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'Breast Self-Awareness': More Blame For Women?

<p>Breast self-exams still cause more harm than good, but the vague new term "breast self-awareness" is no better, a doctor argues.</p>
Image: Bras
A portion of the bras hung across the Hot Metal Bridge over the Monongahela River are are seen above the skyline in Pittsburgh in 2011, part of campaign to heighten breast cancer awareness. It's long been known that breast self-exams are outdated, but a new push for "breast self-awareness" has been criticized, too. Keith Srakocic / AP file

It’s been a dozen years since a definitive study found that breast self-exams did more harm than good and four years since a government task force agreed, telling women to stop the once-mandated monthly shower sessions, circular motions and all.

But some health experts have been hesitant to embrace the message and others have simply replaced it with a vague new term — “breast self-awareness” — that leaves women more confused than ever, according to a commentary published this week in the journal Obstetrics & Gynecology.

“I think that most women still think they’re supposed to be doing them,” said Dr. Katrina Mark, a clinical instructor at the University of Maryland Medical School, and author of the new paper. “I’ve had patients who are just shocked that this isn’t recommended.”

In reality, research is clear that monthly breast self-exams increased the number of biopsies in women, boosted the number of false-positive tests and increased anxiety — all while failing to budge deaths from breast cancer. A landmark 2002 study of more than 260,000 textile workers in China clinched the conclusion that self-exam was not an effective screening tool.

“Breast self-awareness is at best ineffective and at worst costly and anxiety-provoking. When a clinical intervention is shown to have no benefit and to cause harm, it should be abandoned.”

But a follow-up campaign for breast self-awareness, which was intended to free women from the onus of precise exams while still encouraging vigilance, has morphed into more of the same, muddying the waters and making women feel like they’re responsible if they get the disease, Mark said.

“Breast self-awareness is at best ineffective and at worst costly and anxiety-provoking,” she wrote. “When a clinical intervention is shown to have no benefit and to cause harm, it should be abandoned.”

And it doesn’t help that breast self-awareness is promoted by groups from the American College of Obstetricians and Gynecologists and the American Cancer Society to Susan G. Komen.

“The whole area of breast cancer, all of the recommendations are very confusing to patients,” said Mark.

What women should actually do, she said, is to let doctors know if anything changes about their breasts. It’s that simple.

“If you notice anything abnormal, please tell me,” she said. “Otherwise, it’s not something you need to worry about.”

In principle, the other groups agree. Susan Brown, managing director of health and program education for Susan G. Komen, said that organization regards breast self-awareness as completely different from breast self-exam, which they no longer recommend.

“We don’t see breast cancer awareness as a screening tool at all,” Brown said.

Instead, women are urged to know the signs and symptoms of breast cancer, to know their own family history and risk, to be screened appropriately and to take steps to control health factors, such as weight and exercise, that can keep breast cancer at bay.

Dr. Mary Gemignani, a breast cancer surgeon at Memorial Sloan-Kettering Cancer Center in New York, said she understands the confusion, but thinks it’s important to tell women something about breast cancer risks.

“I think it’s unfortunate that the terms are so similar,” she said. “But there’s a potential that if we go completely the other way and do nothing, not have doctors say you should know your breasts, there’s a potential for women to not focus at all.”

In practice, most women didn’t perform the monthly breast self-exams diligently, doctors say, and many were relieved when the U.S. Preventive Services Task Force said in 2009 that there was no benefit and the chance of harm.

Everyone wishes there were a better screening tool that could empower women to detect their own cancer, the experts say. But for now, there’s not.

“It isn’t a technique you’re teaching,” Gemignani said. “It’s a know-your-body kind of thing.”