We lose our own power by not knowing our own bodies. Palpate and make mistakes! So what? The only way away from fear is education or trial and error-- figure out what is normal, what is not. Don't give it up to the medical world, use that world to gain information, not ultimatums.

...but the studies likely ignored one variable. The fact that public health programs have raised the overall awareness of breast cancer risk to the point where many women feel the need to self-examine likely contributes to early detection overall. This overall awareness likely DOES have life-saving benefits that might be lost if the vigilance that self-exams encourage was lost. This wouldn't show up in a study that compared those who self examine against those who don't if BOTH groups are actually more proactive overall as a result of the push toward empowering women to take control of breast cancer. Just a thought.

...due to women spotting their cancers early. They can make a lot more money treating late stage cancer, than simply removing a lump right away. Hence the schill at American Cancer Society.

You don't need a study to teach you common sense:

The more times you check for cancer, the more chances you have to catch it early, and the earlier you catch it, the better your chances of survival.

Or you can take the ignorance is bliss approach...

When my primary care doc asked me at my recent annual physical if I did regular breast exams, I said "no." And he said, "but you'll start tomorrow, right?" And I said "I'd tell you yes, but it would be a lie - it's ALL lumpy in there!" And a light went on in his eyes and he said "Okay, that's a legitimate reason not to do it, and you shouldn't feel guilty if you don't. I completely understand." I schedule my yearly mammograms like clockwork, and that's just going to have to be good enough. With my doc and the ACS signing off, I feel a lot better about it now.

If I found a "lump", I wouldn't just submit to a knife. I'd get the mammogram and ultrasound, then the biopsy if warranted.

On the side, I heard years ago that many "lumps" are discovered by spouses or boyfriends. They are very familiar with the shape and feel of your breast and are more likley to notice any changes, regardless of natural lumpiness. (g)

Just to clarify, this is not a new study, but an analysis of several older ones. The Cochrane Database reviews clinical question by pooling data in a statistaically rigorous way, to increase the power of any one study.

The overall evidence is very compelling. I have long since stopped recommending breast self exam for my patients, although I don't specifically recommend it.

I have yet to have a patient find a very early cancer through systematic breast self exam.

To an earlier point, although breast cancer awareness is high generally, few women perform breast self exam regularly the "right" way. In one of the studies, women were given specific and significant education in these techniques. Despite that, there was absolutely no increase in detection.

And, as noted, a very significant increase in invasive testing (biopsies/surgeries/etc).

Thus, this is not a case of what's the harm, might as well do it. There are very specific reasons to think there is a downside, with studies indicating no upside at all.

That all being said, no doctor or study would indicate that a woman finding a lump (in the shower/during sex, whatever) should ignore it. The point is that regular, systematic self exam has no benefit.

I agree with your points generally. My only addition is that there is a possibility (likelihood) that the general vigilance that self-exams encourages possibly has an overall benefit on encouraging women to be proactive with breast CA. So, for example, even if there is no proven benefit to the self-exam vs. not doing it (and opting for mammo, etc.), there is still likely a benefit overall from the increased awareness that the "self-exam" proponents have helped create. To retreat from that proactive stance might overtime lead to an overall drop in vigilence. Just my two bits.

Breast cancer below 2mm in diameter almost never metastasizes. At 2mm, you are not going to feel it. That is why breast cancer is almost never caught early by the patient.

My mother had breast cancer, her tumor was 1.5mm, it was so small, that they had to stick a trace wire in under the mammogram -- for fear the surgeon wouldn't find the tumor otherwise.

With good health care, breast cancer is caught by mammograms, not self-exams.

All women could afford mammograms. In a perfect world, we'd all have them as scheduled.

"With good health care, breast cancer is caught by mammograms, not self-exams."

This philosophy dangerously discounts a few of the realities of breast cancer. Mammograms are only recommended for women 40 and over (some doctors will start at age 35 if there's a family history). However, there are more than 250,000 women 40 and under in the U.S. living with breast cancer, and over 11,100 young women will be diagnosed in the next year.

We cannot rely on mammograms only to detect breast cancer. Even if you don't do a formal BSE, I would recommend that you get familiar with the shape and feel of your breasts. You have to feel them every time you take a shower anyway, so pay attention when you do. That's how I found my stage 2 breast cancer, at the age of 28, with no family history. Had I not found that lump (which I could tell was different, even in my naturally lumpy breast), I would not have lived long enough to have my first mammogram.

Regular self exams are supposed to increase your chances of noticing changes.

There are other means to the same end, such as having an early baseline mammogram and then regular updates.

(Caveat: x-ray mammography isn't always very useful in younger women (the tissue is different - denser under x-ray) and MRI mammography is not universally available/affordable.)