The BSE advantage
CMAJ 1998;158:471
See response from: B.J. Harvey and associates.
In the article "Effect of breast self-examination techniques on the risk of death from breast cancer" CMAJ 1997;157[9]:1205-12 [full text/résumé], Dr. Bart J. Harvey and colleagues conclude that breast self-examination (BSE) reduces the risk of death. However, in the accompanying editorial "Is breast self-examination still necessary?" CMAJ 1997;157[9]:1225-6 [full text/résumé], Dr. Gregory Hislop questions the efficacy of BSE and therefore its value.
Tumour size and breast cancer prognosis are related, but it has never been clearly established that the difference in the size of a cancer discovered by a woman who routinely performs BSE and that of a lesion discovered incidentally influences the prognosis. In that regard, Harvey and colleagues have provided some important information.
In both articles, the authors concentrate on only a single reason for performing BSE, but not necessarily the most important one. Almost certainly the greatest benefit of regular BSE is the recognition and understanding of naturally occurring changes in the breast during the various phases of a woman's life. In young women, cyclic hormonal effects cause changes that are often perceived as abnormal by women not accustomed to regular BSE. At no time are these changes more evident than perimenopausally, a time when the prevalence of cancer begins to increase.1 As more postmenopausal women receive hormone replacement therapy, such hormonal effects will continue into the postmenopausal stage, a time when the prevalence of cancer increases sharply.
A woman's knowledge about her breasts can greatly facilitate accurate diagnosis. Many physicians are insecure about breast diagnosis and are assisted when a woman is confident that a recently discovered abnormality is new and different. Similarly, insignificant changes can be dismissed and the need for invasive testing reduced.
The work of epidemiologists contributes to clinical decision-making, but some clinical functions do not lend themselves to statistical analysis or even reliable prospective clinical trials. Lack of hands-on clinical experience by investigators can result in a biased focus. It would be unfortunate if physicians did not encourage their patients to conduct monthly BSE because of a review with a relatively limited perspective. BSE is simple, safe, painless, cheap and, with the contribution of Harvey and colleagues, even more effective than I had previously considered.
Ernest E. Sterns, MD
Professor of Surgery
Queen's University
Kingston, Ont.
Reference
- Sterns EE. Age-related breast diagnosis. Can J Surg 1992;35(1):41-5.
 |
Send a letter to the editor responding to this article
Envoyez une lettre à la rédaction au sujet de cet article |
Letters