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Should I be checking my breasts?

REBECCA DUBE

From Tuesday's Globe and Mail

Latest comment posted at 9:15 AM EDT 04/07/07

According to several long-term studies, there is absolutely no difference in survival rates between women who perform regular self-exams and those who don't ...Read the full article

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  1. M F from Canada writes: As a physician I have heard this about self-exams for quite a few years now.

    When patients ask me to show them a breast self-exam, I do. It is important for patients to understand that being familiar with their bodies will help them know when something has changed and when they need to seek medical attention.

    Whether patients do a formal breast exam or just pay attention to changes in their breast should not matter.

    But telling patients they should not bother to examine or check their breasts can mean different things to different patients. For some this will mean that awareness doesn't matter. For others it will mean that they have no power over their health.

    I think that the most important message to send patients is that they can have an impact on their health if they increase their awareness and interest.

    I still tell patients to pay attention to changes in their breast and show them what to look for and how to look......

    In my opinion, telling patients not to bother could send a poor message overall.
  2. James Cyr from Balmertown Ontario, Canada writes: Ms. Ermel did a self examination and discovered a 1.5 cm lump in her breast. This enabled her to treat the cancer in its relatively early stages. This examples shows that breast self-examination works. In other words, if this technique is successful in 1 % of cancer detections, then it works, and should be maintained despite so-called scientific studies. Having said that, screening and mammograms are no doubt the most effective way to detect early breast cancer.
  3. W.A. Darnell from Canada writes: Instead of encouraging women to take more responsibility for their health by promoting self examination -- of any part of their anatomy -- the medical profession would rather continue to alienate humans from their bodies by suggesting that only 'they' know. This comes from a profession that is so steeped in its own arrogance and self righteousness that any therapy other than its own is ridiculed. Just because doctors like to hide in the dark doesn't mean the patients have to.
  4. Dennis sinneD. from Calgary, Canada writes: No need, I shall do it for you.

    All joking aside, if you care about your lady, you'll do it with/for her. Learn how and practice frequently...
  5. M F from Canada writes: hey WA D...I am a physician and I disagree with the message of the study....there are plenty of docs like me....and we are taught to think critically so we don't go along with every study that is put out. Motto: Don't jump on any bandwagons without proper and due scrutiny. Most docs I know are analytical and careful providers.
  6. Vic Hotte from Kettleby, Canada writes: Cancer of any kind is a rather frightening diagnosis for anyone to face.

    We are told that 1 in 9 women will develop breast cancer by the age of 84. Around age 50, the risk is about 1 in 25. It seems that more aggressive forms of cancer afflict younger women.

    Cancer does seem to carry an age-related risk, so everyone needs to be aware of their general health and any changes. Apparently, mammograms do not reveal approximately 30% of breast cancers, since they concentrate on the most common form of breast cancer, ductal, but breast tissue is distributed up toward the shoulder area and toward the under-arm area. Women should be familiar with the risks while they examine their entire chest area.

    Cancer is a cunning disease since it represents a person's own natural body cells that are growing out of control -- cells dividing repeatedly; cancer cells can also raft from one part of the body to another, sometimes using the lymphatic system, so it is NOT so easy to notice at an early stage . Awareness is important.
  7. Colin C from Canada writes: James Cyr - you missed the point of the article. Yes, Ms. Ermel discovered a lump and had it treated, true. But the study found that whether she found it then through a self exam or later when it became so obvious that she found it otherwise does not change her chances of survival. This is a surprising and non-intuitive result, but apparently valid.

    That being said, however, I agree with MF and others that all of us still need to be proactive in our awareness of changes in our bodies.
  8. M D from Ottawa, Canada writes: The problem may arise in false-negatives. A woman self-examining may find no lumps, and assume no problems, and not get a clinical examination (who needs those nasty waiting rooms anyways). Bad idea.

