I have read a lot about breast self-examination the past few years. I
thought that this was supposed to be a good way to find tumours
early but a publication last June from some sort of Task Force in
Canada seemed to suggest that it may not do any good at all. Can you
tell me where to find this article and tell me what I am supposed to
do now? Should I or shouldn't I?

Thanks

Greetings!  I have located information referencing the Canadian Task
Force on Preventive Health Care that deals with your query.  Some
highlights from an article published June 26, 2001, and titled
"Canadian group advises against breast self-examination by middle-aged
women" by Steven Reinberg reads:

"Breast self-examination should not be routinely taught to women
between the ages of 40 and 69, the Canadian Task Force on Preventive
Health Care recommends.

"From reviewing the literature there is no evidence of any reduction
in breast cancer mortality from regularly performed breast
self-examinations or breast self-examination education," Dr. Nancy
Baxter, from the University of Toronto, told Reuters Health.

"Dr. Baxter and colleagues performed a meta-analysis of eight studies
published between 1966 and October 2000, which looked at the
effectiveness of breast self-examination in reducing mortality from
breast cancer.

"We agree with the task force that there is still not much evidence
breast self-examination helps and that there is more evidence it can
harm," Drs. Suzanne W. Fletcher, from Harvard Medical School in
Boston, and a colleague write in a journal editorial.

"Clinicians have much stronger evidence for mammography and well-done
clinical breast examination, and we should emphasize these screening
methods with our patients," the editorialists advise.

At http://www.guideline.gov/BROWSE/alphabrowse.asp?org_id=1228 there
are summaries of the task force studies and suggestions.

I then searched for more remarks on the subject by Dr. Suzanne W.
Fletcher and found a commentary by her and Larissa Nekhlyudov titled,
"Is it time to stop teaching breast self-examination?"  Some of the
commentary read:

"A 1987 systematic review for the US Preventive Services Task Force
found insufficient evidence to recommend BSE as a breast cancer
screening tool.  The Canadian Task Force on the Periodic Health
Examination (now the Canadian Task Force on Preventive Health Care)
came to a similar conclusion in 1994, giving BSE a grade C
recommendation (insufficient evidence to recommend for or against
screening).

"The US task force again gave BSE a C recommendation in 1996.  With
emerging data, particularly from the randomized controlled trials
(RCTs) in China and Russia, some groups have become more skeptical
about the effectiveness of BSE, and several organizations, including
the National Cancer Institute and the American Cancer Society, are now
more cautious in recommending BSE as a screening tool."

The entire commentary may be viewed at
http://216.239.51.100/search?q=cache:qArzisZ64JcC:collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-164/issue-13/pdf/pg1851.pdf+Suzanne+W.+Fletcher+harvard+breast+exam&hl=en&ie=UTF-8

As far as telling you what to do, I can only state what I would do and
that would be to utilize both methods.  If you already know how to do
an effective breast examination, then why cease doing so?  If you are
over 40, you might also choose to heed the basic physician directive
to have a mammogram -once a year or once every two years- to
supplement your own self=examinations.

As I researched your question, I saw a reference to a digital
mammogram (newer technology) and I am including a link to that
information as well.  In the text of an article I found concerning it
was "Studies increasingly show that digital mammograms improve breast
cancer detection, particularly cancer that looks like tiny dots, or
calcifications, on a mammogram -- as much as 40 percent of all tumors,
he said [Dr. Murray Rebner, director of the Vattikuti Digital Breast
Diagnostic Center at Beaumont Hospital in Royal Oak]."

Should you need clarification on this answer, please ask.


SEARCH TERMS and LINKS:

canadian task force health breast examination  [Google search]
://www.google.com/search?hl=en&lr=&ie=UTF-8&q=canadian+task+force+health+breast+examination&spell=1

Reuters Health Information (2001-06-26): Canadian group advises ...
("Canadian group advises against breast self-examination by
middle-aged women by Steven Reinberg")
http://www.hci.utah.edu/content/reuters/2001/06/26/20010626publ002.html


Suzanne W. Fletcher harvard breast exam  [Google search]
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&q=Suzanne+W.+Fletcher+harvard+breast+exam

Is it time to stop teaching breast self-examination?  (I chose HTML
link but it is also available as a PDF document)
http://216.239.51.100/search?q=cache:qArzisZ64JcC:collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-164/issue-13/pdf/pg1851.pdf+Suzanne+W.+Fletcher+harvard+breast+exam&hl=en&ie=UTF-8


digital mammogram  [Google search]
://www.google.com/search?hl=en&ie=ISO-8859-1&q=digital+mammogram

Digital mammogram decision is debated
http://www.freep.com/news/health/mamm6_20020806.htm

I see this is a hard question with lots to think about.  I've looked
at the link you suggested - it is great.

