Breast Self-exam

We believe that doing monthly BSE provides a woman with a layer of protection in detecting small breast cancers and thus reducing the risks associated with delayed detection. Diagnostic delays are a major issue for women under 40 who are more likely to have faster growing cancers than older women.

We believe that the concept of using breast cancer mortality reduction as a measure of success is unrealistic. There are simply too many variables influencing mortality rates to accurately define the role of BSE. I know from my experience that women who are not committed to doing self-exam often present with more advanced cancers that have a lower probability of long-term survival.

However, it is also true that BSE has limitations. From decades of experience, we know that women who learn to do BSE with confidence can detect small potentially curable breast cancers. Patients are often better at detecting small breast cancer than are most doctors as described in the stories of the following two patients.

Patient no. 1:

Kristin was 34 yrs. old when she noted a subtle change in her left breast. She was seen by her primary care physician who reassured her that her exam was negative and she was “too young to develop breast cancer”. She saw me as a second opinion, and my impression was the area of her concern was not suspicious. However, as is our standard policy, a directed ultrasound was done which showed a small suspicious mass that on biopsy proved to be invasive breast cancer. She underwent a lumpectomy plus radiation. On her 10th year follow up visit she continued to be tumor free, and she was delighted with her cosmetic result.

Patient no. 2:

Michelle was a 22-year-old college student who found a small lump in her right breast. Over a two-year period, she saw multiple physicians, and each doctor told her that she was too young to have breast cancer and not to worry! At age 24 she developed back pain and an MRI showed metastatic changes. Subsequent breast biopsy revealed an invasive breast cancer. A simple diagnostic ultrasound preformed at the time she was seen could have been lifesaving.

There are three important lessons to learn from these stories. The first is to never accept the statement that “you are too young to get breast cancer”. The second lesson is that if a young woman is concerned about a lump, a diagnostic ultrasound should be done on the area of concern. Finally, if a women is concerned about the advice she receives from her initial consultation, she should get a second opinion from a breast surgeon.