    This cancels out the statistical successes of those who do find lumps. False security. Go see your doctor.
  9. Sharley Goulais from Kelowna, Canada writes: I am really happy to see that other people were similarly affected by this article. I wrote a very nice long letter to the editor about this article and the negative message it sends out. We should be working together to find and fight cancer in any little way, and this article blows that idea away. It makes people start to believe that they shouldn't think for themselves anymore? What century are we in again? I am quite surprised that this article made it into such an important and popular medium to the average Canadian that feels they can make a difference in their life. And seeing something like this article makes me look at the substance in this newspaper, and whether it is as smart and informative as I thought! Anyway, I think we should be making better informed decisions about how we are dealing with Cancer and breast lump detection, and maybe focus our energies on supporting those who are dealing with such situations, and maybe even at looking at finding a cure! AND people should be aware of their bodies and what the doctor's are telling them to do! Please also don't forget this is not just about women, men are affected as well. This is not just some culteral phenomenon, we should all be expanding our minds together to make this world a better place, not hinder it with very old ideas about the doctor always being right no matter what.
  10. Robert Gow from Oshawa, Canada writes: On behalf of my wife whose family has a long history of cancer, what do we do so that we don't overpower an underfunded health system? Should my wife go for mammograms once a year, twice a year, every quarter? Can our system handle this influx of worried people? Thanks
  11. Lawrence Hutchinson from Houston, United States writes: James Cyr from Balmertown Ontario, Canada writes: Ms. Ermel did a self examination and discovered a 1.5 cm lump in her breast. This enabled her to treat the cancer in its relatively early stages.

    This is anecdotal evidence. There is no way to know whether her outcome would have been any different if she had discovered the lump by accident when it was 2 or 3 cm. The data clearly shows that there is no difference.
  12. Michael Bruce from Nova Scotia, Canada writes: I think people have nicely summarized that it matters not how you detect cancer, but that you make an effort to do so - either through body (and overall) self-awareness or through being proactive medically (visit your doctor, do self-exams, get mammograms). It doesn't matter HOW you do it, just THAT you do it.

    If the numbers show that it doesn't impact your survival rate, then what's the harm in doing it?

    The same goes for men - we should just get over the whole "prostate" fear. It's YOUR body - do what you need to do to keep it healthy.

    Even simple things like changing what you eat or drink can have significant impacts on your odds of getting and beating cancer. While we can't control all environmental factors, at least eliminating some risks should help mediate some of the impacts on our health system, thus enabling more availability of funds and screening/treatment options.

    Enough preaching. My mother-in-law is a double-mastectomy breast cancer survivor, and she's doing all the right things to make sure she doesn't see a return of the disease. We all can do the same.
  13. Sandra Malasky from Peterborough, Canada writes: As someone currently being treated for breast cancer, I am relieved to hear the results of the study of self breast exam (BSE). I have intermittently done BSE all my adult life. I have done the exam not because I believed in its efficacy but because I didn't want to get "the lecture" every time I went to see a practitioner. My breast cancer was detected as a result of routine mammography and for that I am grateful. I respect that BSE is an integral part of the "narrative" for some women but itcannot be given such a prominent place within an overall public health strategy for breast cancer.
  14. Sarah Draper from Bowmanville, ON, Canada writes: I appreciate the studies done by the medical community and was, in fact, informed by my physician at my annual physical last year that the monthly exams that I have performed since age 15 are not necessary. I respectfully disagree, and it may be just one story, but my mother's diagnosis of breast cancer when I was 13 stands as a constant reminder of how important self exams are. My mother discovered a lump in her breast at age 45 during her self exam and promptly went to the doctor. The mammagram did not show a lump and the doctor could not feel it, but because she was familiar with her breasts she fought for a biopsy and was diagnosed with cancer. I am convinced that her monthly exam saved her life and will argue with anyone that if it saves just a few women, then self exams should be encouraged.
  15. Dan Stevens from Winnipeg, Canada writes: Hey, if you want controversy then you could point out that no study of mammography has ever shown an overall survival advantage. The two large Canadian studies of mammography didn't show a breast-cancer specific survival advantage, either (ie not only were women with regular mammograms just as likely to die as those without, they were just as likely to die of breast cancer as those without).

    If you think people get ornary when you start trashing breast self-exam, try suggesting that mammograms are probably a waste of time, too...
  16. Kay Ay from Canada writes: Sarah Draper the same thing just happened to my friend.
    She felt something went to the doctor and had a mammogram...they saw nothing but because of what she felt they did a biopsy and she had her surgery last week.
    My mom had breast cancer at 46 so I'm on the annual mammogram list. I have mixed feelings about this: am I squandering medical resources or taking care of myself so I can be around for my children should they actually find something.
    Let's just say I'm getting the tests because once you see your mom go through chemo you do what ever she wants.
  17. Kate Slater from Penticton, Canada writes: My daughter died at 50, 18 months after being diagnosed with Inflamatory Breast Cancer. This cancer is rare, aggressive and strikes young women. The 5 year survival rate used to be 40%, it is now perhaps 50%. She discovered it herself but obtaining a diagnosis took two or three months longer than it might have, partly because many of the people she dealt with were focussed on cancer being a detectable mass and did not recognise hers, which presented as swelling and skin rash. In this type of cancer, weeks count.

