The effect of breast self-exam practices and physician examinations on extent of disease at diagnosis

Smith, Elaine; Francis, Anita M.; Polissar, Lincoln

doi:10.1016/0091-7435(80)90235-2

Cited by 101 publications

(33 citation statements)

References 18 publications

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“…Several studies have shown that various characteristics that are likely to be associated with dying from breast cancer were also associated with BSE practice, but analyses adjusting for the potential effect of such confounding on mortality were not reported. Women who practised BSE tended to be younger, premenopausal and of a higher socioeconomic status (Smith et al, 1980;Feldman et al, 1981;Tamburini et al, 1981;Huguley et al, 1988;Le Geyte et al, 1992;Auvinen et al, 1996). Much of the reduction in mortality observed in these studies might therefore be explained by a combination of these and other confounding factors as well as the aforementioned biases, rather than a real effect of BSE.…”

Section: Discussion Women Who Practise Bsementioning

confidence: 86%

“…Relative risk of having advanced breast cancer in BSE vs non-BSE groups Practise BSE vs do not practise BSE Foster, 1984Huguley, 1988Kurebayashi, 1994 All All Koibuchi, 1998Kuroishi, 1992Greenwald, 1978Owen, 1985Ogawa, 1987Tamburini, 1981Feldman, 1981Smith, 1985Smith, 1980 Cancer found by BSE vs found by chance 0.60 (0.46 −0.80) 0.66 (0.44 −1.01) Figure 2 Observational studies of women with breast cancer, comparing the rates of advanced breast cancer between the BSE and non-BSE groups. A test for heterogeneity between the studies yielded a P-value of o0.001 for those studies based on women who practise BSE and a P-value of 0.051 for those based on finding cancer by BSE.…”

Section: Resultsmentioning

confidence: 99%

“…Studies on women newly diagnosed with breast cancer A total of 15 studies were based only on women newly diagnosed with breast cancer (Greenwald et al, 1978;Smith et al, 1980;Feldman et al, 1981;Tamburini et al, 1981;Foster and Costanza, 1984;Owen et al, 1985;Smith and Burns, 1985;Ogawa et al, 1987;Huguley et al, 1988;Kuroishi et al, 1992;Le Geyte et al, 1992;Kurebayashi et al, 1994;Auvinen et al, 1996;McPherson et al, 1997;Koibuchi et al, 1998) and they were divided into four groups based on two different measures of outcome and two different measures of exposure.…”

Section: Methods Data Sources and Study Selectionmentioning

confidence: 99%

“…It was monthly (Ogawa et al, 1987;Auvinen et al, 1996), monthly or several times a year (Feldman et al, 1981;Tamburini et al, 1981;Foster and Costanza, 1984;Koibuchi et al, 1998) or at least two (Smith and Burns, 1985) or three (Smith et al, 1980) times per year. In several studies, about half or more of the women in the BSE groups had reported that they checked their breasts monthly (Feldman et al, 1981;Smith and Burns, 1985;Ogawa et al, 1987;Le Geyte et al, 1992).…”

