Myths about Breast Cancer and What You Can Do about Them
The National Breast Cancer Coalition* is posting on its web site 24 myths about breast cancer. NBCC wants to counter unscientific recommendations and help people make decisions grounded in good science.
Like all good education, the myths spark questions in the reader's mind. In this space, I'm going to choose some of the myths to inspire your thinking. I invite your reactions either by email to advocacymanager2@sharecancersupport.org, or to this blog.
The first myth NBCC posted is:
"Myth #1: Monthly breast self exams save lives.
FALSE. The evidence actually shows that breast self-exam (BSE) does not save lives or detect breast cancer at an earlier stage."
NBCC says "there is no scientific evidence to prove" that BSE is a "life-saving personal responsibility." It quotes the U.S. Preventive Services Task Force as follows: "the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination."
Well this comes as a bit of a surprise when I've known friends, family and acquaintances who found their breast lump themselves.
Let's understand exactly what NBCC means by BSE: "when a woman uses her hands to systematically inspect her breasts and the surrounding areas for unusual lumps and shape changes....on a regular basis....with the same technique each time." So that would be for example, the 15th of every month, in the shower or lying down. Generally the technique is taught by a doctor, a clinic, and/or a written document.
NBCC points to one study about 12 years old that showed that fewer than 1 in 10 women (7.6%) who practiced BSE found a breast tumor this way. NBCC also quotes a study showing that 8 of 10 women whose breast cancer was not discovered by periodic mammography found their breast cancer themselves, but notes that not all of them used BSE.
My first thought reading this was that BSE is Chicken Soup -- it can't do any harm and it might do some good.
Digging a little deeper into the subject on NBCC's web site, I found that NBCC says that BSE actually could and does do some harm: namely, the risk of unnecessary anxiety, needless visits to the doctor, and even unwarranted invasive measures if a woman does feel a lump. She could find herself having a biopsy -- a surgery to take a part of the lump for laboratory examination. NBCC cites research showing that BSE results in many unnecessary biopsies of benign tumors.
But which is worse for any one person -- biopsying a harmless tumor, or not finding a malignant one? If a woman finds a lump sooner, she has a chance to get treatment that will extend her life as much as possible. "Possible" can't be defined in advance, but it's certain that few people want to minimize this chance. It seems to me that if women are aware of the risks, they can also be aware of the cautious, one-step-at-a-time actions they need to take if they feel a lump.
If it were me, I'd see a doctor and explain why this feels different. If the doctor thinks it's necessary, a mammogram and/or sonogram will be ordered. If those tests are positive, a needle biopsy -- a very simple procedure that doesn't usually hurt -- is the next step. Only if that third test is positive would I consider actual invasive surgery.
Another harm NBCC warns against could be called the problem of the dog that didn't bark: if you don't feel a lump, that does not mean you don't have breast cancer. Yes, it's scary but it's true: breast cancers develop for several years, as a rule, before they can be felt. So not finding a lump with BSE could prevent a woman from taking other detection measures, such as a regular mammogram after a certain age. (The issue of mammograms will be discussed in another blog post.)
Again, if women are aware of these facts, and familiar with their own breasts, they can choose the right technical screening at the right age given their own personal family histories.
NBCC wants to halt the public health message that BSE alone improves life expectancy. To this laudable end, NBCC says that no studies prove conclusively that for all women BSE results in reduced mortality from breast cancer. But we must always be a little skeptical: the large-population clinical studies that show BSE did not extend life (when breast cancer was found), were done not in the United States, but in China and in Russia. It could well be that factors other than early detection through BSE determined the progress of breast cancer in those countries.
So here's where I come out if we're thinking about one woman (not the whole population of women):
The myth is that if a woman checks her breasts regularly at the same time every month she'll find breast cancer at the earliest possible moment and maximize her chances of surviving the disease for the longest time.
No part of this sentence is actually proven. But, it's not disproved either, and the wrongest part probably is "regularly at the same time".
So I think that what a woman should do is:
- Know what her breasts feel like beneath the skin at all times of the month.
- If she ever feels an unusual bump, go at once to a doctor,
- Explain to the doctor why she thinks the lump is new, and
- Seek expert medical advice as to what to do next.
*SHARE is represented on NBCC's Board of Directors. Many SHARE staff and volunteers, including myself, play an active role in the organization's educational and advocacy efforts.
Posted October 23, 2009.
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