Q&A: Breast Self-Exam Guidelines

New guidelines from the American Cancer Society (ACS) urge a greater emphasis on mammography to find breast cancer rather than relying too heavily on the traditional monthly breast self-exam. Debbie Saslow, Ph.D., director of breast and gynecologic cancers for ACS, talks about this recommendation and what women should do.

What do the new guidelines say?

Debbie Saslow: Women should report any breast change promptly to their health care providers. The breast self-exam is an option for women, starting in their 20s.

Women at increased risk such as a family history, genetic tendency and past breast cancer should talk with their doctors about the benefits and limitations of starting mammography screening earlier, and of having additional tests such as a breast ultrasound or MRI.

Why is ACS downplaying self-exams?

Saslow: We want to emphasize mammograms, clinical screenings and self-awareness over breast self exams. Research has shown that breast self-exams play only a small role in detecting breast cancer compared to self-awareness, which means that women should be aware of what their breasts look and feel like. If she detects any lumps or changes in her breasts, she should see her doctor.

We certainly do not want to discourage women from doing self-exams if they choose to, but we don't want women to see self-exams as a life-saving screening. Women who don't do BSE shouldn't feel badly.

Women should feel very confident that mammograms are highly effective, although not perfect. Mammograms can pick up breast cancers several years earlier than a breast self-exam.

Has the use of mammograms reduced the number of deaths from breast cancer?

Saslow: Routine mammograms have made a huge difference in mortality rates in the past decade - up to a 50 percent reduction in deaths.

What are the risks and benefits of mammograms?

Saslow: First, the biggest limitation is that it is not perfect. Mammograms can miss about 15 to 20 percent of cancers. Second, there are cases where a cancer won't be found early and other cases where some women will still die even if it is caught early. Many times, there are what we call false positives that may lead to a second screening, possibly a biopsy, but it's not breast cancer. Or the cancer may be slow-growing - so slow-growing that if you find it early, it won't make a difference in its progression.

However, for most women, there is an extremely high rate of survival if found early. It is best to detect breast cancer as soon as possible. The benefits of mammograms far outweigh their risks and limitations.

How many women actually get mammograms?

Saslow: About three-fourths of all women have had a recent mammogram. The word is spreading, but there are certain pockets of the population where the rates for mammograms are low. In very rural areas, access may be difficult. Less educated women, women who don't speak English and poor women may not be getting them routinely.

How do you get a mammogram if you don't have much money?

Saslow: Many programs offer free mammograms or low-cost mammograms. Women can call their local health departments. They can also call our toll-free number 800-ACS-2345 to find where they can get an exam.

How does a woman become self-aware?

Saslow: We want to stress that women should be self-aware. They should know what is normal for their bodies and what is not.

They can do regular breast self-exams if that is what they are most comfortable with. But women should know their own bodies. They should pay attention to their bodies as they bathe, dress and stand in front of a mirror. Look for stains on the sheets (nipple discharge is a rare symptom of breast cancer), notice any lumps or skin changes and report them to their health care provider. Women should have a general awareness about their bodies.

Do you have any other guidance for women?

Saslow: All women can get breast cancer, although the majority won't. Take care of your health by getting regular mammograms and exams by your health care provider so if you are one of the unlucky ones, you can find the cancer and get treatment as soon as possible.

External Source The American Cancer Society

This article was reviewed and updated June 2007.

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