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Can Self-Breast Exam Kill You?

By Isaac Ben-Or, M.D., Attending Physician at 75th St. & 126th St. Medical, Ocean Pines Medical & Doctors Weight Control & Wellness centers, Ocean City, MD.

Breast cancer is the most common cancer among women and second to lung cancer as a cause for mortality from cancer.

Three breast cancer-screening modalities exist today: self breast exam, breast exam done by a health care professional and mammogram. The above are done as a periodical exam or a radiological study. By definition, a screening test is done on normal women only. If there is a suspicion of any breast disease, the study will not be a screening, but a diagnostic one.

Many women have been instructed by their physicians to have a self-breast exam (SBE). This screening exam had to be done about one time per month, in a convenient setting such as at time of taking a shower. The patient was encouraged to report any finding to her physician. The general belief was that it increased the detection rate of breast tumors (malignant or benign). Therefore it was obvious to believe that it was helpful in reduction death from breast cancer.

However, a study, which was conducted in China and involved over 250,000 working women for over 10 years, contests that common belief. Its main finding is that there was no difference in mortality rate from breast cancer, whether or not a SBE has been performed.

As a result, various opinions have been expressed. Some expressed their concern that the SBE was a useless exam that resulted in unnecessary costs in radiological studies as well as many surgical biopsies with benign findings.

It is suggested that an early detection of breast cancer is impossible since the tumor is too small to be felt by a manual exam. In other words, if one could feel a mass in her breast, it would be in a stage where only little can be done.

Some even feared that a negative SBE might create a false sense of security, and as a result, the patient may pospond her visit to her physician or to her periodical mammogram.

Some physicians recommend continuing SBE regardless of the study?s results. Others recommend to quit the traditional SBE and to have "body awareness."

So what is the recommendation about minimizing risk of breast cancer?

In my opinion, minimal changes in your body are best detected by yourself. Systematic approach is always beneficial. You should keep your periodical exams by health professionals, and follow his/her recommendations about additional screening studies (as mammogram).

You should extend your "body awareness" to other parts of your body and report any suspicious change to your physician. This recommendation is indicated not only to women, but to men as well.

There are better ways to detect breast disease, and these are good news. But they are not available yet for every day use. Therefore, I will recommend to continue with the present screening tools (self exam, your physician exam and mammogtraphy), until better ones become available.

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