Doctors are encouraging 'breast self-awareness': What that means

October 8, 2018

Doctors are encouraging 'breast self-awareness': What that means


If you’re anxious about performing a breast self-exam (BSE) or embarrassed about skipping it for months at a time, don’t beat yourself up. Major medical organizations no longer recommend BSE as a screening tool for early breast cancer detection in women who are at average risk of the disease.

But they do insist on “breast self-awareness.” Essentially, that means becoming familiar with how your breasts normally look and feel so you will be more likely to recognize anything out of the ordinary.

“I think the take-home message to women is to be alert to changes in their breasts,” says Robert Smith, PhD, an epidemiologist and vice president of cancer screening for the American Cancer Society in Atlanta.

BSE was once considered a crucial tool for early breast cancer detection, especially before mammography became the gold standard for breast cancer screening.

A thorough breast self-examination involves multiple steps. A woman searches each breast and surrounding tissue in a precise matrix using her fingers to feel for any unusual lumps or thickening tissue. It’s performed while lying down and standing up. The final step requires a mirror to observe any changes in the appearance of her breasts.

Naturally, doctors assumed that teaching women BSE would save lives. But evidence from two large clinical trials—one in China and another in Russia—failed to show any significant reduction in breast cancer deaths among women who were taught the technique compared with those who did not receive such instruction.

There were issues with the studies, experts acknowledge. For example, women who learned to perform BSE either failed to stick with it month after month or didn’t do it correctly. Furthermore, the studies raised concern about unnecessary testing because women doing BSE had more imaging procedures and biopsies.

Regardless, some doctors and patient advocates continue to endorse self-examination as an important screening tool.


What it means to be breast self-aware

Mark Pearlman, MD, professor in the department of obstetrics and gynecology at the University of Michigan Hospital and Health Systems in Ann Arbor, was involved in writing ACOG’s breast cancer screening guidelines, which reflect the risk of harm from false-positive test results and lack of evidence of benefit.

Still, Dr. Pearlman notes that half of women over age 50 and 70% of women younger than 50 find their own breast cancers. “So we can’t really say, OK, just ignore your breasts.” That gave rise to the concept of breast self-awareness, he says.

What does it mean, exactly, to be breast self-aware? Actually, there’s no standard definition.

ACOG describes it as knowing what is normal for your own breasts and paying attention to changes you might feel.

Susan G. Komen, the national breast cancer research and patient advocacy group, defines it very broadly. Women need to know their breast cancer risk, including any family history of the disease, it says. They should have regular mammograms and clinical breast exams. They need to make healthy lifestyle choices, and they ought to know what’s normal for them.

“It’s important to know the warning signs of breast cancer,” adds Susan Brown, RN, managing director of Komen’s health and mission program education. Look for a lump, hard knot, or thickening in the breast; a change in shape or size of your breast; or signs like swelling, redness, or nipple discharge, for example.

Dr. Pearlman advises average risk patients to be aware of anything that feels odd while putting on a bra, washing in the shower, or being intimate with a partner. “If anything feels different, call your provider, he says. “It’s a relatively simple message.”

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