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“Breast self-exams are no longer recommended.”
When I saw this headline earlier this year, I thought it was a typo. As someone who found my own breast cancer lump that turned out to be stage 3 cancer, I was surprised to learn that many health organizations such as the American Cancer Society and the National Cancer Institute do not recommend breast self-exams. And they haven’t for years.
So what happened?
Breast self-examination was created in the 1950s as a convenient and low-cost way for people to catch breast cancer early, when it is most treatable. But in the 2000s, research found that performing formal breast self-exams (raising arms, lying down, circular motions, etc.) may not reduce the risk of dying from breast cancer. A meta-analysis comparing women who performed routine breast self-exams with those who did not perform self-exams found that there was no difference in breast cancer survival rates. But people who did self-exams had more false positives and nearly twice as many cancer-free breast biopsies.
Read: What you need to know about breast biopsy >>
Without data showing that breast self-exams can reduce the risk of death from breast cancer—and the potential for harm from unnecessary exams—breast self-exams are no longer recommended for average-risk individuals by most professional organizations and health care providers. (Average risk means you have no personal or family history or genetic mutation, such as BRCA 1 or BRCA 2)
Larry Norton, MD, a medical breast oncologist at Sloan Kettering Cancer Center, said the change in guidelines from official breast self-exams doesn’t mean you should stop paying attention to your breasts. It’s called breast self-awareness.
What is breast self-awareness?
Breast self-awareness is becoming familiar with how your breasts look and feel so you can recognize any changes. “Lack of awareness of what’s healthy in your body can keep you from spotting something that’s not quite right,” Norton said. “It’s great to know there’s something different in your body, and it’s great when you find something different — whatever it is — to draw attention to it.”
Unlike breast self-exams, there’s no timetable or technique for breast self-awareness—it’s basically using your eyes and hands to know what’s normal for you. Signs of breast cancer to look for may include:
- Lumps
- Pain
- Pits on the skin
- Discharge or bleeding from the nipple
- Redness or warmth
- Swelling/changes in size
Norton said changes in appearance and nipple discharge are more obvious, but it’s important to know how your breasts feel because you may be able to spot signs of breast cancer that your doctor or imaging didn’t pick up on. . “When you touch your breast and you feel an unusual hard spot or an unusual spot that hurts but didn’t hurt before — those are the things that are a little more subtle,” Norton said.
Timing and risks of breast self-examination
Although most health care providers recommend breast self-awareness over formal breast self-exams, some people may still want to stick to the standard technique and routine. If you do breast self-exams, it’s best to do them three to five days after your period ends, when your breasts are less tender or lumpy. If you are postmenopausal, do the self-exam at the same time each month.
Read: How to do a breast self-exam >>
Risks associated with formal breast self-exams include false positives and unnecessary biopsies of non-cancerous tissue. Researchers say the mental and financial stress of imaging and biopsies is also part of the reasoning against formal breast self-exams. However, it is important to note that false positives are common and the chances of getting a false positive increase as you get older. Concern about false positives should not stop you from paying attention to your breast health and contacting your healthcare provider if you see or feel anything unusual about you.
Norton said being familiar with your breasts to notice changes is the key to self-exams. But neither breast self-awareness nor self-exams replace mammograms when it comes to breast cancer screening.
Read: A mammogram saved my life >>
When to get a mammogram?
Currently, mammography is the gold standard for breast cancer screening. According to the latest guidelines from the US Preventive Services Task Force (USPSTF), people at average risk should start getting mammograms at age 40 — not 50, as previously recommended. The change reflects recent data showing that 1 in 6 new breast cancers develop in people in their 40s, and aligns with other organizations offering screening guidelines.
Recommendations for how often they should be tested vary from agency to agency, with some saying every year and others saying every one to two years. You should talk to your healthcare provider about what makes sense for your circumstances.
Regardless of the guidelines, Norton said if you feel or see anything suspicious, contact your healthcare provider immediately. “I like to say that your body trusts you, and you have to do the things necessary to honor that trust — and one of them is screening tests, and another is just knowing your body. So when something is abnormal, you don’t ignore it.”
This educational resource was created with the support of Daiichi Sankyo and Merck.
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