I switched to a new OB-GYN this year, thanks to changes in my Affordable Care Act health insurance plan. When I went for my annual Well Woman check-up, my new doctor told me that manual breast exams – which I had received at every previous OB-GYN appointment – were no longer recommended.
Since I was the type of person who performed breast self-exams at home when I remembered (and then set a recurring calendar reminder to make sure I would remember) I was very curious to learn why this recommendation had changed.
Here’s the short answer: Current research suggests that the traditional breast exam – one hand over the head, the other hand palpating the breast for potential abnormalities – is not an effective method of early breast cancer detection.
As the American Cancer Society explains:
Research has not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by yourself (breast self-exams). There is very little evidence that these tests help find breast cancer early when women also get screening mammograms. Most often when breast cancer is detected because of symptoms (such as a lump), a woman discovers the symptom during usual activities such as bathing or dressing.
Women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
(Despite the American Cancer Society’s use of “woman”, it’s important to remember that people of all genders can get breast cancer, and all of us should be familiar with how that area of our body normally looks and feels.)
I wanted a more in-depth answer, so I spoke to Dr. Otis Brawley, Chief Medical Officer at the American Cancer Society.
“The recommendation changed in the late 1990s,” Dr. Brawley told me. Two well-designed clinical trials showed that breast self-exams were more likely to cause people to worry that they had breast cancer. This led to increased doctors’ appointments, unnecessary tests, and so on.
Brawley noted that most people were performing breast self-exams incorrectly anyway. “If you did it right, you’d spend a good 45 minutes examining your breasts and looking for lumps.”
(I don’t know about you, but my self-exams usually took closer to 45 seconds.)
When people do discover low-stage breast cancer, they tend to find it during everyday activity: while taking a shower or getting dressed, for example. “Not in this monthly 45-minute obsession.”
If you are already in the habit of regularly checking your breasts for anything unusual, continuing to perform your own version of the breast self-exam is unlikely to hurt you — though it may also cause some unnecessary anxiety, as noted above.
If you are worried about whether you should be performing breast self-exams, or whether you’re doing them wrong, you can feel comfortable knowing that skipping the monthly exam doesn’t go against medical advice.
What should we be doing instead?
“Women should be aware of their breasts,” Dr. Brawley said. “If they detect any changes, then women should seek medical attention.”
The Cancer Council Australia recommends getting a breast cancer screening from the ages of 50 onwards to undergo mammograms every two years. If you are over the age of 40 you can have a free BreastScreen Australia mammogram (a breast x-ray) every two years.
Those with a family history of breast cancer should make their GP or OBGYN aware as soon as possible, as screenings should be taken earlier than the age of 40 in higher risk situations.
If you notice a change in your breasts, such as the look or feel, see your GP as soon as possible. This includes men as well, who should be aware that breast cancer is a real risk for them too.