“I don’t know what I’m looking for.”
Those words, almost verbatim, are uttered by about half of my patients when I ask them if they are doing self breast exams.
I always respond, “You’re not looking for anything.”
The self breast exam has become a search party in the minds of many women. They have been instructed to look for lumps, bumps, color changes, discharge, basically anything but what their breasts feel like normally.
The problem is that most women will not find anything abnormal, so after a few times of performing the exam, they will stop — like with any exhausting search effort.
The instruction to look for something abnormal is all wrong. Even medical students are trained to know normal before they can recognize abnormal.
Let’s shift women’s thinking. They should be encouraged to look at and feel the normal contour of their breasts, so that they simply get used to what they are seeing and feeling — normally. If later they see or feel something abnormal, they’ll know it.
To demonstrate this concept, let’s take the examples of a new rash popping up, feeling chest pain, or noticing that someone is having a stroke because one side of their face is droopy. You notice these things because they are changes from the norm.
We make subconscious observations everyday, and we recognize these abnormalities when they happen — not because we are actively looking for a rash, pain, or a droopy face.
But, you can’t recognize normal or abnormal breast tissue without making the effort to examine the breasts.
Until recently, the monthly self breast exam was unanimously recommended as part of breast cancer screening. But, since November 2009, the U.S. Preventive Services Task Force recommends against the teaching of the self breast exam to all women.
It was felt that there is not enough evidence to say whether the exam is beneficial or harmful. Ironically, they say the same thing about the clinical breast exam performed by a doctor. But, the Task Force made no recommendation for doctors to stop doing breast exams in the office.
Another concern is that a few studies showed that women who perform their own exams have more unnecessary breast biopsies.
The Task Force also changed their recommendation on mammograms, and no longer recommends routine mammograms between the ages of 40 and 49. Now, it is suggested that women ages 50 and 74 should only receive a mammogram every two years, unless otherwise warranted.
Currently, there is a divide between the Task Force and medical societies, who continue to promote mammograms starting at 40 years of age and teaching patients self breast exams.
As an obstetrician-gynecologist, I believe that the more aware a women is of her body, the better.
Breast cancer is the second leading cause of cancer death among women in the United States. The chances of a woman being diagnosed with breast cancer in her lifetime is one in twelve. In other words, if you are a women with eleven female friends, one of you will likely develop breast cancer.
If you are an African-American woman, you are more likely to be diagnosed later and die earlier than a Caucasian woman with breast cancer. The older you are, the more likely you are to be diagnosed with breast cancer. With all of this information, I find it difficult to tell my patients to stop examining themselves.
However, the steps of the self breast exam also need to become less of a hassle.
The instructions usually go something like this: “Perform the monthly exam a week after each period, or if menopausal, the same day of each month. Look at the breasts in a mirror, hands on your hips, lay down with one arm up while the other goes around the breast in a circular motion, now repeat in the shower, look for lumps, color changes and discharge.’
Really? That is the opposite of normal.
I normalize the exam for my patients, without all of the steps and conditions.
“Just do it in the shower,” I tell them. “You’re washing that area anyway!”
Perhaps, it’s my interest in medically underserved populations and third world medicine, but I remain a strong proponent of the self breast exam. It’s affordable and it’s what every woman has when she can’t get a mammogram.
This article is dedicated to Monique Moise, my godmother, who succumb to breast cancer in October 1989 and Shauwn Whittaker, who is currently fighting her own battle.