    I believe strongly that women need more and broader education in body awareness. Learning to do self exams is a tool for this, and they need to learn to watch for more than just lumps.

    IBC is probably not counted with with other breast cancer statistics, but if it were, my daughter would be in the "I found it myself, but I died anyway" group. But had she not found it herself she would have had no chance at all. Even in other cancers, because a self-detected lump may be larger than one seen on a mammogram, one's survival chance may be lower, thus skewing the stats to a neutral result.

    Please, do more teaching, even if the bottom line says it doesn't make a difference. Bottom lines are not the whole story.
  18. C M from Toronto, Canada writes: I'm not a doctor or a scientist but I say, if breast self-examination saves one life, it's worthwhile and should be encouraged. Knowing your body will help you interpret the messages it sends you about your health.
  19. Jane Champagne from Southampton, ON, Canada writes: Hogwash. Trouble with doctors is that they pay no attention to the survivors. Breast self-examination saved my life -- twice. Both times, the cancer was discovered very early on, thanks to an article in Homemaker's Magazine back in the '80s, which pointed out that a lump often looks like a dimple on the breast. If I hadn't read that article, and done the self-exam, I could be dead. Now, 23 and 16 years later, I am alive and kicking -- thanks to a magazine article. So pay no attention to those who haven't been there and just DO IT!
  20. J Lee from North Vancouver, Canada writes: Does anyone have any data or experimental results that suggest the study is not valid? Has it been submitted to a peer reviewed journal or has it been recently published? If not, then the conclusion about the ineffectiveness of self-examination would seem to be warranted. But on the other hand if you want to continue doing them please face east and spin two times around before you start. I've heard somewhere that that just might help too. So take all the precautions you can, just in case something does work.
  21. Sharley Goulais from Kelowna, Canada writes: To respond to Sandra Malasky, I must disagree with you about BSE not being a part of the overall health system. I beleive that we should be using each and every tool we can find, and it should be common sense that once you find cancer, no matter which way about it, you have it! It's just luck and scheduling that you found it, unless you check on a monthly basis and keep an eye on how your body works. You are one of the lucky ones, or older ones, that get routine mammograms, but I really don't know very many people who actually get them until later in life, and most likely not routinely. I myself found a large lump when I was 16, lucky it was benign, but I would not have known and my doctor would have done nothing about it. So I became aware of how to do it and did it myself and went to a better informed doctor and had it removed. My family has a history of 'lumpy breasts', but it takes some personal work to figure the difference between the lumps and the real deal. My doctor has informed me of this difference so I can check myself, and I wish all people were as well informed. They are not. We should be taking the time to educate ourselves and our friends and families about our bodies and finding the best way to keeps ourselves healthy. Then maybe we can give the medical system a break. Mammograms may be the way to go, but unless you happen to get one, you might be able to make a faster decision if you found a lump yourself.
  22. Laura B from London, Ontario, Canada writes: Kate Slater, your post was so powerful and it struck me more than any other post on this topic. Because of your description of your daughter's symptoms being unusual, I will definately pay more attention to subtle signals from my body. Thank you for sharing your story.
  23. I. M. Al Wayswright (not opinionated) from Canada writes: I see that the article struck a raw nerve with many readers. Here's my advice, eat a mostly raw, fresh fruit and vegetable diet, spend at least an hour outside, even in winter, and stop worrying about cancer.
    Why is it that one hundred years ago only one in a thousand had cancer now it's something like one in three?
    In other words take care of yourself and stop worrying.
    The study says that worrying will not increase your chances of survival.
  24. Jen Donnelly from Canada writes: I found a lump in both breasts, both were required to be removed by surgery before I was 30 years old, both were of different origins. Neither were cancer. Self-examination definitely is a capable tool to find a tumour but whether or not that leads to a verifiable statistic that it prevents cancer death deserves more research.

    And neither results diminishes the fear that a disease like cancer, treated in a society like this, perpetuates in a woman who finds a tumour of ANY type in her breasts (or any human who finds one anywhere!).
  25. Bernard Kahn from Vancouver Island, Canada writes: I.M. (not opinionated) writes:

    "Why is it that one hundred years ago only one in a thousand had cancer now it's something like one in three?"

