1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Does Breast Self-Examination Reduce Breast Cancer Mortality?

Breast cancer mortality was virtually the same among women who received instruction in BSE and among women who did not.

For years, some people have advocated breast self-examination (BSE) to reduce breast cancer mortality, while others have doubted its value. Now, results from a large randomized trial -- supported by the NIH and conducted jointly by American and Chinese researchers -- finally inform the debate.

Female workers in 519 Chinese factories were assigned to a BSE instruction group or to a control group. About 133,000 women working in the intervention factories received detailed BSE instruction and reinforcement sessions, and about the same number of women in control factories received no BSE instruction. Mammography was not available, and most women did not undergo breast examination by clinicians. Most patients who received diagnoses of breast cancer underwent systemic therapy (tamoxifen or chemotherapy) in addition to surgery. Histologic slides from biopsies were reviewed in the U.S.

During about 10 years of follow-up, the numbers of breast-cancer-related deaths were virtually identical in the 2 groups (135 in the BSE group and 131 in the control group). Although it's not clear why, the overall survival rate was slightly, albeit significantly, higher in the BSE group than in the control group (95.2% vs. 94.9%). More biopsies were performed in the BSE group during the trial (about 3600 vs. 2400).

Comment: Results from this trial suggest that large-scale efforts to teach BSE are unlikely to lead to reduced breast cancer mortality. Indeed, editorialists assert that "routinely teaching breast self-examination is dead." Although it remains possible that certain subgroups of women might benefit from BSE, or that BSE combined with clinical examinations or mammography might yield different findings, the study authors advise us to tell patients that the efficacy of BSE remains unproven.

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 25, 2002

Citation(s):

Thomas DB et al. Randomized trial of breast self-examination in Shanghai: Final results. J Natl Cancer Inst 2002 Oct 2; 94:1445-57.

• Original article (Subscription may be required)
• Medline abstract (Free)

Harris R and Kinsinger LS. Routinely teaching breast self-examination is dead: What does this mean? J Natl Cancer Inst 2002 Oct 2; 94:1420-1.

• Original article (Subscription may be required)
• Medline abstract (Free)