Palpation fails to reduce breast cancer mortality

Experience compiled from nearly half a million women suggests that breast self-examination has a negligible effect in reducing breast cancer-related deaths. The practice may even be putting an unnecessary strain on breast care resources, according to researchers in Denmark.

Reputed medical institutions as well as patient advocacy groups recommend that women give themselves a breast self-exam every month, starting by age 20, to check for lumps or other suspicious changes. Though palpation is widely praised as a valuable aid to early detection, a recent review of two large studies from Russia and China found no evidence that it could reduce breast cancer fatalities and concluded that it should not replace established screening methods, according to principal investigator Jan Peter Kosters, Ph.D.

"At present, screening by breast self-examination or physical examination [by a trained health worker] cannot be recommended," Kosters said.

Kosters and colleagues at the Nordic Cochrane Centre in Copenhagen analyzed data from 388,535 women. The investigators found that the women in the cohort who did breast self-exams had almost twice as many false-positive biopsies compared with women who did not perform the exams. They published their findings in the latest issue of The Cochrane Library.

Women who performed the palpation test had 3406 biopsies, whereas those who did not had only 1856 biopsies. The difference in the breast cancer death rate between the two groups was not statistically significant. The Chinese study also compared breast cancer management strategies from the self-exam versus the no-exam groups and found that rates of mastectomy and breast-conserving surgery were similar.

Study findings do not mean that women should stop using the self-evaluation technique, and researchers realize that some women will want to continue performing breast palpation exams. Women should always seek medical advice, however, if they detect any change in their breasts, Kosters said.

"We suggest that the lack of supporting evidence should be discussed with these women to enable them to make an informed decision," he said.

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