Because neither CBE [clinical breast examination] nor mammography is 100 percent sensitive, breast self-examination (BSE) has been advised as an important screening method among women older than 20 years of age. However, its effectiveness in decreasing death from breast cancer has been controversial because evidence from clinical trials is limited. Observational studies evaluating BSE and breast cancer stage at diagnosis or death have had mixed results.45,66
In two randomized, controlled trials with 5 to 10 years of followup, both conducted outside the United States, breast cancer mortality rates were similar in women instructed in BSE and in noninstructed controls.67-69 Both studies involved large numbers of women who were meticulously trained with proper technique and had numerous reinforcement sessions; mammography was not part of routine screening in the countries involved. In both trials, physician visits and biopsy for benign breast lesions increased among those educated in BSE. To date, no studies have evaluated other potential adverse outcomes of BSE, such as anxiety and subsequent screening behavior.
The main reasons not to use unproven screening tests are (1) the
burden of unnecessary workups of false-positive examinations with associated morbidity, anxiety, and cost; (2) the potential to detect lesions that may be clinically insignificant yet are treated; and (3) the false reassurance resulting from having a normal screening examination.
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