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dlaxague · 03-28-2008, 08:14 AM

Good morning Joanne and all,

I'm going to try the copy/paste way of responding to your questions.

Please clarify "Yes, one can find cancer when doing BSE. But finding cancer in this way does not appear to improve survival." ? Why wouldn't it appear to improve my survival?

I don't know the answer to that question, but that is what the studies show. It is not my opinion, it is what the evidence shows (or in this case, doesn't show). It probably has to do with the fact that BSE is finding cancer, not pre-cancer. As we are learning (more each day) survival from cancer probably has much to do with the biology of a particular cancer (which is there from day one) - perhaps more to do with that than with the size of cancer, as was previously thought. This would help to explain why formal BSE does not improve survival.

BSE has a long history of promotion. Shower cards, TV specials, buddy programs, yada yada. For all the effort put into its promotion, you'd think that there'd be some evidence of its importance in saving lives. But there's not. No study has ever shown it to make a difference. Its use was adopted because intuitively it seems like a good thing to do.

In addition, it bothers me that this misinformation about vigilance causes both guilt and complacence. Some will assume, when a woman is diagnosed with a not-early breast cancer, that the woman is at fault for not practicing BSE, or not getting a mammogram. And some women accept this burden of guilt. The other side of that is that those who do regular BSE, get a yearly CBE and mammogram feel that they are safe - that in this way they are guaranteed early detection of their breast cancer.

This evidence is not saying that there's no benefit in feeling a lump and getting it treated. We know that treatment offers us an advantage. It is saying that women who found their lumps by doing a formal regimen of BSE did not fare any better than those whose cancer was found in other ways (mammography, chance notice in the shower, etc). I cannot say why this is so but that's what the evidence says, and that is why even ACS, notoriously slow to act on new information in the past, has stopped promoting BSE as a way to save lives.

Whenever this topic comes up, the comments pour in saying "but Sally found her lump with BSE". Finding a lump (by whatever means) does not necessarily equate with saving a life. I wish fervently that we had better ways of finding breast cancer, or pre-cancer. But right now we do not.

The resources that you posted that still promote BSE are simply sticking to the old party line, because it seems intuitively that it should be true, and because we all naturally want to be able to do something to save lives. It is amazingly difficult to get people to listen to the evidence and to give up promoting this intervention. Those who continue to promote BSE certainly have the best of intentions. But at this time, it appears that they are wasting resources (time and money) and also deceiving women.

You comment that: The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer.
The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE).

I'd be glad to change my opinion. I'd love it if we could find a way as simple as BSE, to save lives. But I value truth above all, and this is a truth. There is no evidence that practicing BSE improves a woman's chance of survival from breast cancer.

I love these discussions that make us think, and appraise evidence. Thanks for participating.

Debbie Laxague
PS: Yes, my husband found my large axillary node, by chance, during a romantic moment. Not during BSE. But no one could find the breast lump - not the GYN, not the surgeon, not the radiologist nor the mammogram nor the sonogram. Even when they knew that it had to be there. Even breast in hand, after mastectomy, the surgeon could not find the lump. It was found by the pathologist as he dissected the breast.

03-28-2008, 08:14 AM	#12
dlaxague Senior Member Join Date: May 2006 Posts: 221	Good morning Joanne and all, I'm going to try the copy/paste way of responding to your questions. Please clarify "Yes, one can find cancer when doing BSE. But finding cancer in this way does not appear to improve survival." ? Why wouldn't it appear to improve my survival? I don't know the answer to that question, but that is what the studies show. It is not my opinion, it is what the evidence shows (or in this case, doesn't show). It probably has to do with the fact that BSE is finding cancer, not pre-cancer. As we are learning (more each day) survival from cancer probably has much to do with the biology of a particular cancer (which is there from day one) - perhaps more to do with that than with the size of cancer, as was previously thought. This would help to explain why formal BSE does not improve survival. BSE has a long history of promotion. Shower cards, TV specials, buddy programs, yada yada. For all the effort put into its promotion, you'd think that there'd be some evidence of its importance in saving lives. But there's not. No study has ever shown it to make a difference. Its use was adopted because intuitively it seems like a good thing to do. In addition, it bothers me that this misinformation about vigilance causes both guilt and complacence. Some will assume, when a woman is diagnosed with a not-early breast cancer, that the woman is at fault for not practicing BSE, or not getting a mammogram. And some women accept this burden of guilt. The other side of that is that those who do regular BSE, get a yearly CBE and mammogram feel that they are safe - that in this way they are guaranteed early detection of their breast cancer. This evidence is not saying that there's no benefit in feeling a lump and getting it treated. We know that treatment offers us an advantage. It is saying that women who found their lumps by doing a formal regimen of BSE did not fare any better than those whose cancer was found in other ways (mammography, chance notice in the shower, etc). I cannot say why this is so but that's what the evidence says, and that is why even ACS, notoriously slow to act on new information in the past, has stopped promoting BSE as a way to save lives. Whenever this topic comes up, the comments pour in saying "but Sally found her lump with BSE". Finding a lump (by whatever means) does not necessarily equate with saving a life. I wish fervently that we had better ways of finding breast cancer, or pre-cancer. But right now we do not. The resources that you posted that still promote BSE are simply sticking to the old party line, because it seems intuitively that it should be true, and because we all naturally want to be able to do something to save lives. It is amazingly difficult to get people to listen to the evidence and to give up promoting this intervention. Those who continue to promote BSE certainly have the best of intentions. But at this time, it appears that they are wasting resources (time and money) and also deceiving women. You comment that: The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer. The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE). I'd be glad to change my opinion. I'd love it if we could find a way as simple as BSE, to save lives. But I value truth above all, and this is a truth. There is no evidence that practicing BSE improves a woman's chance of survival from breast cancer. I love these discussions that make us think, and appraise evidence. Thanks for participating. Debbie Laxague PS: Yes, my husband found my large axillary node, by chance, during a romantic moment. Not during BSE. But no one could find the breast lump - not the GYN, not the surgeon, not the radiologist nor the mammogram nor the sonogram. Even when they knew that it had to be there. Even breast in hand, after mastectomy, the surgeon could not find the lump. It was found by the pathologist as he dissected the breast.