Breast Self-Exam? Hands Off

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If you’re like most women, you probably feel guilty for all sorts of things: ordering takeout pizza for family dinner, not exercising in two weeks or forgetting your great aunt’s birthday. But the monthly breast self-exam is something you can cross off your list of worries.

It turns out women are no longer advised to do routine monthly breast self-exams (BSE). Instead, every woman should be aware of what her own breasts feel like, so you know if there’s a change that you need to discuss with your doctor.

The move away from breast self-exam recommendations by major health organizations  is spurred by statistics showing that it neither detects cancerous lumps nor saves lives.  Many otherwise healthy women were becoming super anxious after they felt a  lump that turned out to be nothing.

Alexis Atwater, MD

“A lot of women have become almost neurotic about the breast self-exams and they’re finding a lot of benign things,” says Alexis Atwater, an MD in One Medical’s Farragut Square office in Washington, DC. “It’s normal for women to have lumpy breasts and peaks and valleys and squishy material. That’s completely normal.”

And just as  breasts come in different sizes and can vary in shape, some women just have  especially dense breasts, with thicker tissue, or benign cysts, which are perfectly normal for them.

The problem is it can be difficult for women to feel the difference between a normal lump and an abnormal one. And the uncertainty created by the manual screenings has caused a great deal of stress and worry.

Although breast cancer rates have been declining since 2000, according to the American Cancer Society, breast cancer remains one of the leading causes of cancer death for women.  So it’s natural for women to look for a way to protect their health.

“I don’t think I’ve seen a single person coming in with a mass in  her breast or a mass that was detected by mammogram or some other screening where there wasn’t a significant amount of anxiety,” says Elizabeth Haskins, an MD in New York. “We have friends and family and people in the media suffering from this… you cannot underplay the anxiety.”

Fear caused many women to undergo extra testing like mammograms or breast biopsies, in which doctors use a needle to extract a cell sample from the suspicious lump. In some cases, women were left with scars or dimpled breasts from the biopsies, and the results were benign, says Haskins.

After statistics showed that breast self-exam wasn’t helping with early detection or saving lives, around 2009, some major health organizations that help doctors make decisions about health screenings revised their guidelines.

A study of women ages 31 to 64 by the Canadian Task Force on Preventive Health Care found that breast self-exam was actually causing more harm than good, because women were getting unnecessary biopsies.  They recommend against routine manual exams by either medical professionals or women at home.

The American Cancer Society and the US Preventive Services Task Force also recommend against routine manual exams for women with no family history of breast cancer or higher genetic risks like the BRCA 1 or 2 genes.

“My usual spiel is the routine, once-a-month breast self-exam is no longer recommended, but you should know what your breasts feel like, so if there’s something majorly different, you’ll know,” says Haskins. “You can stop feeling guilty.”

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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