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Breast Self-Examination: the Case for a Second Look

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Abstract

Purpose of Review

Breast Self-Examination (BSE) remains controversial despite the 2009 United States Preventive Service Task Force (USPSTF) recommendation against teaching of BSE. The USPSTF recommendations were based on results from the Shanghai Study, a high-quality randomized trial of BSE in 266,064 Chinese factory workers from 1989 to 1991; women instructed in BSE did not have a significant difference in mortality versus uninstructed controls. Regardless of the outcome of the Shanghai Study, the practice of BSE in the US over the past 25 years has been associated with a marked reduction in the size of breast cancer identified by women.

Recent Findings

In the Shanghai study, BSE was tested in China from 1989 to 1991. During this time period, Chinese breast cancer screening and treatment was not consistent with standard-of-care in the US and Europe. Breast cancer was a rare illness in China in the 1980’s. Treatment was not standardized; there was no breast imaging or margin assessment of the tumor. Tumor markers (e.g., estrogen receptor, progesterone receptor) were not reported. The Shanghai Study did not report in detail on the anti-cancer agents provided to women who enrolled in the trial.

Summary BSE Needs to Be Rigorously Re-Evaluated under Current Standard of Care

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening. Accessed 11/10/2019. This statement discusses the negative evidence supporting BSE.

  2. Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002;94(19):1445–57. https://doi.org/10.1093/jnci/94.19.1445. This is a major report from the Shanghai study. While this is an old publication, it drives current care; it is important to read in detail to examine the quality of data.

    Article  PubMed  Google Scholar 

  3. Greenwald P, Nasca PC, Lawrence CE, Horton J, McGarrah RP, Gabriele T, et al. Estimated effect of breast self-examination and routine physician examinations on breast-cancer mortality. N Engl J Med. 1978;299(6):271–3. https://doi.org/10.1056/NEJM197808102990602.

    Article  CAS  PubMed  Google Scholar 

  4. Smith EM, Francis AM, Polissar L. The effect of breast self-exam practices and physician examinations on extent of disease at diagnosis. Prev Med. 1980;9(3):409–17. https://doi.org/10.1016/0091-7435(80)90235-2.

    Article  CAS  PubMed  Google Scholar 

  5. Gould-Martin K, Paganini-Hill A, Casagrande C, Mack T, Ross RK. Behavioral and biological determinants of surgical stage of breast cancer. Prev Med. 1982;11(4):429–40. https://doi.org/10.1016/0091-7435(82)90046-9.

    Article  CAS  PubMed  Google Scholar 

  6. Philip J, Harris WG, Flaherty C, Joslin CA, Rustage JH, Wijesinghe DP. Breast self-examination: clinical results from a population-based prospective study. Br J Cancer. 1984;50(1):7–12. https://doi.org/10.1038/bjc.1984.133.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Owen WL, Hoge AG, Asal NR, Anderson PL Jr, Cucchiara AJ. Self-examination of the breast: use and effectiveness. South Med J. 1985;78(10):1170–3. https://doi.org/10.1097/00007611-198510000-00007.

    Article  CAS  PubMed  Google Scholar 

  8. Smith EM, Burns TL. The effects of breast self-examination in a population-based cancer registry. A report of differences in extent of disease. Cancer. 1985;55(2):432–7. https://doi.org/10.1002/1097-0142(19850115)55:2<432::aid-cncr2820550223>3.0.co;2-9.

    Article  CAS  PubMed  Google Scholar 

  9. Kuroishi T, Tominaga S, Ota J, Horino T, Taguchi T, Ishida T, et al. The effect of breast self-examination on early detection and survival. Jpn J Cancer Res. 1992;83(4):344–50. https://doi.org/10.1111/j.1349-7006.1992.tb00113.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Auvinen A, Elovainio L, Hakama M. Breast self-examination and survival from breast cancer: a prospective follow-up study. Breast Cancer Res Treat. 1996;38(2):161–8. https://doi.org/10.1007/bf01806670.

    Article  CAS  PubMed  Google Scholar 

  11. McPherson CP, Swenson KK, Jolitz G, Murray CL. Survival of women ages 40-49 years with breast carcinoma according to method of detection. Cancer. 1997;79(10):1923–32. https://doi.org/10.1002/(sici)1097-0142(19970515)79:10<1923::aid-cncr13>3.0.co;2-x.

    Article  CAS  PubMed  Google Scholar 

  12. GIVIO (Interdisciplinary Group for Cancer Care Evaluation). Practice of breast self examination: disease extent at diagnosis and patterns of surgical care. A report from an Italian study. J Epidemiol Community Health. 1991;45(2):112–6. https://doi.org/10.1136/jech.45.2.112.

  13. Gastrin G, Miller AB, To T, Aronson KJ, Wall C, Hakama M, et al. Incidence and mortality from breast cancer in the mama program for breast screening in Finland, 1973-1986. Cancer. 1994;73(8):2168–74. https://doi.org/10.1002/1097-0142(19940415)73:8<2168::aid-cncr2820730822>3.0.co;2-v.

