The BSE advantage
CMAJ 1998;158:472
Re: "Effect of breast self-examination techniques on the risk of death from breast cancer" CMAJ 1997;157[9]:1205-12 [full text/résumé], by Dr. Bart J. Harvey and colleagues and "Is breast self-examination still necessary?" CMAJ 1997;157[9]:1225-6 [full text/résumé], by Dr. Gregory Hislop.
In response to: E.E. Sterns
We agree with many of Dr. Stern's enthusiastic comments, in particular, the idea that a woman who knowledgeably performs BSE can facilitate diagnosis by drawing her physician's attention to newly developed abnormalities. In addition, she will avoid the false reassurance that may follow negative results from mammography or clinical examination.
However, we believe that the disadvantages of BSE practice must be borne in mind by all concerned. First, as the results of our study suggest, BSE is not a simple procedure. Simply performing BSE did not result in a lower risk of death from breast cancer. This benefit was limited to women who included 3 specific components in their BSE: visual examination of the breasts, use of the finger pads for palpation and breast examination with the 3 middle fingers.
Second, as we state in our article and as Frank and Mai1 have described in greater detail, BSE practice should not be considered safe and painless. BSE poses risks such as unnecessary investigations — including invasive procedures — which may be particularly likely in younger women. In that respect we emphasize that the women in our study were all at least 40 years of age, and as such our results should not be applied to younger women. Like Frank and Mai, we are concerned that BSE performed by young women may result in more harm than good.
It is unfortunate that recent reviews of BSE have tended to be based on either poorly designed observational studies or premature results from randomized controlled trials conducted in populations at low risk for breast cancer. We agree that physicians should encourage patients who are more than 40 years of age to conduct monthly BSE and would add that this encouragement should be combined with a careful clinical exmaination of the patients' breasts, in which the specific components contributing to good BSE practice are carefully taught and then periodically assessed and reinforced.
Bart J. Harvey, MD, PhD
Assistant Professor
Anthony B. Miller, MB, ChB
Professor Emeritus
Cornelia J. Baines, MD, MSc
Associate Professor
Paul N. Corey, PhD
Professor
Department of Public Health Sciences
Faculty of Medicine
University of Toronto
Toronto, Ont.
Reference
- Frank JW, Mai V. Breast self-examination in young women: More harm than good? Lancet 1985;2:654-7.
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