The Canadian Cancer Society's decision to de-emphasize traditional breast self-exams is perplexing some breast-cancer survivors and doctors who say women should continue checking their breasts and reporting potential signs of cancer to their doctors.
So who's right?
The answer is both, though it may be a confusing message for women to hear.
The cancer society reversed its long-held position this week, saying women don't have to follow a strict regimen of monthly breast self-exams.
The decision stems from strong medical evidence that self-exams do not reduce deaths from breast cancer.
The turnaround frustrates many breast-cancer activists, who can point to scores of women who found their own lumps and caught their cancer early.
"It is confusing," says Diana Ermel, president of the Canadian Breast Cancer Network, who discovered her own tumour during a self-exam 14 years ago. "If you're not going to do breast self-exams, what are you going to do?"
But the Canadian Cancer Society is not - repeat, not - telling women to stop checking their breasts.
The difference in their message is subtle: Pay attention to your breasts, but don't feel obligated to do the regimented breast exams ordered in so many pamphlets and shower cards.
It's good to touch your breasts and check for changes - say, while you're getting dressed or showering - but you don't have to feel your left breast with the three middle fingers of your right hand moving in a circular pattern from the outer edge to the nipple, then repeat the process lying down, on the same day every month.
"You need to be aware of what your normal breast tissue is and report any changes right away," says Heather Logan, director of cancer control policy and information for the cancer society.
"Women still need to play an active role in their health. ... There's no right or wrong way to become familiar with your breasts."
The Canadian Cancer Society is not the first to back off breast exams. The American Cancer Society also does not promote them as part of a woman's routine.
"We generally encourage women to get to know their breasts, but we tell women that self-exams are an option," says Becky Steinmark, a spokeswoman for the society.
A Canadian cancer charity called Rethink Breast Cancer decided two years ago to start encouraging "Breast TLC" rather than rigorous self-exams: "The whole idea behind TLC is that it's not that complicated, you don't need a diagram with squiggly arrows pointing every which way on a breast," says MJ DeCoteau, executive director of Rethink Breast Cancer. "You just need to remember: Touch your breasts, Look for changes, and Check anything unusual with your doctor."
She praised the Canadian Cancer Society for spreading the same message. "Women who do breast exams and are comfortable with them, that's great; nobody's saying not to do that," Ms. DeCoteau says. "We're just saying you don't need that complicated technique."
The idea that self-exams are optional doesn't sit well with many women, though.
Natalie Daye, 29, found a lump in her breast four years ago; a biopsy determined it was benign, but with a family history of cancer she doesn't plan to slack off on doing self-exams.
"I know there is no way I would have found my lumps if it weren't for my own self-exam, and I'm proud and glad that I was that self-aware," Ms. Daye says.
"How else are we supposed to know if something is wrong with us?" ?"
Ms. Ermel says she understands the point the cancer society is trying to make - you don't have to have a "perfect" self-exam technique.
But she's worried some women won't hear the "get to know your breasts" message and will simply stop checking for lumps and changes.
Dominique Synnott, a surgeon at Sacred Heart Hospital in Montreal, shares that concern.
If nothing else, she says, regular self-exams send women to the doctor sooner than they might otherwise go.
"I will still show my patients when to do it and how to do it," Dr. Synnott says. "What is weird is this message that you don't have to do self-exams but you do have to examine yourself. It's difficult to know the difference between the two."
The cancer societies' decision to change their message on self-exams is based on several large-scale, long-term studies.
In the most rigorously designed study, according to Toronto surgeon Nancy Baxter, who reviewed the evidence in the Canadian Medical Association Journal, 270,000 women were split into two groups.
One group received intensive instruction on performing breast exams, while the other group was educated on reducing back injuries.
Follow-up with the women in the first group ensured that they were performing regular and effective breast self-exams. After 10 years, the breast-cancer mortality rate was the same for both groups, at 0.1 per cent.
"Our decision was based on the best scientific evidence," Ms. Logan says. "Organizations are heading in this direction because the evidence is taking them there."
Out with the old, in with the new breast self-exam
OLD METHOD
1. Stand and look for changes in different positions: with your arms up, hands on hips, and leaning over
2. While lying down, feel your breast, using firm but gentle pressure with your three middle fingers, moving
in small circles from the outer part
of the breast to the nipple
3. Repeat the same check while sitting or standing
4. Check on the same day every month
NEW APPROACH
There really isn't a right or wrong way to examine your breasts, as long as you get to know the whole area of your breast tissue - up to your collarbone, under your armpits and including your nipples - well enough to notice changes. So get to know your breasts in any way that works best for you.
SOURCE: WWW.BREASTSELFEXAM.CA, CANADIAN CANCER SOCIETY
