This entry was written by Janine E. Guglielmino, LBBC’s Director of Information and Strategic Initiatives:
The U.S. Preventive Services Task Force (USPSTF) caused a second firestorm in November when it recommended against teaching breast self examination (BSE). They found that BSE does not decrease the number of deaths among women at average risk for developing breast cancer, and therefore its potential harms (unnecessary biopsies, test anxiety) outweigh its possible benefits.
USPSTF “grades” its recommendations (A, B, C, etc.); BSE received a “D” grade, meaning the task force has “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” These recommendations apply to large groups of, rather than individual, women.
The task force’s recommendations weighed heavily on my mind in the days following their release, and not just because of their implications for Living Beyond Breast Cancer. Four days earlier, I had found a lump in my own breast. I am 38 years old, have not had breast cancer and do not regularly perform BSE. I saw the mass while standing in front of a mirror.
While I waited for tests, I followed the arguments over BSE and mammography with equal levels of detachment and fear, helping our staff to work through the evidence to formulate LBBC’s recommendation. What we knew, but what many of you may have discovered for the first time, is that questions about the effectiveness of BSE are not new. The American Cancer Society does not endorse BSE, saying it is an “option” for women, starting in their 20s. On its Web site, the National Cancer Institute writes that “formal instruction and encouragement to perform breast self-examinations leads to more breast biopsies and to the diagnosis of more benign breast legions.” And the National Breast Cancer Coalition says that “it is unclear whether BSE aids women in discovering breast cancer…[and] resources would be better spent on funding more research studies to identify interventions that really work, such as better ways to detect, treat and prevent breast cancer.”
Are these trusted sources telling us to ignore the bumps and lumps in our breasts? Of course not. That would be ridiculous (as well as irresponsible and patronizing). What they are saying is that clinical trials have shown BSE to be ineffective at the two primary goals of cancer screening: preventing death and finding disease early. By the time we feel (or see) a mass, by a formal method like BSE or by any of the informal ways we touch our breasts, the biological makeup of that mass has far greater influence on our survival than how we found it.
Even though I knew the facts, I questioned myself. Could I have found the mass earlier? Would it have made a difference? We all struggle with these questions, but in clinical trials the numbers simply don’t add up. At LBBC, our view is that each woman should decide for herself. Some questions to consider:
- Do you have a family history of breast or ovarian cancer that puts you at higher risk?
- Do you feel educated about what to do if you feel a change in your breast?
- Do you know what your breasts normally feel like?
- Do you handle your breasts frequently and intimately enough to notice changes?
That last question is not irrelevant. Formal training in the handling of our breasts—which is, after all, all BSE is—should be unnecessary, but often we are squeamish about touching and discussing our breasts. LBBC encourages you to speak openly with children, at home and in schools, so they learn early in life what their breasts normally feel like and can easily recognize potential problems. As advocates, we need to do a better job of raising awareness of the importance of knowing our own bodies.
In late November I got the happy news that I have a sebaceous cyst, a harmless mass made up of fat. By then, my colleagues and I had already worked through LBBC’s formal position. I feel confident about that position professionally, but I feel equally good about it personally.
By the way, it wasn’t a mammogram that gave the radiologist a definitive finding about my cyst. It was an ultrasound.
How do you feel about the task force’s recommendations on breast self-exams? Continue the conversation here or on Facebook!