Thanks also to everyone for their follow-up comments.

As a surgeon who devoted much of his practice to breast disease and
breast cancer, I can say unequivocally that breast self-exam is an
essential part of breast care. Most breast cancers are still found by
the woman herself; whereas it's true that it would be better if they
were all found before they are feelable, the fact is that when less
than 3/4 of an inch in size (easily feelable in most cases), the cure
rate is very high. There are many arguments about self exam: by the
time it's felt, it's too late to change the outcome, it leads to lots
of "unnecessary" biopsies, etc. For the individual woman, however, it
can make a huge difference: if you find a cancer today and have it
treated instead of waiting for your doctor exam in a year, you have a
better chance of cure. Period. And if the lump you find is not cancer,
it usually can be determined simply by placing a small needle in it,
in the office, in 5 seconds: if it's a cyst, fluid comes back and it's
over. If it's solid, the needle can take a tiny sample which, if your
area has good pathologists, can be used to help decide if anything
more needs to be done. It may be true that, given certain parameters,
a benefit can't be established for large populations (the study which
got the most recent attention was done in China, where mammography was
generally not available). But even if the studies are meaningful,
there are individuals within them who save their own lives by self
exam, no question about it. So why not do it? Finally, as you proably
know, no single modality serves to find breast cancer: you need
monthly self-exam, annual (or more, depending on various factors)
physician exam, and regular mammograms.

I have found journalist's answers always to be well-researched,
insightful commentary :). However, in this case, I MUST disagree.

If you were trying to find the answer to a particularly difficult,
critically important question, would you just post it only on Google
Answers? Or would you also post it in multiple discussion forums about
that subject, to increase your chances of getting a good answer?

Breast cancer vigilance is the same way. Because it has become such a
common disease, and because it is so nasty, women should use anything
and everything in their arsenal to try to ensure that if it occurs,
they can catch it as soon as possible, to increase their chances of
not only survival, but a continued good quality of life.

I can tell you without hesitation that you SHOULD do monthly breast
self-examinations, and I will tell you why: that is how my cousin
discovered hers, even though she was getting annual mammograms and
clinical examinations. Now, if the techique works for just one person,
I would say that it is possible it could work for any number of
people. Just because the statistics show that a very small percentage
of breast cancers are detected that way doesn't mean YOU should play
the odds that yours won't be one of them.

"The Susan G. Komen Breast Cancer Foundation maintains its
recommendation that women age 20 years and older practice monthly
breast self-examination (BSE), despite recently published findings of
a 10-year Chinese study that maintain BSE shows little impact on
decreasing the mortality rate from breast cancer."
http://www.komen.org/news/article.asp?ArticleID=269

American Cancer Society "How to Perform a Breast Self-Examination"
http://www.cancer.org/eprise/main/docroot/NWS/content/NWS_2_1x_How_to_Perform_a_Breast_Self_Examination

I hope very much you will choose to pursue monthly self-examination,
in addition to annual clinical breast examinations, pap smears, and
mammograms (if indicated by age or risk factors).

My apologies to journalist: I see that they were merely quoting from a
study with which I profoundly disagree, and that they suggested
continuing to do BSE despite the study. Right on, journalist! (Keep
those answers coming!)

Heather, I concur with the surgeon that self examination is a must.
Both yourself and the surgeon may be interested in the following link
which may eventually negate the need for self examination.
http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2002/10/30/ncanc30.xml&sSheet=/news/2002/10/30/ixnewstop.html

Dear Heather:

Thank you for rating my answer and for your comments.  I agree there
is a lot to think about in this area but I do believe covering the
most bases is best for a personal wellness regime. I learned a great
deal from researching your question and thank you for asking it.  :)

Dr. Judith Love, a very well known oncologist,specializing in breast
cancer has stated in the press, that women should continue to examine
their breasts on an monthly basis and they should continue to have
mammograms.

I think that Dr. Love is correct.