Section: Definition Of Bse Practicementioning

confidence: 99%

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

2003

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Breast self-examination (BSE) is widely recommended for breast cancer prevention. Following recent controversy over the efficacy of mammography, it may be seen as an alternative. We present a meta-analysis of the effect of regular BSE on breast cancer mortality. From a search of the medical literature, 20 observational studies and three clinical trials were identified that reported on breast cancer death rates or rates of advanced breast cancer (a marker of death) according to BSE practice. A lower risk of mortality or advanced breast cancer was only found in studies of women with breast cancer who reported practising BSE before diagnosis (mortality: pooled relative risk 0.64, 95% CI 0.56 -0.73; advanced cancer, pooled relative risk 0.60, 95% CI 0.46 -0.80). The results are probably due to bias and confounding. There was no difference in death rate in studies on women who detected their cancer during an examination (pooled relative risk 0.90, 95% CI 0.72 -1.12). None of the trials of BSE training (in which most women reported practising it regularly) showed lower mortality in the BSE group (pooled relative risk 1.01, 95% CI 0.92 -1.12). They did show that BSE is associated with considerably more women seeking medical advice and having biopsies. Regular BSE is not an effective method of reducing breast cancer mortality. British Journal of Cancer (2003) For many years, women have been taught methods of breast selfexamination (BSE) and it is recommended that they practise this regularly (Boyle et al, 1995; Shapiro et al, 1998), usually every month. There is a belief that among women who practise BSE, those who develop breast cancer are more likely to find it at an earlier stage and this is expected to lead to earlier treatment and hence decrease their risk of dying from the disease. Breast selfexamination is appealing as a routine screening method because the examination has no financial cost (apart from the initial instruction sessions) and can be conducted in private. Most studies on the effectiveness of BSE have been observational. They suggest that women who practise BSE are more likely to find their breast tumour themselves, that the tumour tends to be smaller and that these women have an increased survival (Hackshaw, 1996; International Agency for Research on Cancer (IARC), 2002). However, survival time as an outcome measure can be misleading because of lead-time bias, in which BSE only identifies cancers at an earlier stage but has no effect on prognosis. Using mortality rates instead of survival time can overcome much of this bias.Recently, the International Agency for Research on Cancer (2002) published a review on breast-cancer screening that reported the individual results from observational studies of BSE in relation to survival and stage of cancer, and those from randomised trials and cohort studies in relation to mortality. We here, however, present a meta-analysis of BSE and breast-cancer mortality by reviewing the published evidence from both observational studies and randomised trials, including t...

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Section: Discussion Women Who Practise Bsementioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Methods Data Sources and Study Selectionmentioning

confidence: 99%

Section: Definition Of Bse Practicementioning

confidence: 99%

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

2003

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“…BSE was recommended for this high-risk group despite its failure to reduce breast cancer mortality in the context of a randomized controlled trial that evaluated teaching women at low risk to perform the technique, because of its association with a shorter lag time from the appearance of clinical symptoms to the diagnosis of breast cancer, earlier clinical stage, and smaller tumor size. 31,[38][39][40] The COG-LESG recommended yearly CBE beginning at puberty, with twice-yearly exams starting at age 25 years, annual mammography initiated 8 years after the completion of radiation therapy or age 25 years (whichever comes last), and monthly BSE. 41 The current study has several limitations that should be considered when interpreting the results.…”

Section: Discussionmentioning

confidence: 99%

The cancer screening practices of adult survivors of childhood cancer

Yeazel

Oeffinger

Gurney

et al. 2004

Cancer

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BACKGROUNDThe current study characterized the self‐reported cancer screening practices of adult survivors of childhood cancer.METHODSA cohort of 9434 long‐term survivors of childhood cancer and a comparison group of 2667 siblings completed a 289‐item survey that included items regarding cancer‐screening practices.RESULTSOverall, 27.3% of female respondents reported performing breast self‐examination (BSE) regularly, 78.2% reported undergoing a Papanicolaou smear within the previous 3 years, 62.4% underwent a clinical breast examination (CBE) within the last year, and 20.9% had gotten a mammogram at least once in their lifetime. Approximately 17.4% of male respondents reported performing regular testicular self‐examination (TSE). Women age ≥ 30 years who had been exposed to chest or mantle radiation therapy were more likely to report undergoing CBE (odds ratio [OR], 1.59; 95% confidence interval [95% CI], 1.32–1.92) and mammography (OR, 1.92; 95% CI, 1.47–2.56). Compared with the sibling comparison group, survivors demonstrated an increased likelihood of performing TSE (OR, 1.52; 95% CI, 1.22–1.85) or BSE (OR, 1.30; 95% CI, 1.10–1.52), of having undergone a CBE within the last year (OR, 1.18; 95% CI, 1.02–1.35), and of ever having undergone a mammogram (OR, 1.82; 95% CI, 1.52–2.17).CONCLUSIONSThe results of the current study demonstrate that the cancer screening practices among survivors of childhood cancer are below optimal levels. Primary care physicians who include childhood cancer survivors among their patients could benefit these individuals by informing them about future cancer risks and recommending appropriate evidence‐based screening. Cancer 2004. © 2003 American Cancer Society.

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Screening for Cancers of the Cervix and Breast

Richert-Boe¹,

Humphrey

1992

Arch Intern Med

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The effect of breast self-exam practices and physician examinations on extent of disease at diagnosis

Cited by 101 publications

References 18 publications

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

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

The cancer screening practices of adult survivors of childhood cancer

Screening for Cancers of the Cervix and Breast

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