Cognitive Therapy for Depression

Abstract

different regions of Britain to compare mortality rates for breast cancer among screened populations, populations intensively instructed in breast self-examination, and control areas left without the putative benefit of either strategy. It will be many years before any definitive data are available. Meanwhile, a recent report in Cancer4 is encouraging. In this retrospective study of over 2000 women with breast cancer from the Georgia Cancer Management Network the practice of breast self-examination was compared with the stage of presentation at diagnosis. Sixty-seven per cent of the women reported that they practised breast self-examination, rising to 760, among those under 50. There were also the differences between social and educational subgroups. The anticipated proportion of cancers at a favourable stage was significantly higher for breast self-examination (84"'/) than for "selfaccidental" discovery (74",). Furthermore, among the 1264 women practising breast self-examination whose axillary nodes were examined 57"),, did not contain tumour compared with 50",, of nodes from 560 women who did not practise breast self-examination. These pathological differences might eventually be expected to result in different death rates. The authors sensibly conclude that the early discovery of lumps in the breast and breast self-examination may not be causally related: both variables could reflect the health consciousness of the patient. They also go on to say that it is logistically and financially impossible to perform a prospective randomised trial to test this hypothesis-plainly, they had not heard of the current DHSS study. While accepting the enormous differences in cultural attitudes and health awareness between women in the United States and Britain I will use the Georgia experience to justify the practice of instructing women who attend my clinics in breast self-examination while awaiting the results of the DHSS study. I remain secure in my conviction that, apart from inducing occasional obsessional neurosis, breast selfexamination is unlikely to do any harm. For other clinicians who agree I would recommend the leaflet produced by the Women's National Cancer Control Campaign, which provides good illustrations and clear instructions.5 MICHAEL BAUM