Breast Self-Examination in Relation to the Occurrence of Advanced Breast Cancer

Abstract

Two hundred nine female enrollees of the Group Health Cooperative of Puget Sound who developed advanced-stage breast cancer during the period 1982-1988 were interviewed about their practice of breast self-examination (BSE), use of other breast cancer screening modalities, and medical and reproductive histories. Each subject's description of how she performed the examination was scored according to her mention of up to 10 recommended BSE techniques. A random sample of 433 women without advanced-stage breast cancer from the same population was interviewed for comparison. Relative to women not practicing BSE, the risk of advanced-stage breast cancer among BSE users was 1.15 (95% confidence interval, 0.73-1.81). Frequency of BSE did not differ between women with advanced-stage breast cancer and control subjects, whether in all subjects or in subgroups defined by age, use of mammography, or frequency of clinical breast examinations. While self-described proficiency in BSE was generally low in both case and control subjects, the small percentage of women reporting more thorough self-examinations, regardless of frequency, had about a 35% decrease in the occurrence of advanced-stage breast cancer compared to women who did not perform BSE. These results suggest that, while carefully performed BSE may avoid the development of some advanced-stage breast cancers, BSE as practiced by most Seattle-area women is of little or no benefit.

Breast self-examination and death from breast cancer: a meta-analysis

“…None of the case -control studies found statistically significant effects with only one suggesting a benefit (Harvey et al, 1997). The results for two of the case -control studies were not materially altered after adjustment for mammography use (Newcomb et al, 1991;Muscat and Huncharek, 1992). Table 3 provides the main results from the trials of teaching BSE and Figure 3 shows the relative risks and the pooled estimates for the main outcomes.…”

“…The results were not materially different if the nonrandomised trial from the UK was excluded, pooled relative risk 1.05 (95% CI 0.90 -1.24, P ¼ 0.54). Or women with advanced breast cancer (Muscat, 1992;Newcomb, 1991). Dashes indicate that the data were not available from the published paper.…”

“…Case -control studies of women with and without breast cancer There were three case -control studies, two from the USA (Newcomb et al, 1991;Muscat and Huncharek, 1992) and one from Canada that was nested within a randomised trial of mammography (Harvey et al, 1997). In each study, cases (women who had died from breast cancer or had advanced cancer) and age-matched controls (women without breast cancer) were asked about their past BSE practice.…”

Freqüência de realização e acurácia do auto-exame das mamas na detecção de nódulos em mulheres submetidas à mamografia

“…Em mulheres mais jovens ou mais idosas, entretanto, esse benefício ainda pode ser considerado controverso 7,13 . Quanto ao efeito do AEM utilizado como método de rastreamento, ensaios não-randomizados, estudos de coorte ou caso-controle evidenciaram que há uma relação inversa entre freqüência de realização do AEM e taxa de mortalidade 8,15 . Há dois grandes estudos randomizados em andamento com o intuito primário de avaliar o efeito do AEM na mortalidade por câncer de mama.…”

Breast Cancer Screening Controversies

“…Women who practiced BSE with high proficiency did have a decreased risk of breast cancer deaths, but the retrospective design could not eliminate the possibility of recall bias. 42 Women do find breast cancers by self-examination. In women ages 40 to 45 years (before many have routine mammography), 65% of the cancers were self-detected.…”