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Do breast self-examinations really work? Why are experts divided?
Breast cancer screening is a medical screening for asymptomatic and healthy women, aiming to achieve earlier diagnosis. It is believed that early detection will improve treatment outcomes. However, experts are divided on the effectiveness of self-exams, which begs the question: Are breast self-examinations really necessary?
According to a 2003 Cochrane review, breast self-examination is not associated with reduced mortality and, like other screening methods, can increase harm to women, leading to misdiagnosis and unnecessary biologic tests.
Breast self-examination is usually done by women themselves by touching their breasts to check for lumps or other abnormalities. However, much of the medical evidence does not support the use of this test in women who are at relatively typical risk for breast cancer. Approximately 80% of lumps are found to be benign, further challenging the effectiveness of self-examination.
However, Professor Lillie D. Shockney of Johns Hopkins University emphasized: "40% of breast cancer diagnoses are discovered by women feeling a lump, so it is very important to establish regular self-examination."
In addition to self-examination, many screening tests have been used, including clinical examination, mammography, genetic screening, ultrasound and magnetic resonance imaging. Mammography is a relatively rapid and widely available screening method in developed countries. It is usually divided into two modes: diagnostic mammography and screening mammography. According to research, the density of breast musculature affects the results of mammography.
However, the European Commission's Scientific Advice Mechanism states that MRI should be considered as an alternative to mammography in women with denser breast tissue.
Controversy over breast cancer screening stems from the potential harm caused by screening, such as misdiagnosis and unnecessary treatment. Although a few lives have been extended during mammography in middle-aged women, for most women the benefits of screening may not be enough to outweigh the associated risks. Some critics suggest that routine screening may lead to over-medicalization of many women.
Specifically, a Cochrane review of women aged 50 to 75 found that mammography reduced the risk of breast cancer death by only 15%. However, many studies show that among women who undergo routine screening, mortality rates, whether from cancer or other causes, are comparable to those among women who are not screened. This raises questions about whether screening is effective.
Regarding the effectiveness of screening, the Nordic Cochrane Collection pointed out in 2012 that due to advances in diagnostic technology and treatment methods, the life-saving effect of mammography is increasingly diminished.
A major debate in the medical community is whether screening improves health. On the one hand, screening can detect certain potential breast cancers earlier, but on the other hand, the negative effects of excessive screening, including unnecessary anxiety and medical procedures caused by test results, cannot be ignored. Therefore, the value of screening in low-risk women remains controversial.
A study pointed out that for every 1,000 50-year-old women who undergo annual mammography screening, only one woman will live longer due to early detection, while at the same time, 2 to 10 women will be misdiagnosed and need to receive meaningless treatment.
Further research shows that cost and psychological pressure are also important factors that many women consider. When women face each screening test, they are often full of anxiety about countless future tests. Past medical data shows that about 90% of women will feel great fear and anxiety after receiving a "false positive" result. However, even if the result is confirmed to be a false positive, this process may still have a lasting impact on their quality of life.
Experts have different opinions on the conclusions of breast self-examination and screening, which makes women particularly confused when faced with the decision-making process. How can we make a more reasonable choice between self-examination and screening to avoid the physical and mental distress caused by excessive medical treatment?
