Are breast self examinations really necessary?
The short answer is yes.
The long answer… hmm.. I guess the truth is nobody really knows if teaching breast self examinations to the population really does help pick up early breast cancer.
For years, we have been teaching and promoting Breast Self-Examination (BSE) to our patients as part of screening recommendations. However, there was a huge controversy in 2009 when the United States Preventive Service Task Force (USPSTF) recommended against the teaching of Breast Self-Examination (BSE) . This recommendation was primarily based on results from the Shanghai Study, a large trial of BSE in 266,064 Chinese factory workers from 1989-1991 . After 11 years observation, the Shanghai Study found no difference in breast cancer mortality in women instructed in BSE vs. controls who were not instructed in BSE.
Regardless of the outcome of the Shanghai Study, the practice of BSE in the US over the past 25 years has been associated with a marked reduction in the size of breast cancer identified by women.
Hence, despite definitive USPSTF recommendations, BSE remains controversial.
So, if BSE is controversial, why is it still part of screening guidelines in Singapore?
I think the benefits of BSE is hard to measure as BSE is difficult to teach and even more difficult to practise routinely; compliance is low; However, I think the true benefit from BSE is not due to BSE but to enhanced health awareness.
Personally, I support and promote Breast Self-Examination to the ladies I meet. This is because I feel that learning about our breasts and being familiar with the way they look and feel is important so that we can pick up any changes early. Although screening mammograms are important, we have to remember that there is no screening modality that is foolproof, be it mammogram, or ultrasound or MRI (magnetic resonance imaging). As a breast surgeon, I have also encountered many patients who picked up a lump which turned out to be cancerous just months after they had a normal screening scan.
A breast self-exam is a step-by-step method women can use to examine their breasts. By looking at and feeling your breasts regularly, you can notice anything that seems abnormal.
How do I perform a Breast Self-Examination?
Women should do a breast self-exam once a month, every month. Women who are still menstruating (having a regular period) should perform a breast self-exam 7-10 days from the first day of their period. Women who have stopped menstruating and those who have very irregular periods can pick a day each month. Choose a day that is consistent and easy to remember, like the first day of the month, the last day of the month or your favourite number.
A good time to do it is when you are taking a shower.
Source: Singapore Cancer Society
There are 3 parts to Breast Self-Examination: Look, feel, feel again
STEP 1: LOOK
With your shirt and bra removed, stand in front of a mirror. Put your arms down by your sides. Look for any changes in breast shape, breast swelling, dimpling in the skin or changes in the nipples. Next, raise your arms high overhead and look for the same things. Finally, put your hands on your hips and press firmly to make your chest muscles flex. Look for the same changes again. Be sure to look at both breasts.
STEP 2: FEEL
With your shirt and bra removed, use your right hand to examine your left breast, then vice versa. With the pads of your three middle fingers, press on every part of one breast. Use light pressure, then medium, then firm. Feel for any lumps, thick spots or other changes. A circular pattern may help you make sure you hit every spot. Then, press the tissue under the arm. Be sure to check under the areola and then squeeze the nipple gently to check for discharge. Repeat the steps on the other side of your body.
STEP 3: FEEL AGAIN
When you lie down, your breast tissue spreads more evenly. So this is a good position to feel for changes, especially if your breasts are large. Lie down and put a pillow under your right shoulder. Place your right arm behind your head. Using your left hand, apply the same technique as step 2, using the pads of your fingers to press all parts of the breast tissue and under your arm. Finally, swap the pillow to the other side, and check the other breast and armpit. Be sure to check under the areola and then squeeze the nipple gently to check for discharge.
Doing a DIY breast self-check (medically known as a "breast self-examination") every month helps you to understand and be familiar with the condition of your breasts and to decide what steps to take moving forward! If you need some help and guidance on your breast self-examination, make an appointment with our doctor, and we'll help guide you through any worries that you might have!
Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002;94(19):1445–57. doi: 10.1093/jnci/94.19.1445.