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Women Should Continue Breast Self-Examinations

May 24, 2003|Jan West and John G. West | Jan West is coordinator of breast health education for the Breast Care Center at the Cordelia Knott Center for Wellness; John G. West is surgical director of the center.

The recent decision by the American Cancer Society, or ACS, to make breast self- examination optional prompted a rash of phone calls from concerned patients. A typical one: "I found a small lump in my breast 15 years ago. My breast was saved; I did not need chemotherapy, and now I am cured. What would have happened to me if I did not find the lump when I did? By the way, my mammogram was negative."

The ACS assumes that by the time a woman finds a breast lump it's too late. This may be the case for large breast lumps, but when performed properly, breast self-examination can detect small cancers, with favorable outcomes.

The ACS also assumes that because studies have proved mammography reduces mortality, it should serve as the foundation for its early-detection programs. The overreliance on screening mammography is problematic; after all, even ACS admits that mammograms miss 15% to 20% of all breast cancers.

We are concerned that by making self-exam optional, the cancer society is sending the wrong message. We predict that as a result of the new guidelines many women will ignore the early symptoms of breast cancer and delay getting medical attention until their scheduled mammogram. This may be particularly detrimental to women under 40 who are not candidates for routine screening.

The ACS points out that improperly performed breast self-exam can increase anxieties and lead to unnecessary biopsies. We agree. For self-exam to achieve its lifesaving potential, women must follow a few basic steps:

Before their first self-exam, women should be seen by an experienced physician. Women over 40 are encouraged to have a current mammogram.

We also recommend attendance in a one-hour training program to learn the basics of self-exam. The attendees are in a supportive medical environment that reduces anxiety and ensures that unnecessary biopsies are avoided. This approach is successful in finding small breast cancers, and women who attend these classes are more likely to follow ACS mammography guidelines.

The statistics are alarming. One in seven women in Orange County will be diagnosed with breast cancer; in L.A. County, it is one in eight. Now is not the time for complacency.

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