Breast self-examination and breast screening

The British Medical Journal (BMJ 2003; 326: 1-2; January 4, 2003) recently had an interesting editorial on breast self-examination by J. Austoker, director, Cancer Research, UK Primary Care Education Research Group, titled "Breast self-examination - does not prevent deaths due to breast cancer, but breast awareness is still important".

It reads: "A large, well conducted, randomised, controlled trial shows conclusively that teaching women how to examine their breasts does not lead to a reduction in mortality due to breast cancer compared with no screening at all.

"The findings should bring to an end more than a decade of controversy and confusion in the UK concerning the efficacy and effectiveness of breast self-examination.

"Breast self-examination has been recommended for the past 70 years, despite the lack of evidence of its efficacy in reducing deaths from cancer. More than 30 studies have produced conflicting results, not providing any strong evidence to support the practice of breast self-examination."

This 'Shanghai trial' provides evidence of the lack of effect of teaching breast self-examination. The intervention included intensive instruction with multiple reminders to examine their breasts, and periodic reinforcement sessions for five years.

The results showed that deaths due to breast cancer and the cumulative mortality were almost identical in both groups. These finding confirmed the preliminary findings reported from a trial of breast self-examination in Russia in 1992 (also refer to BMJ USA 2003; Mar:168 or bmj.com, April 12, 2003).

Another more recent article in the same journal (BMJ 2003; 326: 949 - May 3) shows that mammography screening has cut the number of deaths from breast cancer by almost half, according to studies of screening programmes in two European countries.

The first study compared deaths from breast cancer diagnosed in two Swedish counties (Lancet 2003; 361: 1405-10). The study showed that the risk of death from breast cancer dropped after the introduction of screening by 23% in women aged 40-69 years.

A second study in the Netherlands also showed similar results (Lancet 2003; 361: 1411-7). Mortality among women aged 55-74 years was 20% lower in 2001 than in 1986-8, before screening programmes were introduced.