Should I stop checking my own breasts?

Question

I'm confused and more than a bit bothered! I'm a menopausal woman with a family history of breast cancer. For years I've been told (ordered would be more accurate!) to check my breasts each month. Recently, however, I heard some cancer specialist on the news saying I shouldn't bother. What's going on? Why the change in recommendations? And most of all: do you think I should stop checking my breasts?

Answer

I must admit that I, like you, was upset that, out of the blue, we were given the order to stop doing Breast Self Examination (often called BSE). I also have a family history of breast cancer. Being a questioning sort I really wanted to know if there were new or good data on which to base this changed instruction. In a future articleI'll share with you what I've learned so far about the background and the science behind the recommendation to discontinue BSE.

Right now, however, I'll give you my personal answer to your good question about checking your own breasts: I think you should continue to check your breasts once a month!

But I want to change the name, the ideas behind BSE and the guidelines for understanding what we're feeling in the following ways:

• Call it "Self Breast Check!" SBC is NOT an examination (which is what doctors are trained to do), but simply saying "Hi" to your breasts once a month. Think of it as having a visit with friends. You need to keep in touch with them to know when things change.
• SBC is not looking for cancer-that's too scary a thought for most of us.
• Menopausal women can best remember to visit their breasts on their day of birth each month. Regularly menstruating women can best remember to check breasts when their period finishes (or when breasts are least likely to be swollen or sore.)
• Think about the two breasts as nearly identical twins. If they are similar-even if one side feels like it has a lump in one area-if the other side is firmer in the same area, it is not likely to be something to worry about.
• If you find a tender lump it is not likely to be something dangerous. Most of the time estrogen without enough progesterone makes cysts (round balls filled with fluid) or clumps of growing tissue that feel sore when you touch them.
• Both these (called "fibrocystic" changes) will decrease and go away in a few weeks or at most a month.
• Something worrisome in your breasts will feel like the tip of your nose, not squishy and softly lumpy like the usual breast tissue.

The next things about the new Self Breast Check that are different from BSE, are the reasons to go see your own doctor about what you observe. I think the previous teaching we got about BSE did not give clear enough instructions about what was a cause for further checking, and implied that breasts could develop cancer in a month! Instead, breast cancer develops slowly over tens of years. For these reasons, women were needlessly worried, had unnecessary extra mammograms, ultrasounds and breast biopsies. And cancer experts blamed us, and Breast Self Examinations, for increasing health care costs.

Here are some new guidelines for when to go see your doctor with what you've found on your own Self Breast Check. Go when:

• A definite lump doesn't go away by the next month when you check it
• When a tender lump, that has become non-tender, hasn't gone away in a month after becoming not sore
• When a non-sore lump is growing in size
• When you notice bloody fluid coming from a nipple

I think that a woman's own fingers, feeling her own breasts regularly, are the best early detection of breast cancer that we have. That is especially true for younger women who less commonly get breast cancers but whose cancers are harder to find early. Women who are having periods, who are in the pre- and perimenopausal years, have normal or high estrogen levels that make the breast tissue too dense for mammograms to be able to "see" a cancer. However, we can notice a change if we are regularly visiting our own breasts. Remember, two thirds of all breast cancers are found by us!

I will continue advising myself, and my patients, to check our breasts every month. Until someone shows me scientific evidence that the Self Breast Check has fewer false positives than mammograms (in other words, something that is thought to be cancer and isn't) and fewer false negatives (meaning, when it was thought that there was no malignancy, but there actually was cancer present) than doctors' clinical breast examinations, I'll opt for Self Breast Check as a potential way to find a breast cancer early so that I, like my mother, can be cured.

I hope that this is helpful for you.

All the best.

Jerilynn C. Prior, MD, FRCPC