BREAST CANCER Self-exams saving women's lives, ACS says

Clinical examinations by a doctor and mammograms are vital in the battle against breast cancer.
By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
CANFIELD -- To detect cancer early, women should check their breasts for abnormalities monthly, American Cancer Society officials say.
Breast self-examination can detect cancer in its early stages and save lives, say local and national ACS officials.
Their advice runs contrary to the results of a study in China that showed self-examinations made no difference.
ACS continues to recommend that correct breast self-examinations, as taught by a doctor, be done monthly by women 20 and older, said Al Stabilito, communications and advocacy director for the Mahoning Valley Chapter of ACS.
The purpose is early detection, when breast cancer is highly curable. And "Yes," Stabilito said, "we have breast cancer survivors who discovered their cancer through self-examination."
He said self-examination should be done along with clinical examinations by a doctor and mammograms.
ACS recommends that women ages 20-39 receive a clinical examination at least every three years and that women over 40 have clinical examinations and mammograms annually, both in addition to monthly self-examinations.
About that study
According to the study of about 266,000 women factory workers in China, having women do breast self-examination alone does not lead to fewer deaths from breast cancer, even when intense efforts are made to teach the women how to perform the procedure.
The study is reported in Wednesday's issue of the Journal of the National Cancer Institute.
The study was done in Shanghai from October 1989 through July 2000 and was reported by Dr. David B. Thomas from the Fred Hutchinson Cancer Research Center in Seattle, Wash., and colleagues from China and Norway.
Stories about the report do not mention the age of the women, which would have an impact on the number of cancer deaths. Age is a factor in developing cancer, Stabilito said.
According to the study, women in Shanghai tend to work at a single factory throughout their work life.
Mammography is not available to them, and they receive almost all of their medical care through the factory.
Also, there was no mammography available during the study, so BSE was the sole method of detecting breast cancers.
Although the women who were trained in BSE were much better at performing the exams than the women who were not trained, the study did not show that the women who were trained lived longer or died less often from breast cancer.
Researchers' conclusions
The researchers concluded that the teaching of BSE did not result in fewer deaths because the breast cancer was not diagnosed at a & quot;less advanced stage of progression for appropriate therapy to have altered the course of the disease. & quot;
& quot;For women in more developed countries with access to mammographic screening, the results of this trial should serve to emphasize that BSE is not a substitute for regular screening by mammography, & quot; said the researchers.
But they also cautioned that it is possible that motivated women, performing BSE between mammographic screenings, may increase the benefits of a screening program.
Editorial
In an editorial which accompanied the report, Drs. Russell Harris and Linda Kinsinger from the department of medicine at the University of North Carolina said that it is difficult to learn how to perform BSE well.
They also noted that one of the striking changes over the past 25 years in the United States in breast cancer & quot;is the reduction in the size of lumps discovered by women themselves. & quot;
Large lumps, said the editorial writers, are much less common today than they were previously.
Drs. Harris and Kinsinger said the evidence is increasingly clear and difficult to ignore: "BSE is ... difficult to learn to do well; difficult to continue to do long term; and it doesn't reduce a woman's chances of dying from breast cancer."
Perhaps, Drs. Harris and Kinsinger said, that instead of giving detailed instruction in how to do BSE, doctors should spend some extra time on doing a thorough clinical breast exam when a woman is seen in their office.
"Mammography is the best tool there is for early detection of breast cancer, but to save lives, it must be used, and it must be used regularly, & quot; said Robert A. Smith, Ph.D., director of cancer screening for the ACS.
But, he said, BSE teaches women what is normal for them, provides a heightened sense of awareness and lets them know there is something that needs to be brought to the attention of their doctor.