How useful are breast exams in screening for cancer?

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© Michael Haegele/Corbis

© Michael Haegele/Corbis

The value of self-breast exams as a cancer screening tool has been debated in the medical community, with some physicians arguing that the stress, worry and unnecessary medical procedures that often result when women identify a mysterious lump may do more harm than good. Yet, on the other hand, there are patients and professionals alike who point to stories in which cancer was caught early, or make the point that a woman who regularly examines her own body would be an ideal candidate for identifying changes in her breast tissue.

Adding to the debate over the merits of physical breast exams, a new study published in the Journal of the National Cancer Institute suggests that in conjunction with mammograms, clinical breast exams—those performed by a trained professional—may not yield much greater protection than mammography alone. What’s more, the researchers point out, due to a relatively high incidence of false positives, for every actual case of breast cancer detected using clinical exams, many more would be inaccurately diagnosed, leading to an increased incidence of unnecessary procedures—and emotional trauma.

The study analyzed data for nearly 300,000 women between the ages of 50-69, who were screened either using mammography and a clinical breast exam, or mammography alone. While, compared with previous studies, physical exam accuracy rates had improved significantly, they still found that, for women screened using both techniques, the false-positive rates were far higher for those who had both the clinical exam and mammogram, than for women who had mammograms alone. In health care institutions that offered both clinical breast exams and mammography, for every additional cancer patient identified using the physical exam, there were an additional 55 false positives.

More research needs to be conducted into the overall value of clinical breast exams as a diagnostic tool used together with mammography, but until then, the authors emphasize the importance of discussing the possibilities of false positives with patients, ensuring that they understand the risks and benefits of different screening procedures, and enabling them to make informed choices. In an accompanying editorial, Drs. Mary B. Barton and Joann G. Elmore point out, that while we await further research, a high standard needs to be met for those clinical breast exams that are performed: “[Clinical breast exam] must be done well if it is to be done at all,” they write.

The current American College of Obstetricians and Gynecologists recommendations for breast cancer screenings call for women to examine their breasts once a month—developing a routine that will make it easier to identify any changes, have an annual exam at the doctor’s office, and regular mammograms after age 40.