any worries, check them out with your GP."
Dr Cant said most of the 44,000 cases of breast cancer diagnosed each year in the UK were detected by women themselves. "The earlier that breast cancer is detected, the more likely it is that treatment will be successful. Better breast awareness, together with improved treatments and breast screening, have been shown to contribute to improved survival," she said.
Maria Leadbeater, a clinical nurse specialist at Breast Cancer Care, agreed that prescriptive self-examination had been seen as unhelpful in recent years. She said breast awareness was a much more useful approach.
"We know that many cases of breast cancer are identified earlier because women have spotted and reported unusual changes in their breasts to their GP. Early detection of the disease can mean more effective treatment and the possibility of a better outcome," she said.
A Scottish Government spokeswoman said: "It is important that women aged 50 to 75 take advantage of free breast screening offered every three years. In addition, if anyone has any concerns regarding unusual breast symptoms, we would urge them to consult their doctor.
"The Scottish Government is currently consulting on a new cancer strategy for Scotland, which will published later this summer – any new and emerging evidence will be considered as part of this process."
Health care marred by conflicting adviceMEDICAL research can often produce conflicting advice on a number of health issues, making it difficult for women to know what to do for the best.
In recent years, much concern has been raised over the safety of hormone replacement therapy (HRT).
Millions of women around the world used HRT to control symptoms linked to the menopause.
However, a number of studies have linked the therapy to an increased risk of breast and ovarian cancer, leading to many women stopping treatment.
Despite this, some experts believe the benefits of taking HRT – such as improving quality of life – may outweigh the risks of developing cancer.
Women are advised to take HRT for as short a time as possible in order to deal with symptoms.
Similar concerns have been raised about the contraceptive pill, which has been linked to a small risk of breast cancer.
But earlier this year, women were told not to worry about the risk of cancer when using the Pill – because it can actually reduce the risk of developing cancers for several decades.
The research found that, in the long term, oral contraceptives cut the risk of ovarian and womb cancers.
Meanwhile, women planning to have a baby have also experienced conflicting advice about alcohol consumption in pregnancy.
In the past, mothers-to-be have been told that one or two units of alcohol a week during pregnancy was unlikely to harm their baby. But now, official government advice states no alcohol should be consumed during pregnancy because of the risks of foetal alcohol syndrome, which is responsible for abnormalities in babies.
The patient's view: I wish to God I had checked myself for lumpsBREAST cancer survivor Jessie Mcguire is keen to encourage women of all ages to check their breasts regularly.
The 70-year-old was diagnosed with the disease more than six years ago – but only after being invited to take part in the NHS breast cancer screening programme.
"I was so lucky they invited me when they did. I wish to God I had checked myself for lumps. But I did not want to because I was scared what I would find."
Ms Mcguire, from Edinburgh, was told her mammogram – an X-ray of the breast – had found a lump the size of a golf ball.
She said: "My first stop when I came out of the hospital was the pub, and I had a large vodka. I didn't tell my family. I had a pub to run and I went on as if nothing was wrong."
When Ms Mcguire did eventually tell her family, they were shocked. But she said she always approached her illness with a positive attitude and had superb treatment at Edinburgh's Western General Hospital.
Ms Mcguire said her doctor asked if she wanted to take part in a trial of a new cancer drug, and she was pleased to be involved.
Ms Mcguire was given the all-clear three years ago, but knows she has been lucky to survive unlike many women who develop the disease.
She said: "After they told me I had the lump I was prodding my breast and I did feel a slight lump.
"I just wish I had thought to check myself as I was just lucky that the invitation for screening came through when it did.
"All women should check themselves regularly – check when they are in the shower – to see if they have any lumps.
"Then they can see their doctor and get treatment as quickly as possible."
The doctor's view: Women must know own bodies to spot changesWHEN I first started in general practice in the 1980s, we had women coming in to have their breasts examined.
Then there was a report which revealed women were much better placed to detect any changes in their breasts, rather than coming to see us once a year.
So in the mid-1980s we started encouraging women to check their breasts themselves and see us if they found anything of concern.
It was thought people getting to know their own body was the most important thing, and that is still the case now.
I still believe that, in the same way we encourage men to self-examine their testicles for suspicious lumps and bumps, it is important women get a sense of what their body feels like and are in a position to spot any changes that might need medical attention.
Women should always feel able to discuss any concerns with their doctor and the latest Cochrane Review should not change that.
We get a lot of patients who come to see us after finding what they believe is a lump. We will check them out and give our opinion. Sometimes it might be a case of waiting a couple of weeks because the feeling of the breasts change during the month.
If there are still concerns we will refer them for a second opinion. Sometimes this will lead to a biopsy, but not always. Women will not always have needles stuck in them.
My practice would still want to encourage women to check their breasts at regular intervals. We normally suggest women check once a month, after their period. This is just to try to make it part of their routine.
Doctors will never say you are wasting their time by coming forward with your concerns. It is dangerous to send out mixed messages on issues such as this.
Over time it may become obvious that self-checking breasts is not the best way of finding breast cancers, as this report suggests, but at the moment I am not going to stop encouraging women to check themselves regularly.
- Dr John Garner is a GP in Edinburgh