    Article  CAS  PubMed  Google Scholar 

  14. Koibuchi Y, Iino Y, Takei H, Maemura M, Horiguchi J, Yokoe T, et al. The effect of mass screening by physical examination combined with regular breast self-examination on clinical stage and course of Japanese women with breast cancer. Oncol Rep. 1998;5(1):151–5. https://doi.org/10.3892/or.5.1.151.

    Article  CAS  PubMed  Google Scholar 

  15. Feldman JG, Carter AC, Nicastri AD, Hosat ST. Breast self-examination, relationship to stage of breast cancer at diagnosis. Cancer. 1981;47(11):2740–5. https://doi.org/10.1002/1097-0142(19810601)47:11<2740::aid-cncr2820471133>3.0.co;2-4.

    Article  CAS  PubMed  Google Scholar 

  16. Tamburini M, Massara G, Bertario L, Re A, Di Pietro S. Usefulness of breast self-examination for an early detection of breast cancer results of a study on 500 breast cancer patients and 652 controls. Tumori. 1981;67(3):219–24.

    Article  CAS  PubMed  Google Scholar 

  17. Hislop TG, Coldman AJ, Skippen DH. Breast self-examination: importance of technique in early diagnosis. Can Med Assoc J. 1984;131(11):1349–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Foster RS Jr, Costanza MC. Breast self-examination practices and breast cancer survival. Cancer. 1984;53(4):999–1005. https://doi.org/10.1002/1097-0142(19840215)53:4<999::aid-cncr2820530429>3.0.co;2-n.

    Article  PubMed  Google Scholar 

  19. Mant D, Vessey MP, Neil A, McPherson K, Jones L. Breast self examination and breast cancer stage at diagnosis. Br J Cancer. 1987;55(2):207–11. https://doi.org/10.1038/bjc.1987.39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ogawa H, Tominaga S, Yoshida M, Kubo K, Takeuchi S. Breast self-examination practice and clinical stage of breast cancer. Jpn J Cancer Res. 1987;78(5):447–52.

    CAS  PubMed  Google Scholar 

  21. Huguley CM Jr, Brown RL, Greenberg RS, Clark WS. Breast self-examination and survival from breast cancer. Cancer. 1988;62(7):1389–96. https://doi.org/10.1002/1097-0142(19881001)62:7<1389::aid-cncr2820620725>3.0.co;2-0.

    Article  PubMed  Google Scholar 

  22. Locker AP, Caseldine J, Mitchell AK, Blamey RW, Roebuck EJ, Elston CW. Results from a seven-year programme of breast self-examination in 89,010 women. Br J Cancer. 1989;60(3):401–5. https://doi.org/10.1038/bjc.1989.294.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Moss SM and the UK Trial of Early Detection of Breast Cancer Group. 16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet. 1999;353(9168):1909–14.

  24. Le Geyte M, Mant D, Vessey MP, Jones L, Yudkin P. Breast self examination and survival from breast cancer. Br J Cancer. 1992;66(5):917–8. https://doi.org/10.1038/bjc.1992.385.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Senie RT, Lesser M, Kinne DW, Rosen PP. Method of tumor detection influences disease-free survival of women with breast carcinoma. Cancer. 1994;73(6):1666–72. https://doi.org/10.1002/1097-0142(19940315)73:6<1666::aid-cncr2820730619>3.0.co;2-e.

    Article  CAS  PubMed  Google Scholar 

  26. http://www.fsmitha.com/h2/ch32prc.html

  27. https://www.cancer.net/cancer-types/breast-cancer/statistics. Accessed 11/10/2019.

  28. https://seer.cancer.gov/statfacts/html/breast.html. Accessed 11/10/2019.

  29. Zeng H, Zheng R, Zhang S, Zou X, Chen W. Female breast cancer statistics of 2010 in China: estimates based on data from 145 population-based cancer registries. J Thorac Dis. 2014;6(5):466–70. https://doi.org/10.3978/j.issn.2072-1439.2014.03.03.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol Med. 2014;11(2):101–15. https://doi.org/10.7497/j.issn.2095-3941.2014.02.005.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Demick B. Judging China’s One Child Policy. 2015. https://www.newyorker.com/news/news-desk/chinas-new-two-child-policy. Accessed 11/10/2019. While this article is older than 3 years, it is an important discussion of the impact of China's one-child policy.

  32. Wilke LG, Broadwater G, Rabiner S, Owens E, Yoon S, Ghate S, et al. Breast self-examination: defining a cohort still in need. Am J Surg. 2009;198(4):575–9. https://doi.org/10.1016/j.amjsurg.2009.06.012.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. City of Hope Comprehensive Cancer Center and Beckman Institute, Victoria Seewaldt, Room 101B Lippman Graff, 1500 E. Duarte Road,, Duarte, CA, 91010, USA

    Eric Dietze, Veronica Jones & Victoria Seewaldt

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  1. Eric Dietze
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Correspondence to Victoria Seewaldt.

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Eric Dietze reports grants from NIH/NCI to City of Hope during the conduct of the study. Veronica Jones and Victoria Seewaldt declare no conflicts of interest relevant to this manuscript.

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Dietze, E., Jones, V. & Seewaldt, V. Breast Self-Examination: the Case for a Second Look. Curr Breast Cancer Rep 12, 118–124 (2020). https://doi.org/10.1007/s12609-020-00358-z

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