Breast cancer: should I examine myself for lumps?

Nearly 900 women in the UK are diagnosed with breast cancer each week. Yet according to a new report from Avon, a third of 2,000 British women surveyed never examine their breasts. Avon's Breast Promise campaign has teamed up with a psychologist to come up with tips to encourage women to regularly check their breasts. Daughters should be taught to check their breasts from 12 or 13 years of age, and be told it is as important as caring for their skin or hair. You should tell your family you will be checking your own breasts once a month, and set an automatic alarm on your phone to remind you.

Or should you? Is examining your breasts useful?

The solution

We'd all like to think women can help themselves to detect breast cancer but research from the Cochrane Collaboration, which adds up the results of lots of studies, says there is no evidence that self-examination works. In fact there is evidence it does more harm than good. Breast self-examination causes anxiety and can provide false reassurance, if women miss cancers.

There has never even been agreement on the right way for women to examine their breasts. A large study in Shanghai of 266,064 women aged between 30 and 64 years of age found that those given breast self-examination instructions had the same numbers of cancers detected, and no reduction in the number of deaths. Women who examined their breasts had more biopsies for harmless lumps, which can cause scarring of the breast.

What may be more useful is encouraging women to be aware of what their breasts look and feel like normally, rather than getting them to do a thorough regular examination. Being "breast aware" is preferred to self-examination by Cancer Research UK. This means looking out for changes in the nipple (a pulling inwards, bleeding or rashes), puckering of the skin, a lump or thickening that feels different, any change in the shape of the breast, how it hangs or if one breast becomes larger. Most cancers are found by women themselves (screening by mammography only finds one third to a half of breast cancers), the majority of whom don't practise self-examination but are aware of changes in their breasts.

It's not clear from their report if Avon is suggesting women should self-examine or become breast aware. The report focuses on getting women into a habit of checking breasts. But they do seem to advocate monthly checks for which there is no evidence. As the authors of a paper in the European Journal of Cancer wrote, breast cancer support organisations should recognise their responsibilities. "Intense promotional activity such as breast cancer awareness month every October results in dismayed clinicians finding their clinics overcrowded with the worried well to the detriment of patients with breast cancer."

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