Self-examination does not reduce breast cancer mortality

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Q&A

Self-examination does not reduce breast cancer mortality

J Fam Pract. 2003 February;52(2):94-117

By

Marsha Wittink, MD

Joseph B. Straton, MD, MSCE

BACKGROUND: Does breast self-examination reduce breast cancer mortality? Previous studies have shown that breast cancer detected from breast self-examination is smaller and at an earlier stage than breast cancer detected through other means. However, whether practicing breast self-examination actually reduces mortality from breast cancer is still unclear. The US Preventive Health Services Task Force has concluded that there is too little evidence to either recommend or discourage breast self-examination. This study evaluated the role of breast self-examination in the reduction in breast cancer–related mortality.
POPULATION STUDIED: At enrollment, all women were permanent residents of Shanghai, were 33 to 66 years old, and were employed by or retired from the Shanghai Textile Industry Bureau. The study was conducted in Shanghai to avoid contamination; mammography is unavailable and breast self-examination instruction is not routinely provided for the women employed by the bureau or in China in general. Women were excluded if they failed to complete the initial study questionnaire, if they were judged to be mentally or physically unable to participate (no criteria were given for this exclusion), or if they had a history of breast cancer. The women were recruited through the factories’ health care facilities, where they received their primary health care.
STUDY DESIGN AND VALIDITY: This study was a randomized, controlled, single-blinded trial. Women were randomized to receive an intensive instructional program on breast self-examination or to be in a control group, based on their employment in 1 of 519 textile factories (randomization occurred by factory, not by individual). A total of 266,064 women were enrolled in the study.
OUTCOMES MEASURED: The primary outcome of this study was death from breast cancer. To determine deaths from breast cancer, a physician reviewed clinical and hospital records of deceased participants. Secondary outcomes included proficiency of self-examination.
RESULTS: Eight years after initial instruction, the rates of breast cancer mortality in the intervention and control groups were identical (0.10% in both groups). The instruction group was more proficient in breast self-examination. However, the ability to find a lump was greatest immediately after the videos and declined to the before-video level 1 year later.

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Self-examination does not reduce breast cancer mortality

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