    One reason is that people didn't live as long 100 years ago. Life expectancy in North America in 1900 was less than 50 years. It's now pushing 80. Since most cancers develop later in life, those extra 30 years give you time for lots more cancers.
  26. Pamela Achurch from Peterborough, On, Canada writes: Whatever the outcome, self exams follow the medical concept of 'do no harm'........A monthly self examination of the one's breasts cannot hurt a person so there is no reason not to do it........Perhaps the danger lies in believing that you are cancer free if no lumps are detected. It is a tool, that is all......Why the controversy?
  27. Vic Hotte from Kettleby, Canada writes: Dr. Gifford-Jones, the pen-name for a Toronto gynecologist named Dr. Walker, wrote the following in January 2007: """The Cancer Society and others have lead women to believe mammography results in early diagnosis. This is a lie. It takes eight years before a lump is large enough to detect which provides time for cancer cells to spread to other areas. This is not early diagnosis. One critic said, "Finding a cancer this way is damage control, not prevention". The debate about mammography will continue as economics plays a role. To deny its benefits means a huge economic loss to everyone involved in the procedure. And who wants to admit they've been wrong about the benefits of mammography after stressing its need for so many years? What is rarely mentioned by anyone is the risk of radiation. In the U.S. women are advised to have a mammogram starting at age 40 as breast tissue is dense at this age which makes breast lumps less visible. In Canada the generally accepted age is 50. This involves a considerable number of x-rays by 70 years of age. And since women are often called back for additional mammogram studies, more radiation is needed.""" In his next column, he explained some experts believe women are developing breast cancer due to previous exposure to radiation, and no one tracks cumulative radiation exposure. He wrote: " A few years ago a nuclear engineer told me a story. He had asked a technologist how much radiation he was receiving from back x-rays. The reply? "The same as you would get from a two hour plane trip." The engineer calculated it would take 1,120 plane trips to equal the amount he had received from these x-rays. Then, he called (the radiologist) and said his exposure had been 2.8 roentgens. At the nuclear plant where he worked, this nuclear engineer was only allowed exposure to 0.1 roentgens a year. He calculated it would require 28 years in the plant to receive the same dose as the exposure at the clinic.""" Awareness is important.
  28. K Savage from Ottawa, Canada writes: I can only speak for my own experience. I found a lump in my armpit in 2004. I had a mammogram. Nothing showed up. Since my mother and grandmother both died of bc I was considered high risk so they removed the lump for examination. It was a highly invasive form of breast cancer. I had a double mastectomy. After the mastectomy, the lab found the original site of the cancer to be 1-3 mm in size, far too small to be detected on a mammogram. And yet it had already spread to 3 lymph nodes. Cancer in young women spreads extremely fast. After the surgery (double to be preventative), radiation and chemo I am considered cured. I applaud Belinda Stronach for letting women know that breast self examination is important. It saved my life.
  29. Sharley Goulais from Kelowna, Canada writes: "It is a tool, that is all......Why the controversy?"

    For me the controversy is that a lot of people who read this article will believe that it is telling them they should not do it, just because someone in a smart and important paper like this wrote an article about it. Until they come up with better ways to detect cancer than mammograms and radiation and self-exams, well, we had better all agree that we all do what we can. People are donating for this cause in mass amounts to see progress, and I honestly hope the money is going somewhere to find other ways than mammograms and self exams, and not going towards studies like these to prove they 'don't work' when common sense tells a person it does. But not everyone can trust their common sense when someone important and obviously more knowledgable writes about it in the national newspaper to tell them otherwise.
  30. shoshana berman from Canada writes: The main issue here is listening to your body and going to the doctor is any change is persistent and unusual. This is not just true of breast cancer but STD's, degenerative diseases that can be caught early , such as altzeimers, and other cancers. Many people especially busy mom's or men tend to ignore signals from their own body that somethign is wrong. Sometimes you have to fight the doctor's who may tell you nothing is wrong, whichoften happens to the young or those who present illness atypically. Any signs, be they lumps, bladder or bowel difficulties, swelling, bloating, pain, fever, weight loss, persistent rash, lack of mobility, abnormal bleeding or not bleeding should be cause to report these to your doctor and test for disease. Breast self examination is only a small part of this awareness and encouragement. No study has ever shown that is has hurt and I would be interested in knowing if women who do breast self exams are more likely to catch and reprot other forms of illness and disease, not just breast cancer.
  31. Wilf Kruggel from Onoway, writes: It'll probably never happen but Health Canada is supposed to be looking into all chemicals being used in our food and ensuring that the food we ingest is indeed safe to eat. Everybody knows that this is just not done, All, it seems that we have is a bunch of freeloaders on the payroll at taxpayers expense. Just read the list of ingredients on food that you buy and if it says color and flavor added, gauranteed, those two items are chemicals. Now ask yourself, why do we know so many people with cancer? READ THE LABELS!!!!!!!!, Wilf.

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