Women’s self-exams and physical exams by a doctor both detect breast cancer tumors at about the same size, but older women are more likely to have a tumor discovered via doctor’s examination, according to a new Swiss study.
The authors, led by Fabienne Dominique Schwab of University Hospital Basel, conclude that breast exams by doctors should be an integral part of general medical care for older women.
“What they essentially said was there wasn’t a whole lot of difference in these two modes of detection except that older women were more likely to have their cancers detected by clinical exam,” said Dr. Robert Smith, an epidemiologist at the American Cancer Society in Atlanta, Georgia who was not involved in the new study.
The authors considered tumor size, location and detection method for 948 women treated in Switzerland between 1990 and 2009.
In 236 women, doctors found the tumors during an exam, while 712 women had discovered their own tumors.
Women who found their own tumors had an average age of 60, compared to an average age of nearly 66 for women whose tumors were found through clinical breast exam. Both methods found the same number of tumors in the same locations and of similar size, averaging 22 millimeters (about 9/10ths of an inch), the authors write.
Tumors in the central region of the breast tended to be larger – an average of 25 mm versus about 19-21 mm for those at the periphery - the authors reported in the journal The Breast.
Doctors and women who perform regular self-examinations should pay particular attention to the central region, the authors advise.
Older women may be more likely to overlook or neglect breast lumps, and less likely to go for mammograms, so doctors tend to discover more tumors of their tumors, the study team writes.
The American Cancer Society (ACS) recommends a clinical breast examination, which includes palpation by a health professional, about once every three years between ages 20 and 40, and yearly for older women.
Some women do self-exams once a month, but choosing not to do them regularly or at all is okay, according to the ACS.
“It is encouraging and perhaps to be celebrated that women are detecting similar rates of cancers and this should arm women with confidence that they are performing this task well,” said Victoria Harmer, Team Leader and Clinical Nurse Specialist in the breast care unit at Imperial College Healthcare NHS Trust in London.
“The risk of breast cancer increases with a woman's age, so it is vital older women continue to be breast aware,” said Harmer, who was not involved in the new study.
Anthony B. Miller of the Dalla Lana School of Public Health at the University of Toronto has studied breast cancer detection in a large group of women in an ongoing study begun in 1980.
“Although in the (Canadian National Breast Screening Study) we learnt that women who practice (self-exam) well had a reduced rate of death from breast cancer, what we tend to promote now is what people call breast self-awareness,” Miller told Reuters Health by email. “By this we mean that women should be aware of the structure of their own breasts and should be alert to any change, which if it occurs, should lead them to seek professional advice.”
Especially for young women, self-exam tends to create many false alarms, he said.
Some women can have "lumpy" breasts, Miller said, adding that "very few lumps turn out to be breast cancer."
The ACS recommends annual mammograms starting at age 40. But the U.S. Preventive Services Task Force, a government-backed panel that weighs current medical evidence, recommends mammograms every two years starting at age 50 for women without special risk factors (see Reuters Health article of April 1, 2014 here: reut.rs/1CxdWUf).
It is questionable whether clinical breast exams add anything on top of the mammograms, Smith said.
Clinical breast exam quality in the U.S. is low, he noted. “In the U.S. it is quite cursory, it doesn’t take very long,” Smith said. “The physician usually has not had much training in clinical breast examination.”
In the big picture, mammograms are going to account for more breast cancer discoveries than clinical exam, and the new results do not change existing ACS recommendations, he said.