Should You Really Do Your Own Breast Exam?

Photographed by Lauren Perlstein.
For decades people with breasts were told to regularly examine them — like, with an actual feel-yourself-up kind of exam. The thinking was that this would help us spot breast cancers forming early on and, therefore, save lives. But that idea has fallen out of favor with pretty much every major cancer organization, and experts are now reversing that once-common guideline.
"Most of the groups have moved away from a specific recommendation for breast self-exam and instead use the idea of 'breast awareness' as the concept that we want to communicate," says Therese Bevers, MD, medical director of the Cancer Prevention Center at MD Anderson.
Rather than giving directions for a specific type of exam and telling you to do it every month, for instance, breast awareness simply means knowing how your breasts normally look and feel. And, if there's any sort of change, it means getting that checked out by a professional.
So why such a major adjustment? Dr. Bevers says much of the shift comes from the results of a large trial performed in China. The study followed over 260,000 women for 12 years — approximately half were given thorough instructions and told to practice breast self-exams while the others were not. Contrary to expectations, the data showed that there were no mortality differences between the two groups, meaning that breast self-exams, even if they help detect cancers in some cases, don't reduce your chances of dying of cancer.
Not only does there seem to be no real upside to doing the exams, there is also evidence of a few potential downsides: The one major difference that Chinese study turned up was that women who were told to practice self-exams were twice as likely to undergo biopsies than the control group.

If you see or feel a change — I don’t care what it is — you need to get it checked out.

Dr. Therese Bevers
In addition to the anxiety the biopsy process is bound to cause, there are countless other costs associated with this sort of testing: There's the financial cost of diagnostic mammography (which is different from your routine screening and, therefore, not totally covered by insurance). There's also the time cost: The inconvenience (and possibly lost wages) of having to take time off from work to have the test done. Plus, although it may be minor, there's physical pain associated with the biopsy.
Then there are the broader financial costs to the organizations that advocate for self-exams, including paying for ad campaigns and printing up tens of thousands of laminated exam guides to go in your shower. "We needed to recognize from a public health perspective that we need to not be spending millions of dollars for something that has no proven value," Dr. Bevers says.
It's not as simple as just totally ditching the old recommendations, though, because we know that it's important to make sure that patients play an active, central role in their own care. That's because, in addition to helping you feel more empowered about your health, it's true that patients are still the people most likely to find their own cancers. But, Dr. Bevers says, not during self-exams. "They find it during activities of daily living, such as showering, dressing, or scratching," she says.
So the idea of breast awareness became a good compromise: You're not ignoring those sacks of fat hanging off your chest, but you're also not stressing yourself out trying to remember to do a complicated exam that doesn't even really help.
Still, if just "being aware of your breasts" feels like kind of vague advice, that's understandable. It's also kind of the point: If your doctor mentions discoloration and nipple discharge, but doesn't mention dimpling, that might make you think that you don't need to worry about it. "People ask what women should women look for, but I try really hard not to be specific," Dr. Bevers says. "If you see or feel a change — I don’t care what it is — you need to get it checked out."

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